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That's a good question and a good description of your situation. You have a good attitude and sensible questions, so there is reason for hope. You should allocate time daily to explore the exercises and make them work for you so that you cover most or all of them once or twice weekly. A necessary ingredient is motivation. Your first motivation is that there is hope (your case does look hopeful). You must ask yourself what your motivations are. They might be "keeping mobile to enjoy pain-free walks in the park" or "offering a top service at your place of work while not distracted by pain", or getting a good night's sleep". A friend with a listening ear can be your coach and sounding board. Since no single health provider has all the answers, be sure to seek the advice of more than one health professional. Go well.

@@BruceThomsonDoesPilates thanks, I appreciate the advice! I'm stubborn and motivated 😂

Thank you for your comment, which highlights the precarious state that hip arthritis can lead to. First off, it is what it is. You should not let feelings of shame or resentment come between you and the quiet inner hero that - since you took the effort to search the internet and study your problem - I know you to be. One quiet step at a time is your good motto. You might adapt the exercises to work while lying on a bed or a massage table. I think that supervision and coaching from a movement therapy specialist is appropriate. Reformer and other equipment-based pilates is a good option. The rest speaks directly to your concern. Please forgive me for being rather blunt with what follows. It is intended in a kindly fashion. The inability to lower and rise from the ground is a clarion call to get the best possible help from all possible sources, to help you regain this vital health-and-safety pattern of movement. Strong friends with whom you can brainstorm "raise and lower strategies". Learning how to use their help and the help of furniture such as dining room chairs and chairs with arms you can push on and pulleys attached to ceiling hooks: Brainstorm! Internet-connected wristband alarms! Surgery is a good option for many. Supervised quality nutrition with appropriate gentle fasting if weight is a problem. Let direct sunlight warm you every day, whether fully clothed or partially stripped off. Do not be scared of getting small doses of tanning from the sun - benefits include vitamin D and mitochondrial melatonin, both have poweful anti-inflammatory and healing effects. Receptionists at physios, doctors and social security (these are people who listen to patient stories and have insider knowledge) may offer recommendations and referrals to appropriate helpers and specialists for your problem. Massage specialists are likely to be of help. Pilates studios with trained rehab specialists, offer a unique and friendly environment. Surgery may be your best option. Somewhere in my comments, there might be something that you can use. Thank you for asking your question Go well, and God bless.

Thanks interesting.

Going up and down stairs is good for your hips. Do it smoothly. Use the handrail. Go both up and down. Take the same shape as in the ****05:39** Reverse chair sit** because it will make it easier to add the **SQUEEZE THE GLUTE** and get the benefit.

@@btpilates-solutions Thank you!!

Metabolic flexibility... I'm naturally skinny. I do a lot of mid to low-level abdominal exercises (demonstrating). And I perform as a national level masters athlete in New Zealand (sprints, hurdles, harriers in winter). Wilderness hiking (often, I'm following nothing more than deer trails) gives me a lot of joy when I have the time. For what it is worth, I am pre-diabetic, so I "restricted time eat" (an 8 to 10-hour eating window most days) and semi-fast one or two days a week (no animal protein, 600 to 900 calories), and I follow the principles of the Prolon 5 day fast twice a year. My blood sugars are improving slowly (over a period of two years), and I have the weight I had when I was a teenager. There is nothing magical about what I do except that I enjoy doing it, which makes me consistent, as in doing something every day. All this leads to "metabolic flexibility"... Dr Berg has a good article with video. I'm giving you the reference because Google won't recommend his article (Google favours research institutions but they are often way behind when it comes to modern, effective health advice). (Dr Berg has 12 million RUclips subscribers). www.drberg.com/blog/the-best-way-to-get-metabolic-flexibility I hope that's some help?... Your first daily habit to is to walk in the sun (even if it is raining it is still "in the sun") every day. Make it 20 minutes, or 40 minutes or 80 minutes. Make it enjoyable. Amongst trees, scenery and friends if possible. You can do as little as 5 minutes at a time (exercise snacking). Other References Search: walter longo prolon video eatlikeanitalian.com/fasting-mimicking-diet-2/ brucethomson.substack.com/ bthealthyliving.substack.com/

