Leg, Muscle, and Knee Safety with Al Brown

Studies show that our work has shifted from a 50/50 balance
between sedentary and active work to 80% sedentary and 20%
active.  Overall that shift has led to a negative effect on
our general health and in particular, our knees.  Our knees
can play a big part in workplace safety as they form a critical
link in our kinetic chain, connecting us to the ground and
allowing freedom to move.  They can be affected by numerous
factors such as the work environment, life habits, and even
genetics.  Unfortunately, our trend toward a more sedentary
work/life balance can put us at even greater risk of dysfunction.


On this episode of the MEMIC Safety Experts Podcast, I speak with
Al Brown, MEMIC’s Director of Ergonomics about knees, why they
can be a pain, and how to keep them healthy.


Peter Koch: [00:00:04] Hello, listeners, and
welcome to the MEMIC Safety Experts podcast, I'm your host, Peter
Koch. There are a lot of joints in the body. Some are small like
your fingers, and some are complex, like the shoulder or the
wrist, but some are built to sustain heavy loads like the hip.
And then there's the knee. We have two of them and the knee may
seem like a fairly simple joint, after all, it just hinges back
and forth. It doesn't even rotate or twist like other joints do,
or at least they're not designed to do that specifically. But
think about what it has to do. It really has to stabilize us when
we're moving, when we're standing, when we're sitting. It has a
lot to do with our ability to balance. And even though the joints
below it, like the ankle joint in the bones that are in the foot
and the hip, have a lot to do with how our knee works and
functions. It really does connect the two parts of the body
together. From a sports standpoint, knees have a pretty high
percentage of injury, especially those that require surgery
[00:01:00] in activities like a weighted pivot, sort of like
soccer, football, tennis and basketball or sports that have a
tendency for lateral posterior loading like skiing. There's a
fairly significant proportion of injuries in those sporting
activities have to do with the knee. There are tons of different
ways that you can injure the knee. And in my work history, prior
to me coming to MEMIC, I spent some time as a paid ski patroller
about 10 years or so, and I still do that off and on. And I can
recall plenty of knee injuries to both the staff and the guests.
Some were impact related where you're going to fall down or hit
something or strike something. But many were from a slow,
backward, twisting fall and still others were from overuse
walking down the mountain as a snow maker or even that weighted
pivot as a lift operator trying to bump a chair. Knees I think
overall we're one of the most frequently injured joints that I
saw. And then never mind injuries. My knees, as I get older seem
to be the thing that slow me down [00:02:00] after having been in
a static position for a while. I just want to think about this
for a minute. Can you feel it if you're sitting in a car
listening to this or maybe you're sitting in a chair or have been
seated for a while? When you start to get up, though, your knees
might be the thing that are a little bit creaky or a little bit
slow. And you can't move as fast maybe as you once could. Well,
to talk about this a little more, I have Al Brown on the line
with me today. And Al is MEMIC's director of ergonomics, Al has
been on the podcast before and brings a unique insight into how
our bodies deal with the stresses placed on them during work and
play. So on today's episode, we're going to look at the knees
specifically how they work and how we can keep them healthy and
from being injured. Al welcome back to the podcast.


Al Brown: [00:02:47] Thank you. Be happy to be
here.


Peter Koch: [00:02:49] Psyched to have you back.
Hey, so you've been on the podcast before. Why don't you take a
couple of moments here and give folks who might be listening for
the first time a little background about what your history is and
what you do for MEMIC [00:03:00] in your position?


Al Brown: [00:03:01] Sure. Pete, appreciate
that. I've been around for a while. I'm a baby boomer, but I'd
like to try to keep the body young as much as I can. Started life
out as a went to Penn State University for my undergrad degree
and athletic training, then went on to Howard University in
Washington, DC for my physical therapy training, then ended up
moving to Maine. About forty years ago, I worked in an orthopedic
clinic and then started my own practice with a partner and we
worked on site industry, which is was a spectacular experience
for me simply because that was where I got my interest in
ergonomics and looking at people coming into the clinic that were
injured and asking myself, well, why? What's the root cause of
this? So we would actually walk back out to the job and take a
look at the job tasks and realize there would be specific things
that would create the risk [00:04:00] and exposure and then made
our abilities to treat them much easier. So it was a natural flow
to transition to work injury management, which is where we are
today. I been with MEMIC for probably 18 years, fifteen of those
as an employee. And essentially that's what we do, is we go out
and we're partnering with industry and we look at the risks and
exposures and we try to figure out what might be the cause and
what they can do from an ergonomic standpoint to reengineer the
job and make the change so we can lower the risk. So it's a win
for all of us. So and that brings me to here today and what we do
and from doing podcast to webinars to live trainings. Looking
forward to those you're back to live trainings. But that's how I
got here today. Have done some supplemental education at the
University of Michigan, working with Armstrong and chafing up
there in the engineering department and also at Harvard at the
School of Public Health. So, [00:05:00] you know, you have to
stay fresh. Things change, it's like medicine. A lot of what we
do in the world of medicine is based on research and a lot of the
other stuff is just fairy dust. So we like to kind of dust out
that fairy dust when we can and get real data and statistics and
follow the science. So and with ergonomics, it does change. So
we're always having to stay on top of the research.


Peter Koch: [00:05:23] That's one of the reasons
that you bring so much depth to these conversations, is you have
a great history and you've not only seen it from a physical
therapy side, but you've looked at it from an industry side and
you've looked at it from the research side. So I think kind of
trying to build on that in our discussion today about the knee
joint itself. I think it's important for us to start with the
basics. Right. So we want to move out that fairy dust and we want
to make sure people understand that the joint isn't actually as
simplistic as folks might seem or might think. So why don't we
start with some anatomy? So why don't you take us through how
[00:06:00] the knee is designed, what makes it work and maybe
what some of its limitations are?


Al Brown: [00:06:07] Sure we can go way back
Pete, but we'll try to keep it. But it's funny. You look at arms
and legs and those are pretty non-functional and a human being
when you're first born because we're all trying to develop core
stability and that core is your butt your gut, your whole axial
skeleton. And once you get some strength and control in those
areas, you then can start using the extremities and that upper
extremities seem to be first. And then eventually we get down to
where we wobble over to the you know, we kind of pull ourselves
up on the sofa or on the coffee table and we learn to stand up
because we're controlling our hip muscles and then our legs and
knees and then we're able to get very mobile. And that's where we
are now. Sadly enough, as we age, we begin to wobble again and
then we regress. When you look at the knee joint, we often
sometimes [00:07:00] just refer to as the hinge joint. But it's
not really true. It does hinge. But it also translates to so that
there's two big bones, actually the two biggest bones in the
body, the femur, which is your thigh bone, and then the tibia,
which is the second largest bone, is the lower leg bone, which
bears about 80 percent of the force of the weight created by the
body. There's the fibula, which is the smaller bone down the
side, which you can actually fracture of the fibula and still
keep on going just simply because it doesn't bear much of the
weight. The largest, sesamoid bone. That'll be on a test later.


Peter Koch: [00:07:36] OK, thank you.


Al Brown: [00:07:37] Sesamoid bones are the ones
that just kind of free floating and it's kind of. And it's your
kneecap or your patella, as they call it. So those four bones
kind of come together. They're held together by ligaments and
tendons and muscles. We look at the alignment because you have
both the anatomy and the strengthening of the developmental
sequence. That's what a baby goes through to where we [00:08:00]
are now. But you also have the genetics that you were handed by
mom and dad. So, you know, when we look down at our feet, they
may impact the knee. You know, a quick thing everybody can do to
see how well they're aligned is if you take your little hipbones,
that little bump on the front, not your side down where your
pockets are, but on the front side when you lay down and you
know, you can feel those two little bumps out in the front,
there's a fairly large muscle that goes through the kneecap that
attaches there. And if you drew a line from there and then go all
the way down to the bump right below your kneecap on your shin,
there's a big bump there. And then you look at so you draw a line
straight down or, you know, take a chalk line and snap a chalk
line on that bad boy and see where your kneecap falls, it should
almost be divided, split in half by that line. But the way people
are built, if some have knock knees, are going to find that the
kneecap will fall inside the line or valgus knees [00:09:00] as
the term you would hear medically or if they had various knees or
Bow-Legged, that kneecaps are going to fall outside that line. So
that's going to impact how that kneecap moves up and down. So if
you look at the underside of the kneecap, it's sort of V shaped
and that V shape, it's convex. So that's you know, it's a V the
projects out covered by cartilage and it fits in a complementary
v shaped concave cavity in the femur. So they sort of what they
call track. It's kind of like tracking in there. So you want that
thing to sit right in the middle. But unfortunately, with
genetics, with postural habits, with aging, with, you know, we're
more sedentary lifestyle. We begin to change muscle length,
muscle strength alignments and we begin to start messing around
with where that kneecap, you know, tracks. So, you know, we could
go on our whole podcast just on the anatomy, but it's a fairly
complex [00:10:00] joint. Think of it this way, too. It functions
as a close kinetic chain. Most of the time. That's a fancy term.
But let me see if I can. It works, it's the thing that connects
us to the Earth. So every time we put that foot on the ground,
it's a kinetic chain. It's closed. We put the distance and the
foot on the ground. So now all the loading comes up through the
body for us to function, you know, give you an example of an open
kinetic chain. Your arm is more of an open kinetic change. So
when I reach out to get something, I'm not sure of a push up. But
what I'm reaching out to grab something this end is not
connected. It's allowing me to do stuff, to bring things to me.
But your lower extremity is a closed kinetic chain, so it has to
control and then move us forward. And just gate is real complex
thing that we will see how it impacts us as we go through this
podcast. We'll talk a little bit about, you know, what happens to
us when certain things happen for example, sitting you [00:11:00]
know, when you sit down Pete what happens to those giant muscles
in your hips and pelvic area? What are they doing?


