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Dr. Cathy A. Kim, MD, APC

Tips for Short Women | Ep. 10

Studio waist-up shot of tall man smiling and showing with hand at height of short girl standing beside him and looking with perplexity at camera, over gray background. Variety of person's heights

Tips for Short Women | Ep. 10

In this video watch (or read) how Bella improved her heel pain and painful periods by being mindful of her hypermobile knees! Also, learn the basic tips I give her about: 1) how to sit in her car and 2) how to stand and sit using a regular chair, to help her chronic low back pain.

Transcription:

Dr. Kim: 
Hi everyone, thanks for tuning in today. This is Bella.

Bella: 
Hey guys!

Dr. Kim: 
This is my daughter’s friend, and luckily Bella was ready and game to be my model. Because I’ve been looking for a while for a short statured woman with knee hyperextension, who could demonstrate the problems that happen to women that have this combination of problems in our modern society.

Today is gonna be about how I work with women like this, to help them move differently, so that their short stature doesn’t continue to be a liability. Alright?

Bella:
Mhmm

Dr. Kim:
Okay, so probably a year ago, I noticed that Bella did this with her knees, so she’s gonna bend them forward a little bit like… yes, and then all the way as far back as she can go. Ready? There she does. And so turn around towards me a little bit so everyone can see how far back you can go… yes, you’re so great at it. 

So I would call this moderate hyperextension, it’s not mild. If you watch me do it, I go like this, and then mine continues like this, but she’s able to go way further back, and she does it actually much further back I think on the left than the right. So we were debating about them. So this is impressive. Alright.

Bella:
Thank you.

Dr. Kim:
Yes, you’re such an overachiever. 

Bella:
Thanks.

Dr. Kim:
So if you look at her from the side, Bella used to, when I saw her… let’s put your hands up here… I would always see her talking to Talia and everything, and she would always be talking and your go-to position was to do… show it. Yeah, you talk like that. 

And so, you happen to mention that your heels bother you a lot at your restaurant job, and I said, I think you gotta stop doing that to your knees to help you not have your heels keep hurting you because all of this is putting so much pressure on the back.

So one of the first things that I do for women who are complaining of this, is to have them stop doing that and bring this here so that this now is softer, but it’s in line with their hips so that then they are not… do it again for us… that. This creates so much tension because you would never build a table with a leg that does that and coming back, it would make it not stable and would make it strain the joint that’s up here. So why don’t you put your hand on the muscle that’s right about here, so bend your knee a little, there you go, now lock your knee back and feel what happens to that muscle right there. Can you feel the difference? 

Bella:
Yeah

Dr. Kim:
Bend your knee just a little bit there, and now lock your knee back the way you used to stand all the time, so what… 

Bella:
It pulls.

Dr. Kim:
Yes, you feel a lot of tension in the muscle. So this pulling that happens, tightens up this muscle, and then this was… if you watch the line of her pants, you see that her pants go from like here to actually like tipping like that. So what I showed in one of my videos… let’s turn this around… so I’m gonna show them how this action of pushing this back, drags your whole pelvis down. So let’s see when she does that, drive this and then drive your… and then lock backward there.

Okay, so we took a little break ’cause I thought that these tights would show what I wanted to illustrate better, which is that when she bends her knees forward like this up and then locks them backwards, so lock back… do you see this wrinkling that happens here? 

So do it again, bend forward, and then back… there. This wrinkling is what I wanted to point out, that when that wrinkles, this means that she shortened up her muscles in her thigh area so that there’s slack left in the tights that we can see. 

This is what’s in the fascial muscular layer under the skin that we can’t see, and those are the subtle forces that are what you’re working against as you move this way your whole life and get tighter and shorter and shorter and shorter. Tighter through here, till we look like… help me out a little here… until we look like this. So we’re actively working against that… myself and what I’m doing with my patients and my kids and their friends, to help them not have that happen. 

Okay, turn around one more time in this way… yes, so when you do this… so then when you stand the other way to move your hands a little, so we can see that.

