About Elliot Well-known for his functional manual therapy approach, which works to free restrictions in your joints and muscles to allow more freedom of movement, he aims to strengthen your body in a new, fuller motion and re-train it to avoid further injury. He treats each patient as an individual, addressing the whole body to eliminate weak links that lead to pain and injury. With a diverse educational background and a wealth of hands-on experience, Elliot enjoys helping others by customizing specific treatment plans to meet each patient’s individual needs. He is expertly trained in the evaluation, diagnosis, and treatment of injuries and many chronic conditions to get your body functioning at its best.
Elliot’s past experience is rooted in both orthopedic and neurological rehabilitation gained working at Burke Rehabilitation Hospital, Mount Sinai Medical Center, and as the clinical specialist in the outpatient spine clinic at New York Presbyterian Hospital. He has also completed certification training in Proprioceptive Neuromuscular Facilitation (PNF) at Kaiser Permanente Medical Center in Vallejo, CA, and his fellowship training at Johnson and Johnson Physical Therapy in Steamboat Springs, Co.
In addition to his clinical experience and functional manual therapy training, in which he is only one of 17 therapists in the country to have completed the one-year fellowship training in this area, Elliot is a board certified specialist in Orthopedics and a certified Vestibular (dizziness) therapist with the American Physical Therapy Association. He has also completed coursework in craniosacral therapy, and currently teaches both as an associate instructor with the Institute of Physical Art and as Adjunct Faculty at Long Island University’s Physical Therapy Department. When not treating patients, Elliot can be found playing with his daughter, riding his bike, or playing tennis & basketball.
Keep reading for his insight into a common injury that walks through his door; find out more about PT @ Kinected here.
Knee Pain – Finding Answers Above & Below
by Elliot Fishbein PT, OCS, CFMT, FAAOMPT
When patients come in with knee pain, they expect the emphasis of treatment to be centered on the knee itself. Often times, however, knee pain arises as a result of weakness and tightness above and below–at your feet, hips and low back. Here’s a quick look at how addressing each of these areas can be the key to successfully treating your knee.
Your feet act as the foundation for your body. If you are not balanced and stable over your feet when walking, then everything above cannot be stable. The most common problems are pronated feet (“flat feet”) and supinated feet (“high arches”). In an ideal and biomechanically-efficient world, the foot features a fairly high arch when not bearing weight, and flattens out (pronates), though not excessively, when standing on it. The high arch is designed to give your foot stability and provide a base of support for your body. The flattening out of the foot (pronation) is designed to allow your foot to adapt to the surface underneath and absorb shock.
Flat Feet When somebody over-pronates, the foot either flattens out excessively or does not rebound out of that flattened position, leaving no resting arch of the foot. This loss of the resting arch decreases the stability of the foot, so when you contact the ground, your foundation is unstable. As a result, that instability translates to poorer stability and abnormal medial rotation at your knee and can lead to arthritic changes, tendonitis, bursitis, or any other common knee ailment.
Tip: Pronation can be addressed in physical therapy in various ways including mobilizing the joints of the foot to increase the balanced position of the foot,orthotic fabrication, and strengthening muscles that limit excessive pronation.
High Arches When somebody over-supinates, the foot strikes the ground with a high arch and doesn’t flatten out enough. This creates the opposite condition where there is too much stability and not enough shock absorbed by your feet. As a result, the shock absorption that should occur at your feet occurs at your knee, hip and low back. This can be just as problematic as having flat feet and can cause all of the same problems at the knee, but for different reasons.
Tip: Treatment for a supinated foot may include an emphasis on mobilizing the foot to allow it to absorb more shock and decrease excessive stress at the knee.
Where’s the Gluteus Medius Love? What many people don’t realize is that your hip muscles are among the main muscles that keep your knees from collapsing inward when standing. Mutliple muscles, but particularly your Gluteus Medius, prevent your knees from turning in when you climb stairs, squat or just walk. This prevents excessive torsional stress on your knees. When these muscles are weak or not firing in correct sequence, alignment at your knee goes awry, and wear and tear along with knee pain often ensue.
Tip: Strengthening your hips (especially your Gluteus Medius) to reduce knee stress and prevent long-term pain.
Hip Alignment In addition to hip weakness, hip misalignment can also be a pain in the knee. Your hip is a ball and socket joint. If the ball is not properly centered in the socket, the same compensatory inward rotation at your knee caused by hip weakness can ensue. This misalignment may have developed over your life due to trauma, muscle imbalance, or mild arthritic changes in the joint. In this scenario, even if you have strong hip musculature, you can end up with excessive stress at your knee due to improper mechanics at your hip.
Tip: A good physical therapist can use various techniques including joint mobilization, soft tissue mobilization, and neuro-muscular re-education to re-establish normal hip alignment and create normal mechanics for you knee.
Strengthening Your Core:
The latest fad is training “the core” for total body wellness. The question is, does this actually work? The answer is, unquestionably, yes. But why would strengthening your abdomen reduce pain at your knee? That answer is multifaceted.
Moving Forward Efficiently First, your spine acts as a stable base from which your lower extremities muscles can move. The psoas muscle, for example, originates on the front of your spinal bones (vertebrae), and travels down to the front of your hip to attach onto your femur (thigh bone). This architecture makes your lower spine an anchor for the psoas to help propel your thigh forward. If this anchor point has poor stability, your legs loose that connection to your trunk and, thus, loose that stability as well. This creates inefficient alignment and muscle function, which will eventually contribute to knee pain.
Tip: Strengthen your core to create a stable base from which your thigh muscles can work efficiently and reduce stress throughout your legs.
You’ve Got Nerve! Another way that poor core stability contributes to knee pain is via nerve dysfunction. Your lower spine has small holes (foramina) on either side where spinal nerves exit from your spinal cord, to then combine together and travel down your legs. When you have poor core stability, the positioning of your vertebrae is not as stable. This can cause excessive tension on a nerve, or potentially change the space of the foramen, either of which can affect how efficiently your nerves get their message to your muscles. This is another way that core instability can lead to minor weaknesses in your legs, which can decrease balance and shock absorption in your joints, and ultimately contribute to your knee pain.
Tip: Do Pilates! 🙂
Want more? In person? Come in to see Elliot today!