Peter Koch: [00:11:06] Depends on what side
they're on. Right. So by sitting down, everything on the front is
relaxed. If I'm sitting in the back, I've got some tightness
going on because it might be stretching the bottom. My glute,
right. Is that how it works?


Al Brown: [00:11:17] Yes. Yeah. So they're
passive. So you have some that are shortening some of the
lengthening. But think about activity. Is there any activity
going on in.


Peter Koch: [00:11:24] There's nothing going on
there. Just relaxing.


Al Brown: [00:11:27] Yeah. So what happens is
they begin to atrophy, so now those get weaker. So what happens
is those muscles get weaker. It begins to impact what goes on
down below because remember that developmental sequence as a
child, we have to strengthen our core and then we can start to
use our big muscles on our hips and legs and our extremities. And
we can function to be mobile. But if we lose some of that core
strength, we begin to impact what goes on  down below.


Peter Koch: [00:11:53] And all that progression
as the infant grows relies on activity. If the infant is
[00:12:00] not able to be active, they don't, you know,
strengthen their core and then they can't build the musculature,
the movement patterns in the muscle groups in order to make
everything,  function. I do want to take you back a little
bit into the anatomy part. So we talked about the bones. We
talked about some about the muscles. We talked quite a bit about
the kneecap. And I like that that conversation about how the
kneecap tracks and the visual line and where does that fall,
because it could give you some indications on what might be in
your future. And then we'll talk later about what might we be
able to do to compensate for some of that. But you didn't talk a
whole lot about the tendons in the ligaments in there, which are
some of the things that do get injured, especially in activities.
So whether it be a sport activity or even a slip and fall, those
are the things that are going to get damaged. What are the
tendons and ligaments make up the knee joint and what do they do?


Al Brown: [00:12:51] Sure, yeah. There's quite a
few. There's four major ligaments that we look at. There's a
whole bunch of ligaments. But if we look at the four that
typically are highlighted [00:13:00] and take the hit and again,
you know, when you look at athletes today, you know, there's a
lot of let's take football, for example. You see a lot of the
interior linemen just with all these things on their knees. And
part of that is just to protect them because there's such big
bodies moving around. And if one falls in the wrong position and
whacks the knee, you can impact those ligaments or tendons or
cartilage. But the four there's a medial collateral in the
lateral collateral ligament and basically they're there. You
know, the medial side is to prevent your news from getting.
Inward, sort of like in a knock kneed position, the lateral one
does the opposite, it prevents you from getting shifted outward
and then inside there's two that are fairly large. There's the
anterior cruciate ligament and then the posterior cruciate
ligament, the anterior cruciate prevents sort of that shifting
forward of your [00:14:00] that tibia. Remember that big bone in
the lower leg from shifting forward and it does control some of
the rotation. Posterior ligament does the opposite. So you had
referenced skiing, skiing as an example of where there's a lot of
torque and forces created by skis and skis today are actually you
know, they're different. Back in the day when I used to lace mine
up and clipped down the wire binding, we saw more just boot top
fractures. And just because that's where the hit would be. But
today's world, you know, it's reengineered and the boots halfway
up your leg and it's clipped on. Fortunately, that tends to
translate the forces up into that knee. For an example, what's it
called? You're more familiar with the skiing industry than I
where the back of the ski hits and it creates an interior
translation of the knee forward. So it forces the knee forward
quickly and you get to enter cruciate ligament injury.


Peter Koch: [00:14:56] Sure. That's part of what
they call the phantom foot injury. So that [00:15:00] that
phantom foot motion, when the ski accelerates forward and, you
know, more of your mass is above your knee than below your knee.
So the thing that moves faster is the tibia and what's below the
tibia with the boot that accelerates forward things above that
don't move quite so fast. So you put a significant stress there
on the ligaments, ACL, PCL or ACL specifically.


Al Brown: [00:15:25] So that, you know, there's
an example of, you know, two sports where you have traumatic
injuries. You know, we also see that in industry to where
somebody might be driving a truck and they've gotten to their
location. And instead of climbing down like we encourage workers
to do, they may step out onto those saddle tanks, look down and
jump down, and all of a sudden they get a rotational force. And
now we've got a torn ligament, medial collateral ligament, maybe,
you know, the inter cruciate ligament with that sort of
rotational torsion force, you might throw in the medial meniscus
[00:16:00] and the terrible triad, as they would call it. And so
you've started the process of sort of degeneration of the knee.
And we've all had those little oh boy, my knee aches a little
bit. What was that or what did I do? Or I jumped out of a tree or
I, you know, was running around the backyard and I torqued on
something and where I'm skiing down the hill and I twisted all
those things kind of contribute to the general breakdown of the
knee as we age. But there's those four ligaments. There's a bunch
of different cartilage. There's fibro cartilage, and then there's
hyaline, cartilage, fiber. Cartilage is more fibrous, just like
the name implies in the hyaline, cartilage is more smooth. So
that's more on joint surfaces like the top of the tibia, the
bottom of the femur. It's almost like taking those bones and
dipping them in a can of paint. That's where you find your
hyaline cartilages, you know, sort of puts a coating over them,
the meniscus or more the fibrous cartilage. So those look like
donuts and they sit on top of that lower bone, the tibia, and
there's like two of them side by side because the femur has that
big rounded double  [00:17:00]end there that actually sits
down in those cartilage. So, again, it's kind of a stabilizer for
them to a certain extent when we're upright.


Peter Koch: [00:17:07] So it kind of gives them
a pocket, that fibrous cartilage for the femur to sit in. And
then the hyaline cartilage gives those surfaces the ability to
glide instead of grind.


Al Brown: [00:17:18] Right. Yeah. And a key
component of all that then is just moisture or snow. You know,
it's called synovial fluid, joint capsule fluid. That stuff is
there to lubricate the joint. And, you know, needless to say, as
we get older, yeah, there's less lubrication. So, you know,
things get a little stickier. It's called it you know, sometimes
it's referred to as the gel factory. I think you referenced it in
the beginning when you said, you know, when you go to get up in
your little stiff and achy.


Peter Koch: [00:17:49] That's exactly it.


Al Brown: [00:17:50] Yeah. Movement promotes a
reduction in that gel factor because it's like taking anything
mechanical. And if you haven't moved it for [00:18:00] a while,
it things get sticky. You know, there's not lubrication that
grease and oil moving around the thing and we're no different. So
when you're static sitting for an extended period of time, you're
sort of draining out the fluids and then you start to get sort of
a I'm going to call it a dryness, but no fluid between, say, the
kneecap and the femur. So when you start the movement, get up to
walk, get out of the truck. You have to get through that. Oh,
that ache is that dryness. But then you eventually lubricate and
then you're good to go.


Peter Koch: [00:18:35] We talked a little bit
about your body being like a car, too. And so if you think about
that car that's been sitting. Idle all night, cold, cold evening,
and you go to start it up in the morning, if you don't give it at
the opportunity to warm up at Low Rev's and you push it down the
road at moderate to fast speed, you haven't allowed the engine
oil to warm up and to start to lubricate the pistons and all the
internal workings. And we're [00:19:00] very much like that. The
longer we sit idle, like you said, the less lubrication we're
going to have and those places. And really, unlike a car, we have
some advantages the younger we are. But as we get older, we have
some disadvantages. Like the younger we are, the better our bar,
the easier our body will have, the easier time our body will have
to move fluid through those joints. The older we are, the less
fluid we have and the harder it is for our body to move fluid
into those joints so that we aren't quite as creaky. But like you
said, movement is a great thing, right?