So you said that you felt this muscle tighten, which then since it’s tightening, it’s gonna drag you down… that’s right. So this will give you this kind of tension right here, which will then cause your back muscles right here, which are the pink muscles that I’ve shown on other videos of me. That these muscles… or these short ones right here… these will then over-work to try to make her do this to keep her from that feeling of going forward. So when you correct this… by bend this there… and then you keep your weight over your heels, then right there, do you see how you’re more in line and now she doesn’t have to arch her back right here. 

Bella:
And I bring the shoulders back too… It used to be… and then they come back a little more.

Dr. Kim:
And this is now… show how you now stand at work…

Bella:
This is… yeah, this is about how I stand.

Dr. Kim:
So this is now how Bella stands at work, so now she told me that her heels… You hurt less, right? 

How much less, like what would they… I don’t know if we can assign a number, like what number would be… 

Bella:
They used to ache after three, maybe four hours, and now I could go the whole day without them aching

Dr. Kim:
And do you still have pain at the end of the day?

Bella:
Not really.

Dr. Kim:
Not really. Okay, that’s great. Not bad for being 18 years old. 

So one of the things that I was shocked by was that Bella mentioned that she had pain since she was like… like her whole life, and it was really like young… since you were how old?

Bella: 
Probably, I probably started noticing maybe around eight or nine.

Dr. Kim:
Eight or nine years old. So these mechanics of having this, standing this way, this is happening to kids from the time that they’re really young. This is what I have to see all the time. So my heart was like breaking ’cause I thought there’s no way you should have pain since eight or nine years old. Now, you are also a competitive, what do you call it? BMXer? What is the term?  

Bella: 
BMX Racing 

Dr. Kim: 
Can you show me a little bit like what that would look like when you’d race? 

Bella:
I mean, it depends on like what part.

Dr. Kim:
What part, oh okay, so when you’re – so I don’t know – the bike, is it kind of short, or?

Bella:
Shorter. I mean so I guess if you’re starting, I’ll go this way… I’d be like that…

Dr. Kim:
Okay, to start?  and then…

Bella:
Which actually gave me lower back pain, because you kind of push out to put strain on your quads and then this part right here, and so… yeah, and then when you start, you pull up and you kind of… you push your pelvis hard forward. And so I would have lower back pain. But I think that also helped me hyperextend this ’cause I got so used to pushing forward. 

Dr. Kim:
That you would use your…

Bella:
I would… yeah.

Dr. Kim:
But this combination is very common in short women… that they do a lot of knee hypertension in here, and then this tension right here drags so much that they overcompensate with their back. So this combination, however you explain it, that BMX biking and doing that, like that gave you back pain or how you compensated. This is actually the problem, the plague of short women in this culture of one size-fits-all chairs in general.

So I’m gonna show you what I do to help short women decrease the amount of back pain they have, and when you do that to help the flexibility of your thigh, then what happens is as part of doing that, other things get better. Women who have… short women who also have vertigo… short women who have painful periods. Heel pain, right?

Bella:
Yes… painful periods. 

Dr. Kim:
Yeah, so here to look at all the boxes we check off. You’re a short woman, low back pain, painful periods and heel pain, all of this comes from the mechanics of having a very stiff thigh from locking her knees.

Bella:
Actually, that’s a really good point, because I went on birth control when I was 14 because of horrible period pain, and then I went off of it for almost a year, and it was about a year and a half ago after I’d like practiced starting to stand differently, and I was able to have not painful periods, so…

Dr. Kim:
No way, I didn’t know that. Yeah, that’s awesome! And it probably will help your back pain, although you didn’t really say you suffered too much with that.

Bella:  
Yeah, well back pain…

Dr. Kim
Well you stopped BMX biking? 

Bella:
Yes, I never really had a painful back from my period. I still have lower back pain just because I think I tweaked my back racing for so many years, but that… I don’t know if it will go away, guess we’ll see.

Dr. Kim:
So you’re 18 and you live with chronic back pain?

Bella:
Most of the time, lower, like right about here.

Dr. Kim:
And you do not have to, whatever we’re gonna blame it on, whether it’s BMX biking, whether you were a skateboarder, whether you were a skier or just… you’re just like… they’re just like,  “Oh Bella’s just a complainer”. You’re not.  

Camerawoman:
Bella’s never been known as a complainer.

Bella:
I trudge through!

Dr. Kim:
Yeah, well, you’re an athlete, so you know right. So you have that mindset.