(For the diaphragm, downward on the inbreathe means toward the pelvis...) (For breathing during meditation, you can't stay calm and relaxed if the breathing is destabilising and moving your axial skeleton - the head, spine, and pelvis. If your axial skeleton is tall and still and stable (and not moving!!!), your meditation will be more effective).... That's a good question about the visualisation of diaphragmatic movement during breathing. I'm reluctant to show anatomical videos of breathing movement and will explain why.... The trouble with the videomatic portrayal of invisible movement under the skin, is that an artist gets to do it. In contrast, a formally trained functional anatomist (such as a physiotherapist who gets to see the damage caused by wrong breathing patterns) would better understand what a healthy breathing movement should be. With this in mind, you can look at the following two videos. FIRST VIDEO SHOWS RIBS LIFTING SIDEWAYS LIKE HANDLES ON A TWIN-HANDLED BUCKET: (I do not believe this is a healthy breathing movement - I am showing the video so I can discuss and recommend caution when viewing anatomic movement videos). ruclips.net/video/SAk77hTiwtY/видео.html This JESSICA WOODS ART OF BREATHING video shows ribs lifting like twin bucket handles. It's a beautiful video, but it is (1) an artist's impression of ideal breathing and not that of a formally trained clinical anatomist. (Jessica is a teacher of performing artists, not a doctor, not an anatomist, not a physio who treats people with pathology caused by poor breathing habits; she is an artist first and foremost). I respectfully disagree with her "correct breathing" video (with ribs lifting like the side handles on a two-handled bucket) because my personal experience shows: (a) When I lift my ribs like bucket handles the movement fires up and puts tension in muscles in my neck (scalene muscles). These muscles lift the uppermost ribs, which then pull the lower ribs upward. I get a tense neck and headaches when I do this, and it makes me more anxious. (b) When the lower side ribs lift (like twin bucket handles), the spine tends to arch backward, which means that each inward breath destabilises my spine. Not at all what I want if I am doing deep breathing while running! - I need to stay tall and stable, not have my spine and rib cage swaying forward and backward on each breath! NOTE: when you are heavy breathing, the upper ribs do lift, but the lower ones shouldn't - if they do, your spine arches backward - if you are a distance runner, this would cause pain and damage in your lumbar spine (not what you want during preparation for your big race), if you are an older person, this instability will contribute to spinal stenosis pain (not a a pleasant place to be). SECOND VIDEO SHOWS RIBS LIFTING AND DIAPHRAGM LOWERING. This SOHAMBIS 3-D VIEW OF THE BREATHING DIAPHRAGM also shows ribs lifting (in my body, this destabilises my axial skeleton, as discussed in (b) and "NOTE", above). ruclips.net/video/hp-gCvW8PRY/видео.htmlsi=2T3may6AC0xuKR8m As the SOHAMBIS youtube channel is old and its outward links go to web addresses that no longer exist, I could not identify the credentials of this videomatic rtist. Nevertheless, the diaphragm movement is quite useful to answer your question. A THIRD VIDEO WOULD DEMONSTRATE THE RECIPROCAL ACTION OF THE DIAPHRAGM AND THE ABDOMINAL MUSCLES DURING THE BREATHING CYCLE. It is explained here: www.ncbi.nlm.nih.gov/pmc/articles/PMC4933622/ but I could not find a video. My own explanation follows: When the diaphragm contracts and pushes down on the tummy organs, the abs slightly relax to permit the organs to "balloon" the tummy outward. The reverse happens upon the exhale: the tummy gently pulls in like a corset to offer support to the tummy organs, which are moving upward to fill the space left under the upward-moving diaphragm. This push and pull of the breathing around the bag of tummy organs is a magical thing by which the muscles of the torso breathe, brace, (and move, when movement is required) the axial skeleton, all at the same time. It's exquisite, and it is health-enhancing, provided it is working well. (Unfortunately, all the fashionable "tight tummy: engage your core" mantras tend to destroy the breathing balance). I wish I could explain it better. Your feedback tells me that I must polish my breath-work teaching- thank you! Keep searching. Keep learning. Good luck.

Wow thank you for the response and clarification of techniques! And all the extra videos! I will watch these and keep learning and practicing!

Thanks for asking. - I'll do my best to help. There are quite a lot of causes of knee pain. Is yours a knee cartilage? Or something else?

Hi, thank you for the message, I have cartilage and knee roughness. Thanks,

Thank you! We're working on it. I'd love you to take a look at how the video looks at:- open.substack.com/pub/brucethomson/p/pilates-posture-correction-exercises?r=12cke2& And while you're there, you might like to trial a subscription to live Zoom matclasses (Leprechaun Pilates by request)

You are welcome!