Al Brown: [00:19:34] Oh, yeah. Pete, I am a 56
Chevy, you know. And let me tell you, it takes a while before I
don't just pop out of bed anymore. It's kind of a let's give it a
moment. Let's sit on the edge. Let's stretch the hamstrings. Let
me stretch my arms above my head. Let me just make sure I can
see. And where are my glasses, by the way? And then  I wait
or I make sure that I slide my hand over to the bedrail. So
[00:20:00] as I walk, I does everything work. You're sort of
testing it first so that chill factors a little.


Peter Koch: [00:20:06] Yeah. And you're not a
broken guy. I mean you're, you're a fairly you're a fit
individual. You do work out all the time or as often as you can
to because you recognize that. So you're not you aren't in the
place where you have to do those things because you're broken.
But what you're doing is you're warming yourself up to give your
body less opportunity to be broken through that movement because
moving something that's not ready to be moved is not good for
anything. So that's really that's a I want to make that
distinction that this does not like the warm up phase, the things
that we do before movements. All of those things are important to
prevent injury. It can be done because you're injured, but they
should be done in order to prevent it from happening in the first
place. And we'll get into quite a bit of that when we start
talking about strategies to lower the risk. And what do you do
after you get hurt? So we'll talk about some of those things as
we move through the podcast. [00:21:00]


Al Brown: [00:21:00] Sure. Sure.


Peter Koch: [00:21:02] So we've talked about a
number of things that might make the knees hurt, but let's delve
into that a little bit more. What are some things that we talked
about? Sports and certainly activities that weighted pivot when I
stand on one foot and then I go to turn in one direction or the
other, I might be putting my cartilage at risk. I could be
putting one of the ligaments at risk depending on the lateral
forces, or an impact might make my knees hurt or injured. But
what else can really make our knees hurt? What are some of the
things that happen in today's society or are in our workplaces
that make our knees ache and hurt and be sore and maybe even
injured over time?


Al Brown: [00:21:39] Sure. The yeah, the ones we
sort of just covered and talked about are more trauma. And we do
see those in the workplace, you know, those come along probably
less often than we used to see because you know, know this, I
don't know you realize. But back in the 60s, 1960, do you
remember the 1960?


Peter Koch: [00:21:59] I remember [00:22:00] at
least one year of the 1960,


Al Brown: [00:22:04] About half of our jobs were
physical and half were sedentary. So it was about a 50/50 split
as technology has crept into our lives and as we move forward in
time about 80 to 85 percent of our jobs now are sedentary, and
that 17, 18, 15, somewhere in that 15 percent range are now, you
know, heavier work. So because you've seen that switch, we see
less of the traumatic injuries. Does that mean that the injuries
have gone away? No. Your question is what else?  So when we
look at sedentary work, which means I think if you go into Social
Security definition of sudden sedentary work, it's handling 10
pounds or less occasionally throughout the day. So in the way
they referenced it was carrying a file here or walking over
[00:23:00] here doing this. So but you think about most of the
jobs a lot of us do nowadays. That's what we do. But what comes
coupled with that is we tend to sit more. So when we sit more, we
change the biomechanics of the leg in the lower extremity, in
that we lose muscle mass in the buttock, we begin to tighten
muscles. So now when we get up to move, we begin to see changes
in the lower extremity that then begin to create knee pain. But
it's from being inactive. So we see those types of injuries. Then
we see the truck driver who is sedentary, the logging industry.
They're up driving trucks, you know, the forwarders going in, the
forwarder is coming out, and they don't even have to get up. The
seat now rotates in the forward or so they can don't have to get
up, but then they have to get out of the truck. Occasionally when
they jump down, there's that that sedentary precursor that set
them up for an injury and then they might jump down or just even
stepping down. They twist wrong and then they've got the problem.
And then you just have medical [00:24:00] conditions that might
predispose, you know, rheumatoid arthritis and osteoarthritis, as
you know, from previous trauma. So comorbidities, those aches and
pains, you know, trauma that you may have occurred before in your
life are now beginning to raise their ugly head if you haven't
done things where you stand to lose strength. We have a sedentary
job now that mal alignment of the foot, you know, if you
genetically were handed over some coronating feet and coronating
feet, again, fancy term for, you know, like a flat arch, you
know, that's going to take that little bump we talked about
earlier right below the kneecap. And it's going to shift that and
it's going to shift that sort of in a position that's going to
make that kneecap align and properly. So what do you do to fix
some of those things? So, you know, you look at trauma, you look
at sedentary activity, and then you look at disease processes and
those all kind of contribute to the problem. It's hard in our
world sometimes to parse out what's related to the work and
[00:25:00] what's not related to the work. I think I told you
earlier I was going through looking at, you know, looking at
research articles on the knee and I typed in knee work injury in
the first seven pages of the search were law offices. So that
sort of gives you an indicator of, you know,


Peter Koch: [00:25:20] It's hard to parse it out
like So if one person has a concern and one person has an
argument against that, it's natural to look to somebody else to
help make that decision. I really do think that discussion is
kind of interesting. You talk about the I guess we'll start with
genetics a little bit about that. I know one of my daughters has
flat arches and she's the only one in our family that has flat
arches. And that translated into her when she played sports to
have trouble when she ran. And now this time of year with covid
and everything, sports aren't really happening. But where she's
finding a difficulty [00:26:00] is actually standing for long
periods of time. So if she doesn't wear her insoles to help
support that arch, then what hurts on her one? It's her arch. But
then her knees are sore as well because her job requires her to
stand if she's going to work a seven, six, seven hour shifts,
sometimes she'll be on her feet the entire time. And just that
because of the arch will cause a little mal alignment. And since
there's misalignment in places, it's going to cause things to
become sore. That might not be sore with someone else who doesn't
have that genetic challenge. Or maybe it's a challenge from an
injury, like you said before, that comorbidity.


Al Brown: [00:26:42] If you look at people, I
mean an example of your daughter, you know, when that foot goes,
you know, rotates in into a flap, you lose your arch. What it
does is we can all make our foot go flat if we sort of push our
knee inward, you know, like a knock kneed position. And that's
kind of what [00:27:00] happens with a flat foot is that you get
that lower tibia rotates outward, the knee tends to come inward.
And then if you couple that with the one anatomy piece we didn't
talk about early on was there is a difference between the hip
with female hip width tends to be a little wider because of child
bearing in the way they're built as opposed to males, tend to be
a little more narrow. So you couple a pronated foot, you know,
the flat foot, the female hip, which in fact she has a wider hip,
and then that knee going inward and you get almost a bowstring
effect. Where that that giant muscle tendon complex that goes
from the hip down below the knee and incorporates the kneecap,
the kneecaps getting pulled way in. And those two lines are
almost on the outside of the kneecap. So it wants to take that
kneecap and fire it out to the outside so she could end up with
foot ankle pain, but she could also end up with knee pain just
because of that mechanical [00:28:00] alignment down below. So
the foot orthotic actually kind of lifts that foot. So when she's
standing there, the knee comes back into position, the tibia
comes back into position and that kneecap gets realigned.


Peter Koch: [00:28:13] Yeah. And actually,
that's what happens if you watch if I watch her walk and stand
insoles versus no insoles. That's exactly what you're describing.
So there is a slight knock knee when she is or her knees coming
inward when she's standing and you put the insoles in. And it's
not magic, it's not incredibly noticeable. But if you're paying
attention, you can see the difference in the alignment and you
can totally feel or hear the difference in when she comes back
from work or comes back from doing something that when she's on
her feet all day, the thing that she'll complain about is the her
arch will be sore because she's got the insole and it's just
stretching the muscles in the tendons and the ligaments in there
because it's forcing the arch into a position that the body was
designed to. But genetically, we didn't give it to her. So we've
got to do it mechanically. She's [00:29:00] going to love me for
years, I can tell you. But I think that's an interesting place
because I think if you understand more about how you're
structured that like we started with anatomy and physiology. So
if we understand the makeup of the knee and what makes it up and
what its limitations are, what it's supposed to do, and then you
understand your own genetic makeup and how your knee actually
functions and what affects it from your postural and your habits,
then you can start making some better decisions about what you do
and how you do it. I know we were talking before the podcast a
little bit about teaching kids how to run in sports, which, you
know, it's something that you really don't think you need to do.
But I know for me specifically, coaching, coaching girls soccer
at the high school level, a couple of years ago, the head coach
and I made a decision to  [00:30:00]work on stride and foot
placement and knee angle and explosive force in our pre-season
instead of really pushing fitness. So we did a lot of fitness
work, but it was more from a plyometric standpoint and really
working more on movement patterns. And whereas we didn't see a
huge increase in fitness, what we did see is a decrease in sort
of overuse injuries that we might normally get kind of a third of
the way through the season as the workloads were starting to pick
up pretty heavy as you got into our gameplay season and a
sequence of practice, practice, game, practice, game, practice,
rest and working that through the season. So I do think that
understanding where you are and then doing some things to help
with your habits can help set you up for some success to not hurt
overall.