So now I’m gonna show, like how the modern chair has hurt you for that, and then how you can convert the mechanics so it actually works in your favor. Alright? 

Bella:
Yeah.

Dr. Kim:
Okay, so we’ll move on to that. So during the break, we got out a chair, so that Bella could sit down and do a demonstrate… oh you cracked your neck!

Bella:
That is so funny!

Camerawoman:
I wonder if you can hear it on the camera?

Dr. Kim:
Yeah, I wonder if you can hear it later. So that she could show me how she sits. So this chair is fairly low, so when she sits it’s pretty good, because she can have her feet flat on the ground. 

The problem with these chairs is that they lean you backwards, so with the leading backwards, this makes her pelvis… if you see her angle of her pelvis is not straight up, she’s sitting more on her pockets, so this posterior rotation of pelvis makes you shorten the distance from all of here to here, so that actually ends up tightening up your hip joint in there, you drive your hip bone up in there more, ’cause you don’t get a full stretch of it all the way, ’cause it turns under. If you see it turn under, you can kind of see some slack happen.

Bella: 
Instead of sitting, say like this?

Dr. Kim:
Yeah exactly. You see that. And then if you have a pillow, which is what I recommend to women sitting and driving. 

Is that I say, okay sit… when you drive, you see how you sit like this, then that headrest, which is usually a little bit too much pitched forward, pushes your head forward. So people are forced to drive like this, yet the bucket seat is deep for one size fits all, so it has them like this. So it makes you drive like this with your head forward. 

So this contributes to all the factors that give you neck pain and back pain. So I have women or actually men too, everybody. I have them, I say, let’s have a pillow, either like a flat pillow or a rolled hand towel in your low back, this one is a little bit too big, but as for the example, but it’s in your low back, do you see how now her pelvis can be a little more vertical, there you go, so a little more vertical so that that gives her more stretch through here, and then now there’s distance here from the headrest, so that this is not making her push your head forward. So this is one of the first changes I recommend for driving for short women. 

Then when your seat is pulled up more, than when you’re gonna drive and pedal, then you want your seat pulled up more so that you have a little bit of bend in your knee. Because in the video that I show about the flexing of your elbow, that this is analogous to your knee, when you bend your elbow, which is like your knee, this is stretching this part of your thigh. So having your knee partly bent as you drive will help you partly stretch this. Then when you start using the accelerator pedal and end up tightening up your calf and the muscle back here, you’re not already starting with a very tight thigh in the front.

So these are the changes that I recommend, is that you get your seat up, a little bend in your thigh, a pillow right here, so that your pelvis can be a little more level and you will not be forced with your head forward with the headrest. 

Alright, cool. So that’s one of the things that I change. So that’s for driving, ’cause that’ll help you for hours.

Okay, so the other thing that’s interesting about sitting in chairs, is that this, is that I tell women or the people that I’m working with is like, when do you need help when you’re older? When you see someone in church, when do they need help? They need help when they’re getting up from a chair or when they’re sitting down into the chair. But when you’re already sitting, you’re not grabbing on needing help, right? And standing you’re not. So what uses all your muscle strength is actually the act of getting up. So what I do with women is, I’m telling them, okay, how about we get you to get up and use your heels to get up, so push down on your heels. So let’s show everybody what that looks like, so when you push down on your heels.

Bella:
Do you want me to use my hands or no?

Dr. Kim:
No. Just push down on your heels, there you go to stand up, wonderful. And then when you sit down, use your heels also, there. So when you did that, did you feel a stretch right here? Maybe so?

Bella: 
I really wasn’t paying attention. We can do it again though.

Dr. Kim:
That’s okay. Let’s just try again. So let’s put your hand right here and now push your heels into the ground, push them in, there. Do you feel what happened to these muscles? Okay, now push on your toes, just on your forefoot. Do you feel a difference? 

Bella:
Yeah. Well, there’s less tightness. 

Dr. Kim:
Yeah. They’re like stiffer, but they don’t get full, like they don’t flex, right?

So when you get up then and you use your toes, which is usually what people do, is they go like this, scoot up on their toes, and then they just stiffen these muscles and they go up. Right, so when you do that and stand up, you use your ankles right here, use these.