Probably reflux (LPR) that affects the trachea and/or lungs. It happens to me sometimes, although I have more sore throat and mucus in throat and not problems with breathing. But reflux in some people can cause it

Or hiatal hernia, or liver. I' m in the process of finding out.

Thanks for the bible quote. It's not on topic, but I like it, so I'm leaving it here. Go well and God bless you.

greetings also!

You are welcome. Appreciate your feedback.

You are welcome! :)

How often do you repeat it?

@@emilyerdbeere9210 In gentle form, every minute of every day. Thus: Breathe into the belly and lower circle of ribs. Pause on the inbreathe to relax your neck and grow tall. Stay relaxed as you breathe out. You might practice various forms of deeper breathing during any and all forms of exercise, or especially in a yoga class. As stand alone exercise you might use a deep breathe to stretch your ribs and abdomen once or twice a day. But basically all the time. Welcome to a calmer, taller, happier you!

You're welcome!

Oxygen

Are you not feeling the ribs expanding? That's my guess as to what you are feeling at present. Try this. It might work for you. Imagine at the peak of your in-breath that your body is like a glass two-thirds full. The lowest third is more full than the middle third. Now your lower ribs have expanded, and you feel like there is air in the lower half of the chest and it is rising a little (or even a lot), into the upper half of the chest as well. You no longer feel anxiety due to "no oxygen reaching the lung", and you can relax tall and ask the hollow above the collar bones to relax as well.

Some people will understand the video with ease and some won't. If you don't it's as much my problem (as the teacher) as yours (as the student). I suggest you find someone to observe the pattern of your breathing and if necessary, perform tests to check that your lung tissue has no diagnosable problem that might limit airflow.

Good question Can the tendon regenerate without significant rest? The question assumes that tendons are like muscles and need to rest from activity to heal. Not strictly true for tendons, however. Tendons rest when they don't (all at the same time) handle a heavy tensile load and go around a sharp corner. They can rest from damage while doing a straight line load or when unloaded and doing a sharp corner. But not both at the same time. If you slightly straighten your ankle every time you load your PTT tendon, you have given the tendon the rest from the sharp corner that it needs, while also providing the straight-line tension that stimulates healing. This is the safe way to load (and heal) the tendon. so... Regular and consistent time under load, **loading the tendon in a safe way** is the solution. Small or infrequent bursts of exercise won't work and are the main reason why PTT exercises fail. So the solution is to learn to **safely load**. Safe loading happens when you have done a good two minutes of loaded work, and you say to yourself, "yes I can do that again in 12 or 24 hours". (In other words, it's comfortably sore, and not desperately sore) This is how to safely load (3 strategies): 1. Isometric (minimal movement) 2. Reduced load (you can do this by sitting in a chair, lifting the heel of the affected ankle 2-3 cm off the ground, and then leaning a hand or elbow onto the knee (rest a dumbbell weight on it if you like - 2 kgs to start). Once you know the load you can perform for 2 minutes every 12 hours, you can increase the load gradually by (a) higher heel lift, (b) more pressure on the knee (heavier elbow or more dumbbell weight) 3. Avoid the tendon going around a sharp corner (already covered above by lifting the heel an inch or two). Tendons are not strong when going around sharp corners. You also reduce the tendon's sharp cornering during the day by wearing ankle braces/hiking boots, and using a heel wedge (but not all day - only on days that you have to do hard walking or prolonged standing/running). Once you have safely loaded for a good two minutes, you can give your ankle a shake out and some ankle circles (mobilise it to encourage the blood flow), and you can massage the PT muscle (it may be grumpy and knotted after all that sustained loading). Does that cover it? Thanks for the good question. Let me know how it goes

Thanks, that is a good question. The answer is "No we need to point the kneecaps (and toes) outward". My explanation is based around table 2 in:- (1) www.jospt.org/doi/pdfplus/10.2519/jospt.2010.3025 AND (2) www.ptkorea.org/journal/view.html?doi=10.12674/ptk.2021.28.1.27 Explanation Internal rotation (toes inward) is a common fault with the elderly and is due to weakness (amongst other muscles) in the **posterior** gluteus medius. We therefore need to strengthen the **posterior **gluteus medius; this will best happen when we perform the exercises "toe out" (external rotation of the hip joint). Toe out will also retrain the elderly to avoid over-use of the tensor fascia lata (see quote of reference 2 below) Quote (reference 2): "Overuse of the tensor fasciae latae (TFL) as a hip abductor due to Gmed weakness can also cause several pathologies such as pain in the lower back and hip and degenerative hip joint pathology"