Al Brown: [00:30:57] If you look, we mentioned
this phenomena [00:31:00] in our past podcast and that's that
unconscious behavior or subconscious behavior. Most of our motor
patterns, most of our movement patterns in our body are
pre-programmed or they are things we've done over and over and
over again. And they become we get muscle memory, we get body
position, memory, and we repeat those. And then they get to the
point where they're pretty much automatic. So we don't have to
think about them. They can be good motor patterns and they can be
bad motor patterns. And you take a guy like LeBron James, he's
probably got a pretty good motor pattern with putting the basket
in the hoop. But that's all automatic. That's not something he
has to think about. It's actually become sort of a subconscious.
You take someone like a young athlete you're talking about and
for the first time or go back to that baby. They're just trying
to create motor patterns to create mobility. And then when you
get to a level of becoming good at a sport activity or [00:32:00]
work activity, whatever it is, you have to develop motor patterns
and you typically don't see what you do. You're just doing it
because it's getting you from point A to point B, but a second
set of eyes, like a coach or manager or whatever, can see
sometimes those poor behaviors and try to modify them and create
active. Is that will allow you to practice we take folks that are
delayed in the world of muscle activity and one of the things I
remember back when I was a physical therapist, we would say, hey,
do you guys have a play set in the backyard? You might want to
think about investing you want because kids will, you know, climb
whatever, and they're creating different motor patterns to do
different things. And through play, they actually improve their
ability to stand in the world of gravity and move around because
of those motor patterns. You know, you put them in front of, you
know, something like a computer or a book or sit them down and
it's not going to do it. You know, you need to kind of create
those good motor patterns. So that's what you did, which
[00:33:00] was great in the working world, the workaday world, we
have to do the same thing because the workaday world is, you
know, eight hours a day. I go in there and some people have good
patterns and some people have not so good patterns and some have
a blend. So we try to be the eyes and ears so they can understand
that because you don't look at yourself. That was the other thing
that, you know, we never look at ourselves. We see parts of us or
in today's world. I mean, you know, you are on a virtual looking
at ourselves right now and each other. But typically we don't get
that opportunity. So you don't get to see what your shoulders are
doing, what your hips are doing, what your legs are doing, unless
someone shows you a video of it. So it's important that we help
develop those motor patterns, particularly if we see that are not
so good.


Peter Koch: [00:33:43] Yeah, and you talk about
video. I just and we're going to move on here in just a moment,
but I wanted to bring the video piece up. That's one of the tools
that you use when you're trying to diagnose manual material
handling challenges in the workplace, photos from an office
ergonomic standpoint [00:34:00] so that you're able to see
certainly in an office ergonomic standpoint, you can look at the
setup, but from a manual lateral handling, looking at the cycle
of what's happening, because it's hard for the person to describe
what they're doing. If you were to talk to them, you're going to
walk into the workplace or talk to them on the phone and say,
what do you do? What do you do that's causing you pain? Oh I lift
stuff? Well, that's really not enough. You've got to know not
just where they lift to, but what do they look like when they're
lifting? And is the environment what's causing them to lift in
that particular way? Or is it actually their postural habits that
are keying them into doing those particular pieces? Because you
could have something set up very ergonomically well, right within
that power zone for someone to lift. And they may still bend over
at the waist because that's what they're habit is. So habits play
a huge part in how we manage things.


Al Brown: [00:34:56] Well, hey, Pete, you know,
you talk about habits and we're [00:35:00] talking about motor
patterns and we're talking about muscle memory. Here's a classic
that we've all encountered. And it's in the work environment
sometimes can be an issue. And that's steps bear with me first. I
think about the most steps are, you know, six inches or seven
inches, you know, or somewhere around there in that range. That
seems to be a feasible height that most of us can encounter. But
you go up a staircase and it's and there six and a half inches,
six and a half inch, six and a half inch. And then you hit that
seven or eight inch step because someone miscalculated the step
when the rise and run, when they built the steps, how many people
go up and they stumble over that last step because they're
depending on their body calculating and then going, OK, these are
six and a half inch steps. I'm going to bring my foot up, you
know, six inch, six and five eighths inches, you know, so I have
clearance. But all of a sudden they get to that last step that's
just a half inch higher. And they [00:36:00] trip over it. You
know, I mean, there's an example of, you know, that repeated
behavior and how we incorporate it and where we can get into
trouble.


Peter Koch: [00:36:08] Yeah, that and in those
habits that we build over time, age changes our ability to rely
on those habits as our kinesthetic sense and our proprioception
changes as well. So the that electrical feedback, if you go back
to think about the knee, right. If I'm walking and I'm stepping
up into something, my normal habit is to bring my leg up, bending
at the hip, bending at the knee that six and five eighths inch.
But as I age those receptors, those electrical signals that fire
to tell me how high my leg is actually lifted, they aren’t
working quite as well. And there could be a dementia in there.
There could be an illness in there that's causing even more of a
lag. So now I don't lift my leg up. I think it's six and five
eighths, but it's really four inches. And so now I just don't
stumble a little bit. I catch my [00:37:00] entire foot on that
step and I go right on my face onto the landing. We totally build
those habits over time and age. There's lots of different things
that can change how effective those habits can be, both
externally and internally, it seems.


Al Brown: [00:37:15] Yeah, and with a sedentary
shift, you know, again, we do have that aging workforce, you
know, you look at Maine in particular, we are the oldest
workforce in the nation, but in general, there's a real
demographic shift in the workforce out there. So those kinds of
things occur. And then you've got the perfect storm with not only
the aging workforce, but now much of our work is much more
sedentary. So we don't get up and like that child out there
running around, jumping up on the swing set. If you take the
adult version now, we're not out there sort of plowing the field,
pulling the weeds, walking around and exercising those muscles
and sort of re-cueing all those motor patterns. We're sitting at
the computer. So then when we go and do something like climb
[00:38:00] those stairs, we've lost, you know, if you don't use
it, you lose it. It starts to fade. And, you know, the cues
aren't correct. So how do we fix that? Sometimes we go, I'm going
to get rid of those stairs. I might get our house on one floor
and I'm going, start digging the hole. You know, you're going in.
Come on. We live in a world of gravity. You can't avoid it.


Peter Koch: [00:38:20] Yeah. You got to keep
moving.


Peter Koch: [00:38:23] Let's take a quick break
so I can tell you about our E-Ergo resource that can be used to
help solve ergonomic challenges at your workplace, sometimes
contacting, contracting with and scheduling an ergonomist or
occupational health nurse for an onsite evaluation doesn't fit
with our Just-In-Time workflow. In a competitive economy, fixing
the problem right now is essential, and improving worker comfort
and efficiency are key components to ongoing success. Free to our
policyholders. MEMIC's E-Ergo tool can help you overcome
ergonomic challenges. With just five quick photos or [00:39:00] a
short 30 second video and a brief description of what's being
shown, you can send us the critical demands and essential
functions within the work tasks. Once received, our ergonomics
team can identify risks and exposures and provide reasonable
suggestions for ergonomic improvement within just a few short
days. Start the E-Ergo process by logging into the MEMIC safety
director at www.MEMIC.com/WorkplaceSafety. Now let's get back to
today's episode.


Peter Koch: [00:39:34] That statistic that you
quoted before about our work, our sedentary work versus active
work was about 50 50. If you go back into the 40s, 50s, 60s. And
as we've moved into the 80s, 90s, 2000s and to current day, we
have gone into a mostly sedentary work style. So even if you had
an active [00:40:00] lifestyle back in the 50s and 60s, so you
actually got out and you did stuff, if you had a sedentary
lifestyle, you may be like, I remember my grandmother. Right. So
many, many years ago. She might be fairly sedentary in the house.
But once my grandfather came home, she would be out in the
garden. She spend four or five hours out in the garden, weeding,
planting, harvesting, and then coming back in and doing all that
active work inside the house. So even if she did do some
sedentary work inside, there is still active work that she did
outside. If you have a sedentary job and now a lot of our
recreational opportunities have been truncated as well, so we're
not maybe as active as we once were outside, we have that double
effect of having a sedentary job and also maybe a sedentary
outside of work life, too. So it's a double [00:41:00] whammy
almost, if you think about it. So let's talk more about how that
sedentary life affects our knees specifically.