Bella:
You use your calves more.

Dr. Kim:
Yes, right. And so that contributes to all that tightening. So what we wanna do, is you wanna use your heels and sit your butt back, there. So when you did that, you felt a little stretching happening there right?

Bella:
Yes.

Dr. Kim: 
Right, cool. Okay, so when you get up and down from a chair then, so what I recommend is that you use your heels always, because now you can see that you’re actually fully robustly using your thigh muscles in the front, and then you do that on the way up and then you do that on the way down. So let’s have you try that again, so push your heels, there you go, and don’t lock at the top, there you go, ’cause then you won’t lock this muscle that gets so stiff. Right?

Bella:
Right.

Dr. Kim:
And then when you sit down, pretend you’re gonna go for a squat and get your butt all the way back there. There you go. And so you got some stretch going on you?

Bella:
Yeah. 

Dr. Kim:
Did that hurt your back?

Bella:
No.

Dr. Kim:
No, not at all?

Bella:
No.

Dr. Kim:
Does that usually hurt your back to stand up and sit down?

Bella:
I think it depends on how much I’ve been moving that day.

Dr. Kim:
Oh really? 

Bella:
I guess it depends on how much I’ve been sitting and how I’ve been sitting.

Dr. Kim: 
Oh okay. So I would add one more piece of homework for you to be doing in the meantime, is that, when you… now that we’re gonna activate your heels all the time, this will robustly make these muscles go like this, and then stretch them out, and go like this and stretch them out. So that will start to make them more flexible, so that’s activating them from the heel, if you kegel at the same time, you should notice that you get a little lift in the front and it makes you feel stronger when you do it. So can you try that again, ready?

Bella:
Yeah:

Dr. Kim:
Hold your pee and push on your heel to stand up… Yeah. And don’t use your hands at all ’cause I always joke, you’re not old. So ready? And then sit down with your butt all the way back. Wonderful. Do you feel the difference with this?

Bella:
Yes

Dr. Kim:
So what do you feel the difference with using… holding your pee?

Bella:
You put less pressure, you like… it holds you up a little bit.

Dr. Kim:
It holds you up, that’s right! So your back is not doing all the work. Absolutely, so I just needed someone to say that because you know, we can’t just take my word for it. Or the fact that, that’s what happens every time. Right?

Bella:
Hey we should be doing kegels anyways.

Dr. Kim:
Yes, that’s right! But instead of doing them at stop lights, when nothing else is going on, you should do them as you’re moving, because as you’re moving and these muscles are pulling you down, then this kegel action is lifting you up, so that dynamic pulling like this, this is what strengthens it way faster. 

Do you understand what I’m saying?

Bella: 
Yes

Dr. Kim:
Alright, cool, so when you’re getting up from a chair then, so what everyone ends up doing is they do this and then they push onto their toes, they usually go onto their toes and scoot up, so you just scoot, yes, this forces you… so this is why when I have people stand up and sit down, I have them focus on their heels first, so ready… So now you’re gonna sit down, use your heels.

Bella:
With my heels?

Dr. Kim:
There it is, with the kegel right? So when you’re gonna get up, what you wanna do… what you wanna do is you wanna scoot up, you can kegel while you scoot up and still start off with your heels then. Even though this is behind you, yes, you start off with your heels, so it doesn’t matter where you are, if your legs are too weak to start at a right angle, don’t worry about it, scoot to the front of the chair and use your heels, even if they’re behind you. So ready, sit back.

Bella:
Use my heels?

Dr. Kim:
Yes, there you go. 

Bella:
And you can scoot back?

Dr. Kim:
So yes, you can scoot back if you need. And then see how this is 90, you can do 90 degrees when your legs are already strong and flexible, and if they’re not, like some other people might not be flexible enough, so you would kegel, kinda come to the front a little, there. So now you start with these behind you to push on your head, there you go, and not lock at the time. Because the not locking will help you not tighten up that muscle over and over. Sound good? Alright, great, I think that was a good place to stop.

Bella:
Okay.

Dr. Cathy Kim

Dr. Cathy Kim

Dr. Cathy Kim is a Board-Certified Family Medicine physician and Body Function Specialist. She practices in Camarillo, CA and specializes in complex cases.
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