Hi Kiran, Likewise much love and peace, and also gratitude for your passionate and challenging challenge, which makes me stop to reassess what I have been recommending. Everyone needs a challenge to keep them responsible. -:) Yes you are right, it is easy to do isometric work and overdo it such that it "burns the targeted muscle" - (perhaps you also mean "burns the targeted tendon"?). So yes, I do need to be more diligent about advising how to de-load the workout to a point that most people are working within the limits of what their damaged tendon can give them. Some comments. (1) A theraband exercise might also "burn the tendon and muscle", if one spends sufficient time with a strong band and with the toes in a hard ballet point, with the toe pointing inward - that makes the PTT and the PT muscle work extremely hard. (2) You need to find a comfortable and doable way to do the exercise for perhaps 5 minutes a day for three months or more. I'm sure some people can do that with a theraband, but I would find that a hard chore myself. (3) Whatever exercise is used, it should contract and strengthen all the muscles of the foot and ankle, because they are all team players and the all help protect and take the load off the PTT tendon. Standing isometric will do this more efficiently than the theraband. (4) Whatever exercise, the tendon must be loaded in a non-jarring way, in a more or less straight line, for two minutes per session. The beauty of "isometric" PTT work is you can do it on autopilot and check your emails while the healing stimulus heals the tendon. Finally Isometric has worked for me, but I do need to think about fine-tuning my advice and showing how to keep it low-level for beginners. Thankyou for your challenge It is very welcome.

@@btpilates-solutions Isometrics are goated fr.., last sep 2022 i underwent ankle surgery., and i see swelling on sides of ankle if i sit for minimum of 1 hr., those puffy ankles are disgusting tbh., so after i was able to walk due to my physio., i began the hunt for my solution. after these many months i discovered ., its the Intrinsic Foot Muscle Strengthening thats need to be heavily focused on., slowly building arch and stuff i recntly came across your video and after watching i did standing 3 min hold with posture as you mentioned., no cap this works...... thanks man..., love from India ::)

Yes, a long time. Tendons are slow to develop their weak spots and slow to regenerate. If your daily management makes the rate of repair exceed the rate of degeneration, then improvement will eventually happen. Your job is to make that daily input an enjoyable habit. If you do that then 3 months will pass by quickly enough. Good luck.

You are welcome. Thanks for your feedback. Best of luck.

An ankle brace is a good idea. But I am not an expert in that. Try some searches on youtube and in the product comments at Amzon.com

Good. You need more than one strategy, however. Find a daily exercise routine that works for you.

I read your comment and swear I wrote it. 😢 How is your healing journey now?

You are welcome!

Thank you!

Thank you Rurik, and good luck. I suggest you read my reply to Tyler March below. Stay in touch and let me know how it's going in a year's time.

Can you run again? Did the exercises help?

Thanks very much, go well!

**If you are weight-bearing and able to walk (or is that hobble at the moment?), then yes! ** Do all the suggested interventions at a slow and gentle level. Work at a level that you can sustain day in and day out for months or years. For example, isometric loading will likely reduce pain by squeezing inflammatory fluid (doctors call that oedema) out of the inflamed areas of the tendon. But you will only know if you give it a go. **You must be disciplined about supporting your ankle during the standing activities other than your PTT exercises** Give your foot and ankle the support they need when you are walking (such as tightly laced hiking boots and instep lifting orthotics - you can loosen the laces when seated at the office desk). This support improves the alignment from "sunken down and rolled in" toward more of "ankles wide, knees wide and foot arch lifted". In this alignment, you load your painful tendon *in a straight line* which causes a lot less damage (tendons get damaged when they are loaded and moving around sharp corners). It also changes the geometry so that the muscles don't have to work so hard to maintain the correct alignment. **The wheel barrow analogy** When you stack logs on a wheelbarrow and start pushing it, you have to maintain an upright alignment because the moment the barrow sinks to one side, you have to use massive strength to bring it back to vertical. It's the same with your sunken PTT ankle. That's why support with boots is important. **You must be patient and disciplined** Once you have developed comfortable daily habits, keep going. The damage has probably developed over many years? It will take years to improve. My own experience (mild to moderate strain) is that a good daily habit will still deliver gains after five years. **It's a multi-strategy approach. Use help and advice from many sources.** Don't just rely on me!

You're welcome!