Al Brown: [00:41:09] Yep, let's take sitting
because that that we see sitting everywhere, it's, you know,
again, you take something that is heavy duty as the logging
industry all the way down to someone that works kind of in our
environment like an office environment. And we see Uber, you
know, and anything you name a lot of us sit. So when we look at
that and we look at what happens to the anatomy of the lower
extremity, you know, we can talk all about the back and the
shoulder and all that stuff. But if we stay down just in the from
the hip down, we're taking there's a bunch of muscles are two
muscles that we look at called the iliopsoas there's the hip
flexor, so if you were to bring your knee up in front of the
muscles, sort of initiated, that's this giant hip flexor. Well,
that muscle [00:42:00] is it sort of starts in the front of your
thigh. And if you could stick your fingers through your pelvis
and out the back side to your back, it attaches to the inside of
your pelvis bones and then it attaches also to the spine on the
back. So you shorten that muscle up. And then if you look at your
knee, your knee is flexed or bent and the muscle on the back side
of your thighs called your hamstring so that muscles actually
shortened up. And so just looking at those two muscles, if you
spend quite a bit of time at a desk and a lot of us do or
sitting, it could be driving, could be it doesn't matter you
seven to eight, nine hours, you begin to change the length of
those muscles. So now let's try to stand up with the muscle that
won't let that thigh fully engage and go fully vertical. So you
have to slightly forward flex pelvis and then the knee can't
fully extend since you got a slightly bent knee. [00:43:00] So
now you watch people and it changes the balance and the gate when
we walk. And this is when, you know, we start to see trouble
because you can tell if someone's been a sitter for a long period
of time because they'll start their head when they walk, will
wobble back and forth side to side, side to side. And that tells
me that their hip flex or their hip muscles have gotten so weak
they can't stabilize the body over one leg. So when the person
steps on that one leg on your right leg, the right hip has to
pick up the left side, the left hip so your leg can swing through
and you don't stumble. And then you wait there on the left side
and the left hip kicks up and brings you through. The problem is,
is that muscle gets weak when you weight bear on the right, right
is weak. It drops the left. So now for you to block without
stumbling, you have to throw your body back [00:44:00] over the
right leg and you get this wobbling walk that you see, folks.
It's actually a Trendelenburg gait. There's actually a name to
it. And that tells me there's trouble ahead because we've got
weakness starting. But all that translates down into that kinetic
chain that attaches to the earth. So when that foot touches,
we've got all those tightness going on in the muscles we
de-lubricated the kneecap, the underside of the kneecap. Why
wouldn't you have trouble? You know, it's a storm.


Peter Koch: [00:44:29] Sure. And it all starts
with sitting. Yes. And sitting for a long time. And I think it's
an interesting if you're listen to this podcast and you have the
opportunity to watch other people do things in the workplace. So
watch somebody sit at a desk for a while, watch what their legs
do. And so, you know, we talk about good ergonomic position, a
desk or in a chair. And you want sure. That you want a 90 degree
or close to 90 at the between the femur and the lower leg or the
tibia there [00:45:00] and their feet firmly planted on the
ground. We'll watch some people sit at the desk and they'll shift
from that position as they get closer and closer to the screen,
as their stress level goes up and up, their legs will kick
underneath them, kind of curl around the legs of the chair, or
I'll watch people actually sit on one leg. And you're shortening
things a lot more. You're stretching things a lot more on the top
side, forcing really all that lubrication out of the joint. Watch
that behavior, watch those patterns, see what people do. And it's
a wonder that when you sit up or stand up after being focused for
a while on a conference call or focused for a while on a project
at your desk or at a problem that you're trying to figure out,
those habits just sort of kick in and they put you at a
disadvantage. And then all of a sudden we want to move like the
phone rings in the other room, or we have somebody else that
comes in and we want to turn around quickly or stand up quickly.
We're not ready and we've put ourselves in that odd position.
Then we're going to, [00:46:00] we're not going to do our body
any good that one time. And if we continue to do that, it's just
going to wear parts down over time until it breaks.


Al Brown: [00:46:10] Exactly right. And the one
thing we, you know, the one we haven't touched on, but probably
not so much again for today, but, you know, if you go back, I
think in May 2019, the Harvard Health Publishing from the Harvard
Medical School put out a newsletter that said the dangers of
sitting and what we haven't talked about is, you know, as you
approach 11 hours of sitting a day, there's 35 medical conditions
and diseases that go up exponentially. You know, that's the type
two diabetes, cardiovascular disease. What we don't, what we
forget about is, you know, we're talking about all the mechanics
today, but in the physiology of life or the physiology of these
muscles, these giant muscles really help to kind of use some of
that blood glucose. And if they're not, [00:47:00] and they take
up a good chunk of it because they're so big so that your
grandmother, when she was out doing her thing in the garden, she
was using up that blood glucose. So she was you know, she was
keeping her body in balance. But with the new normal of we're
more sedentary. Those muscles are quiet. So not only are they
getting weaker and tighter, but now we're not consuming the blood
glucose. So now that begins to have physiological impacts on us.
Type two diabetes, the heart disease and all those kinds of good
things, right, bad things. So there's, you know, there's research
around it. So we understand it. And here we are.


Peter Koch: [00:47:39] Right. So it really does
go to that point where the information's out there. It's not
rocket science. And I don't want to belittle any of the
information out there, because some of it is fairly complex. But
the simplistic form of some of that research is movement is good
for you. So move. And the less you move, the [00:48:00] harder it
is to move later on. And so it's this downward spiral where all
of a sudden you get to the point where you can't functionally
move anymore, or at least you can't do it without a lot of
preparation or a lot of help, and therefore you don't want to do
it as much anymore. So that downward spiral of no movement is
pretty challenging. So let's take that into our knees again. And
what if our knees sore, like we are sore at the end of the day,
our knees are kind of achy. Maybe this is the first time we
really looked at it as something that we can solve. What are some
things beyond general movement that we can do to help when our
knees are sore after a day of being sedentary or a day of work?


Al Brown: [00:48:46] Mm hmm. Well, if we go
back, I mean, just looking at work, if we were to look at I'm
looking at a job now or an ergonomic assessment of a foundry and
right now in this particular job, they're allowing the worker to
kind of move up [00:49:00] and down the line and glue castings
and assemble these casting molds. And they're looking to minimize
that movement. And I actually encouraged him not to take that
movement away, to allow them to move. So within the work
environment, sometimes we look at can we create more work pods if
it's a manufacturing environment? So instead of someone standing
in one place for an extended period of time, manufacturing
something and assembling things, they can actually move within a
pod. So it allows them to kind of move around. So that's sort of
an engineering thing that you can do, that you create you broaden
the job task. In that particular case, in an office setting, you
know, you've seen the introduction of dynamic desks where folks
consider stand now, realize because everybody thought that was
the solution, not everybody. But, you know, you hear the press
and the narrative was like, well, that's going to solve the
problem. And then the research came out. That doesn't solve the
problem. And that's right, [00:50:00] because I want you to know
that standing is just as static is sitting. The value of
something like a dynamic desk is to be able to take a knee joint
that's been maybe in a bent position and a hip flexor that’s been
in a bent position and allows you to change to a different
posture and get yourself up. And when you're standing, just like,
you know, when I stand on my desk, I don't stand still, you know,
I wobble back and forth. I bend my knees. So I'm actually
lubricating and adding value. Now, if we take an administrative
change, you get construction sites, construction workers, even
manufacturing that now have incorporated let's kind of like an
athlete warm up before we start the day so they might have a
morning session of discussion of how the day will go. But during
that time, they're actually stretching their body. I have a
granite installation company that does that every morning at
seven o'clock, they have a circle, they do their stretches, but
they also go over what's going to go on for the day. And then at
the second half [00:51:00] of the day after lunch, they do it
again. We have an oil delivery company fairly large in the state
of Maine that when they get out of the truck, first, they step
down, they climb down. They do three movements to reset their
body and gravity before they initiate the pulling of the hose and
yanking and filling tanks and so on and so forth, so you can take
those kind of active pieces and look at it from broaden the work
task or, you know, encourage change of body posture throughout
the day with the office worker. We encourage we change the
stretch a little bit of the movement, but we do it more midday in
mid-afternoon because when you get there, you know, you're not
going to do heavy activities like work. So when you sit down,
it's that sedentary activity you want to break up. So getting out
and moving with truck drivers, with long haul folks, you'll see
now signs that say, hey, take a stretch, break it out, move
around. So we try to encourage folks to kind of break up those
static [00:52:00] postures, either through engineering changes by
broadening the task or by just, you know, general stretch rate
movements and finding opportunities to move.


Peter Koch: [00:52:10] That's a really good,
great point there. And I bet you folks listening to the podcast
right now are in agreements with you that, yes, changing body
posture throughout the day is beneficial for you. They feel it
themselves. When they shift, they move, they sit, they stand.
They don't stay static in one posture for too long during the day
or even if they exercise before work, after work, at lunch,
whatever happens that they're going to feel better at the end of
the workday. But why do we have to keep repeating the message? I
mean, I think that's a it's an interesting human thing to
consider and it goes back to the habits. Right. So a habit is
difficult to build, but easy to break. So if you've built that
habit of stretching before work or doing something to [00:53:00]
encourage posture, change, sit, stand desk. But if you've built
that habit up over six, eight, 10, 12 weeks and now you have a
different project or you get a job change or something shifts or
the busyness at work, you're not finding the time or you are
thinking that you can't build that time in anymore. It doesn't
take that long to remove that habit. And you're right back to
where you were before. So the constant repetition, that's why
like a company led program, whether it be for stretching or
whether it be just a check in to make sure that people are
actually doing that on their own, like your delivery driver that
you talked about there or I don't know, I see like your flaggers
on the side of the road,


Al Brown: [00:53:45] Brutal job, brutal job.


Peter Koch: [00:53:47] And people think, oh, no,
it's an easy job. It's not an easy job, man. Stand on your feet
all day long and have a couple of breaks where you can sit by the
time you get to sit during the day, if you're just standing there
and if you've ever been at a [00:54:00] stop for a while, waiting
for the flagger to let you go. And you've been there for one
minute to minute, five minutes. Sometimes it's ten minutes
depending on what's happening in the construction zone. And watch
the person who's there, the person who's there, who knows their
body is doing what you're saying. They're moving back and forth
or stepping out. They're stepping back. They're not, not paying
attention, but they're moving their body around some of those
guys and gals that aren't paying attention as much. They're in
that one position. They're just standing there kind of leaning on
their stop sign. And they are going to be very sore at the end of
the day, whether they know it or not.


Al Brown: [00:54:37] Yeah, well, and it goes
it's a kinetic change. So the more static you are, the more you
constantly load one part of your body. I mean, that's and
discomfort breeds change. So some of us have a better feedback
loop than others so that if you start to act a little bit, you
go, I'm going to move. And it's called you know, it's fidgeting
and fidgeting as I was trying to find comfort. And if you're not
a fidgeter, you're more you're more [00:55:00] just a plopper.
like you just sit down, you don't move. You're going to be more
prone to those things like osteoarthritis, the diabetes, all
those kinds of things, because you don't get the cues to do it.
So it is hard. It is a very hard thing because with aging, you
have a decline in the quality of your joints faces as much as you
try to. You know, let's go back to that 56 Chevy analogy. You
know, even though you try to take care of it, you take care of
the rust spots, you make sure the tires are aligned to keep the
carburetor tuned. You know, it still probably leaves a little oil
on the floor and it doesn't corner like it used to or it corners
like it used to, but it's nothing compared to the newer stuff.
And things break. It's not as smooth as it used to be, and it's
just the aging process. So we are fighting that declining battle.
But you can slow that down. I think if you look back [00:56:00]
physiologically, you know, we look at what is a 78, 79 years is
sort of what life expectancy is now. But you can physiologically
be. 20 to 30 years younger than that chronological age. If that
makes sense, you know, so you can and again, that's genetics, how
you take care of yourself. And when we look at knees, it's really
important because that's what connects us to the Earth to a
certain extent. Your feet all the way up to the knees and then
the hips and gives us the mobility we want. So if you take care
of those through, you know, just healthy activities of getting
out and walking, getting out and moving during the workday work
because again, you don't want to just jam it all into, like, you
know, a half hour or 45 minutes of exercise because we call those
active couch potatoes. I think they coined that phrase in
Australia. But there they have the same health risks as those
folks or pretty close to the same health risk as those folks that
sit all day long and don't do that because what they do after
[00:57:00] they do their 45 minutes, hours of exercise, what do
they do?


Peter Koch: [00:57:03] Nothing.


Al Brown: [00:57:03] They go sit down. They go,
thank God. 


Peter Koch: [00:57:06] Check that box.


Al Brown: [00:57:08] The collective number of
hours you spend sitting are the problem. You are better off just
being a mail person, walking around and delivering mail. You're
like a diesel. You just keep moving around, keep moving, keep
moving. And you're burning a lot of energy, but your body is much
healthier. And again, just to go back to your grandmother and
grandfather back in those days, there's a lot of people that were
physical, I think, of like a coal miner and those jobs to live in
just today. But back in the day I lived in north eastern
Pennsylvania, coal mining was very physical and so physical. It
was traumatic, traumatic to the body and destroy the body so you
can overdo the physical stuff, you know, that doesn't keep you
healthy. You know, there's a balance. There's a sweet spot in
there where one needs to take care of the human physiology and
body, but not over abuse. But you can't be sedentary because
[00:58:00] that's going to sort of deteriorate all those things
that make up your body. So there's that you have to find that
sweet spot in between.


Peter Koch: [00:58:08] It brings up a thought to
me that the body always seeks balance. It seeks stasis, whether
it's temperature, fluid, blood pressure or whatever that is, it
always seeks to be in balance somehow. And when we're out of
balance, then something goes haywire. And that goes just from a
structural imbalance, too. So when you're the physical demands
are greater than your body can deal with, like those incredibly
harsh physical jobs like coal mining, salt mining. And even today
we think about some of those harsh physical jobs. Driving a truck
is a pretty harsh physical job overall because it might not be as
physically engaging all parts of your body in an active way,
driving a truck, a long haul trucker, the forces that get placed
on their back and their knees and their shoulders and their neck
and everything [00:59:00] else, it's just as damaging because
there's no balance. There's no stasis there. So you've got to
know, like, almost know thyself, know how much is too much,
whether it be a sedentary activity or it is an actually active
thing that you're engaged in. You've got to know how much is too
much and where to back off and how to find that balance. And like
you said, I think that's a great term. Find that sweet spot for
you between activity and stasis because we all like to relax. I
mean, there's nothing wrong with sitting down and enjoying a
breath every once in a while. But when that gets continued out
too far, it certainly has some detrimental short term and long
term effects on our physiology, our morbidity and our abilities
to engage in the world effectively.


Al Brown: [00:59:50] You know, we deal with
employers and, you know, employers are dealing with an aging
workforce. And so, you know, collectively they've got to think
about that from an ergonomic standpoint. That's one [01:00:00] of
the challenges we're faced with. And you look at its funny stairs
an example. You know, some of these sort of industrial locations
might have that three stairs to get by on up into change,
something in a paper machine or whatever the case may be. Then
there's other places that might have a whole flight of stairs.
And if you're an employer and you're requiring employees to carry
something and go up and down the stairs, all of a sudden if it's
a two handed carry, you have to totally rely on those old knees
to support you to go up or down. It's easier to go up than it is
to go down. And anybody who's hike knows that it's a lot. Most
people it's easier to go up the mountain than it is to go down
the mountain simply because it's always a double transfer. You
are putting one foot up ahead of you and you push off with the
leg that's behind you to help to accelerate up over that other
one that's going to help lift get your other foot up. So you
always have sort of a general propeller, a double propulsion to
get you [01:01:00] up. So when you climb, it works pretty well.
When you come down, you are decelerating with one leg to lower
yourself down. There's no you're just going. I hope that left
knee holds and lowers me down to the right knee. And that's where
people have problems because the mechanics change stairs, you'll
see folks modify their behavior. And again, this is one of those
things you think you're doing a safe thing, but they sort of turn
their foot sideways on the step to come down the step. We've all
done it thinking, well, if I just turn sideways, I won't. You
know, it's not as bad.


Peter Koch: [01:01:35] Just not as scary


Al Brown: [01:01:35] Yes, it's just not as
scary. But the problem is they've taken that. If we go back to
your analogy of a hinge joint right now, again, it's not a simple
hinge joint, but now you've taken that hinge joint, you've turned
it sideways, and then you've asked it to bend in a direction that
doesn't go. And you put all kinds of stress on the inside of, you
know, the knee when [01:02:00] you're coming down the stairs. So
you're going to talk all kinds of arthritic changes. So I guess
my when you're looking at the work environments, really look at
stairs as can I avoid those, is that part of the essential
function of this job? If a person has to go up and down it, are
they big enough? Are they all equal in height? Can we get the
tools up there without them having to carry them? Never have them
to hand carry something up or down stairs because they always
need that extra hand to support the legs, to go up and down, get
in and out of a truck. There's always got to be a three point
touch to come in and out of vehicles.


Peter Koch: [01:02:33] Those are great points
from a workplace standpoint. And really, when we think about it,
we want to make sure that we have some strategies in place to
help prevent knee injuries. And those are some great pieces.
Where can you limit those areas where you're going to have people
put stress on their knee either through balance, through carrying
stairs, ramps, uneven surfaces, all of those places. We want to
make sure that there's nothing unexpected [01:03:00] in the
workplace that someone's going to encounter. Maybe it's the
lighting changes. Those things can certainly put you in an
unbalanced position and put your knee back shoulder, whatever
happens at risk, depending on what you're doing. But certainly
those places where you have stairs and ramps, check them out, see
if there's something that you can do to reduce the potential for
a knee related injury because of what we're asking the employee
to do. That's great. Great advice Al great advice.


Al Brown: [01:03:29] It's you know, there's one
body part. You know, everybody can go realize what aging has done
to them. And there's one muscle that you can check out right
away, and you can do it one or two ways, whatever works for you.
But if you lie down on your back and you keep one leg down on the
floor and you bring the other leg up straight to the leg, then
knee is straight and you bring it up and you try to bring it up
to a position so that it's 90 degrees from your body.


Peter Koch: [01:03:58] That's really funny Al.


Peter Koch: [01:03:59] You're not going
[01:04:00] to get there. You're going to. But if that's not a
gauge of life, you know, if you can only get it 20 to 30 degrees
off the off earth, you know, you've got some really tight
muscles. If you can get closer to that 90 degree range, you
actually are doing really well. But it is one of the muscles that
really impacts back pain, knee pain, not the only. And, you know,
that's my qualifier here. My disclaimer. But it's one that you
can go easily test for those that have good, stable cardiac
conditions and also don't have a back issue. They can also just
slowly walk themselves down, keep the legs straight and slowly
walk themselves down and do a stretch on the back of their
hamstrings, and if they feel a lot of tightness, that's a great
place to start to work on, just lengthening that muscle. And the
nice thing about lengthening muscles as they come along pretty
quickly and there's great results and you'll begin to find a
freedom in that lower extremity because tight muscles think
[01:05:00] of this. If you wear size large pants, we're going to
say large, you know, whatever that might be, go home and put on a
pair of small pants and or medium pants that are super tight and
try to do the same things. And you'll be exhausted by the end of
the day because of the resistance those pants create. Tight
muscles do the same exact thing. They resist the movement of your
body and it's exhausting as well as throwing off your body
mechanics. So when you lengthen, you get this newfound freedom.


Peter Koch: [01:05:32] Now, that's awesome.
Let's talk a little bit about that then, because this kind of
leads into the discussion about, all right, so my knees are sore.
What do I do? We've talked about changes, engineering, changes in
the workplace or even at home. You can look at those the same
things you look at in the workplace. You can take those
personally and look in your home for those same pieces and same
strategies. But what are some things that we can do from a maybe
it's a stretching standpoint or it's an exercise standpoint
[01:06:00] that might help reduce pain or prevent pain?


Al Brown: [01:06:06] Sure. Hey, Pete, we forgot
one major thing.


Peter Koch: [01:06:10] What's that, Al?


Al Brown: [01:06:11] Kneeling. Oh, my gosh.


Peter Koch: [01:06:15] I hate kneeling.


Al Brown: [01:06:16] Oh,


Peter Koch: [01:06:17] Yeah. Let's talk about
that, because we all do it. We all do it. Right. So, no, just the
other day. Yeah. Yeah.


Al Brown: [01:06:25] And that's probably one of
the big bigger causes of knee pain. You know, you see jobs where
folks will go, oh, I'm just installing tiles. I'm just going to
kneel here and or I saw bricks being laid in the city of Portland
the other day and no knee pads and they're just kneeling on a
hard surface. And it was one of these oh, I'm not here long. No
problem. And I'm going any kneeling on any hard surface is not
your friend, you know, because you're taking your kneecap, which
is curved. There's one point on that kneecap touching the hard
surface underneath, and it's transferring that force [01:07:00]
directly through that little smooth cartilage on the backside.
And so that force is being transferred in one spot and that
begins to create breakdown. And then when you go downstairs,
walk, you feel like your knee is going to give out because you
get to that spot and your body tends to shut that muscle off
because it says, oh, I don't want the pain and you feel like your
knees buckling. So housekeeping, same thing. We see that. And,
you know, people just kneel down to clean the, you know, the tub.
So knee pads, knee pads, knee pads, knee pads. And a lot of
people are reluctant to do that simply because, you know, it
chaffs  the back of their leg, like the strap hurts. I don't
like it. But in today's world, you know, we've got some great
knee pads out there for those like floor people that lay floors.
There's actually a company in Maine I can't think of the name
right now that creates a high end. I mean, there are a hundred
twenty five dollars a pair, but fabulous in terms of protecting
the knee for folks themselves. So if you have the high end
kneelers, you really need to look at good PPE. [01:08:00] If you
are low end, like you're, you know, maybe housekeeping, you know,
if you don't have knee pads, just throw a towel down on the
ground and you can kneel on the towel and just to distribute the
force around the knee. But we're all guilty of it. We're all
guilty of it. You know, I. I always tell the story of going to
the recycling center. And, you know, I used to have to climb in
my pickup because the stuff would slide forward and be like, oh,
my knees are killing me. And then I bought myself a little hook
so I can just reach in and pull anything that slid forward back
to me. And I can't tell you how many folks have walked by me
going, oh, that is the coolest thing. Where did you get that?
Because I hate the way my knees feel when I climb in. So, you
know, pain breeds change and discomfort. So I'm sorry, but I
didn't mean to digress back to kneeling, but a huge one that can
be avoided.


Peter Koch: [01:08:50] I think it is. And even
those who are going to say no, yeah, you're right, Al, but I'm
only going to be there for a minute and there's no way I'm paying
one hundred twenty five dollars for a pair of knee pads. And
there's [01:09:00] a lot of other solutions. But something else
to consider, too. You don't just typically kneel down in that one
spot. If you watch that person who is kneeling, they are going to
kneel. And that contact point maybe go from the center of the
knee and they might shift to the side a little bit, which not
only puts that contact stressor there, but it shifts the kneecap
to one side or the other of that channel that's there, too. So it
creates more friction. It creates more challenges. And yeah, you
might be active and great, but the more time you spend on the
knee, the. You're reducing the amount of life that your knees
have and we were talking before this, you had quoted a statistic
about knee and hip replacements over the last three years and how
much they increased. And I can't for the life of me, remember
what that stat was. Do you have it at your fingertips?


Al Brown: [01:09:51] Actually, I think it was an
older study, but it was the 2001, 1993, up to 2011 or 14.
[01:10:00] And hip and knee surgeries have tripled.


Peter Koch: [01:10:04] Wow.


Al Brown: [01:10:05] Which that's an incredible
you know, and you have to ask yourself why. And again, we look at
that aging workforce. You're looking at, you know, more sedentary
lifestyle. So is it those things that have led us? We do know
that you can feel better being more active with osteoarthritis
again in that sweet spot. But, you know, is that the true cause?


Peter Koch: [01:10:26] Yeah, I think it's just
one indicator that we've seen a tripling. And I wonder if we
continued that study forward to today, if we would have seen a
leveling out or a decrease in the trend. But I imagine it
probably would have leveled out. But that's still a ton of knee
and hip surgeries that that are occurring and knee replacement
surgeries. You know, having a knee replaced might fix the pain
that you're in right now, but it's certainly not going to bring
you back to where you were before the knee pain happened
[01:11:00] in the first place. So it is a potential solution.
And, you know, one of the things that comes to mind about why
we've seen so many technology gotten much better. So the process
for a knee replacement or knee surgery has gotten and the
recovery has gotten much shorter. The technology for has gotten a
lot better. So it's easier to do. But it is really it's not the
solution. Like if you're going to go and spend a lot of time
abusing your knee, whether it be at work or outside of work or a
combination of both and think, well, I can have my knee replaced.
It'll be fine. It's not the fix all, you know, talk to somebody
who's had their knee replaced and ask him. Really? So, yeah, it
was worth it because the pain's not gone, but you're still not
able to do everything that you used to do before the knee pain
happened in the first place. So prevention, I think is a big key,
whether you're kneeling, whether you're sedentary, whether it's a
motor movement or a genetic deficiency, that you have to do
something to change.


Al Brown: [01:11:56] I just found that it's
actually was from the American Academy [01:12:00] of Orthopedics
and it was actually a hip surgeries had doubled knee surgeries
had tripled in that time period. So, you know, Blue Cross Blue
Shield was kind of putting that data together in one of their
newsletters. And just as a quick aside, we were talking about it
was interesting. I used to work at Bath Iron Works and it was
talk about unconscious behavior and what gets us there. But you
would see a worker walk towards you with a problem with a knee
and you would see the wear pattern on the jeans or the Carhart's,
and you could tell which knee was their knee of choice. And not
only was it the wear pattern on the on the pants because you
would see it would be lighter in color, but the toe on that boot,
on the steel toed boot the leather would be gone and they would
be down because again that toe was always pointing down where
that side is kneeling. If you saw both boots and both knees worn,
you knew they were double kneeler, but you always saw that they
had a knee of choice by the wear patterns on the clothes
[01:13:00] as they were coming toward you.


Peter Koch: [01:13:02] That's pretty
interesting. And again, know thyself. So there's plenty of
indications if you pay attention to your own body and what you're
doing during the day that you can foresee a problem and you might
even be able to make a change. So cycling back through and
looking at that. So what do we do? Our knees hurt. Our knees are
challenged. Aside from movements, maybe what specific movements
are good for us to keep our knees healthy first?


Al Brown: [01:13:29] Always understand that
we're not giving medical advice here. And if you do have an
issue, you know, you definitely need to there are conditions that
nothing that ergonomics or exercise is over there is going to
fix. So it might be that you do need to see your doc and there's
anti inflammatory and all that kind of good stuff. But a huge
part of getting better is looking at behavior and your body
mechanics to understand it and see if there are things that are
contributing. You [01:14:00] know, kind of what we talked about
today. But you as an individual, you know, as we age again when
we get up in the morning to take time to get yourself through the
gel factor when you go to work and they're creating a stretch
program, get involved. It's one of those things that you look at
the Tom Brady's of the world and Ben Roethlisberger, they haven't
gotten that far in life by not stretching and preparing for the
event. So if you're in a physical environment, you need to
prepare yourself for the day's activities. Actually, we probably
need to do it more so because we're less fit than those folks
are. And they have professionals that help them, you know, eat
and exercise, all kind of stuff, so take advantage of that if
your company doesn't have that kind of thing, stretch yourself.
Take a moment to stretch yourself out. At the end of the day,
take time to lengthen yourself back out. Hard day, different
work. You would mention different activity. You can come home and
it's usually a day or two later that your body says, oh, I'm
pretty sore give you something benign, building a sandcastle
[01:15:00] with your kids at the beach. What do you do? You take
your legs, just splay them out real. Why do you bend over at the
waist? You want to work on the castle in front of you and have
fun with the kids and you think, oh, that was cool. And then a
day or two later you're like, oh, I got hamstring cramps and my
back hurts. What makes it better? Lengthening it back out because
you did something very different than you normally do. I think
you referred to it as changing job tasks that, you know, it's
going to impact our bodies. So as we get older, we feel that
impact. So, you know, being cognizant of the day of what you're
doing and you go, that was very different. I need to sort of
lengthen out my body, kind of open it back up and some good
general stretches. You can go online now and look at what's a
good way to stretch my whole body. What's a good way to stretch
this? My knees and hamstrings, you know, you can find those
things, but it's then just making it part of your routine and
your day that makes the difference. You will never fit it in. You
don't fit things in. It needs to become a habit and you'll wax
and wane. [01:16:00] You know, it's just like stretching programs
in industry. They'll do it, then they'll forget. And then just,
you know, good nutrition, hydration, you know, water's important.
70 percent of our body is water. And that's, you know, 70 percent
of muscle is pretty much water. So you have to hydrate, hydrate,
hydrate, make sure that that homeostasis you were talking about,
that balance is there. And then certainly nutrition, you know,
making sure that the sodium, potassium, all those, can you get
into the physiology of it. But that's just good nutrition. So I
know it sounds pretty basic, but it's like anything else, those
little things can make your 56 Chevy look pretty darn good and
function OK in this world, even though it's aging.


Peter Koch: [01:16:42] Sure can. And I think
what you laid out there, I think it's better than listing out.
Here's ten stretches that you can do because everybody's
different. So when what you started with know, know thyself, know
your body, know what challenges you're going [01:17:00] to have,
you know what challenges you've had, and then try to do something
that counteracts that. So that's going to be different for you
than it is for me, because my habits one are different. My job
tasks are going to be slightly different. My flexibility is
different. My tolerance is different. My balance is different. My
nutrition is all those things are different. So I'm going to do
something. If I do what you do, it's not going to be as effective
for me as it is for you. So that suggestion of do a little
research and maybe even start with your doc, like if you're
finding yourself that you've got some knee pain, like you get up
every morning and like, holy cow, my knees are killing me and it
really doesn't go away until I get all the way down stairs. I get
four cups of coffee in me and I'm an hour into work and now I
feel OK, something's not going right. So go see your provider, go
see your personal care provider and find out what's going on
because you don't want to start an exercise regime or a
stretching regime or a nutrition regime that's going to be
counter [01:18:00] to what your body actually needs. And even
though we might know what we need, sometimes a little
professional guidance is really good to be able to tune that so
that you get the most out of it. Because the crappiest thing, and
I don't know if you've experienced this before, but you start an
exercise regime or you start a health diet regime or you start
something and it doesn't have the effect that you expect, like
you get a week or two into it and you're like, man, I've been
really pushing hard at this and I don't feel any better than I
did at the beginning. Matter of fact, I feel not so great. So
maybe we're not targeting the right things like you talked about
before, the psoas muscle. Right. So I wrote this down. I said so
as I sit, it gets shorter. Right. That's what happens. That's
bad. Bad.


Al Brown: [01:16:42] It hurt me


Peter Koch: [01:18:51] But you know, which
muscle group is it that's really affecting your posture? Which
muscle group is it that's affecting the knee? Is it genetics
[01:19:00] or is it truly a shortening of a particular muscle
group because of the work or the activities? It doesn't always
have to be work. Matter of fact, we talked about this earlier.
It's typically a combination of the work activities and the off
work activities. So one or the other is going to compound what's
happening in your body.


Al Brown: [01:19:21] Yeah, it's a logical
physics problem. There's no magic to it. Again, remember, I
reference fairy dust back there and sometimes we look to go to
professions for the fairy dust. And a lot of times the problem
rests right there with us with our behaviors, what we do or an
environment and a movement pattern that we've created, that's not
helping us. So it's not fair. You're not going to get a magical
solution to fix it. You know, we live in this world of gravity.
And I'm going to tell you, as I've told you before, you know,
gravity's undefeated. In the end, it's going to win. It'll take
you. But it is our job to minimize, [01:20:00] you know, keep
these things called antigravity muscles, of which your quad
muscles, your hamstrings, your buttock are. These are muscles
that keep us upright and battling gravity all day long. And you
can't give in to them. And unfortunately, job tasks that we do
now are more sedentary. So it does promote inactivity. So you
need to find movements that you can do throughout the day on the
weekend, walk the dog any opportunity you get to keep all those
structures nice and healthy and strong.


Peter Koch: [01:20:31] I think that's a great
place to end on Al. We've covered a lot of ground today just
talking about knees, but we've expanded into a bunch of other
areas. But I think you've provided us with some great
suggestions, some good feedback and an outline really for, what
do we do to help keep our knees healthy? And if to summarize, we
think about it, we want to look at our environment. Right. So
what are some changes that we can make in our environment to make
things happier [01:21:00] and healthier for us? And then we need
to move during the day. We need to change up our posture. We need
to change up our activities. So we encourage fluid and we
encourage blood flow within those body parts. So those two things
right there are a huge chunk of keeping our bodies healthy and
specifically our knees healthy as we end up here. Is there
anything else? Is there maybe one tip, one piece that you really
want our listeners to leave with about knee safety and health?


Al Brown: [01:21:34] Typically, most of us start
out with two of them and hopefully you end with two of them. They
are the things as you referenced and metaphorically, we have
covered a lot of ground. And the only way you can cover that
ground in a realistic sense is to have two healthy knees that
allows you to move about the onus falls upon us, even though we
try to find, you know, [01:22:00] external reasons. Oftentimes
it's mechanical internally, the tightening the muscles, a
traumatic event that oftentimes will, you know, create the injury
but think logical. Don't think something strange is happening.
There are some disease processes that will creep in there that
that might be mysteries, but for the most part, it's usually
mechanical, logical thing. And, you know, don't, you know, try to
minimize that sedentary behavior as much as you can because it is
creeping into our lives. Even as we have this podcast today, you
find that we move less and less and less. You know, I always
laugh and I tell folks, I said, think about this. Back in the 60s
when you backed up your car, if you had a car, would you have to
do it to turn your head around to see where you were going? So
you just increased blood flow, you know, lubrication of the neck
muscles. What do you do today? You just take your eyes and you
glance down and you look at the back of [01:23:00] the camera. So
that technology is wonderful in our lives and it's very helpful.
But it also can collectively be harmful because it takes away
some valuable movements. And I'll leave it there.


Peter Koch: [01:23:15] That's perfect Al. I
really appreciate you being here and sharing your expertise with
us, so thanks for that.


Al Brown: [01:23:20] Thank you.


Peter Koch: [01:23:21] I appreciate you joining
us. And then to all of our listeners out there, this is the MEMIC
Safety Experts podcast. And we've been speaking about knees
healthy knees, knee injuries, how to prevent them with Al Brown,
MEMIC's director of ergonomics. If you have any questions for Al
or would like to hear more about a particular topic on our
podcast. Email me at podcast@MEMIC.com and also check out our
show notes at MEMIC.com/podcast, where you can find additional
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