Brian Schiff’s Blog
Injury Prevention, Sports Rehab & Performance Training Expert
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Unearthing the cause of anterior knee pain and ridding our patients and clients of it is one of the never ending searches for the “Holy Grail” we participate in throughout training and rehab circles. I honestly believe we will never find one right answer or simple solution. However, I do think we continue to gain a better understanding of just how linked and complex the body really is when it comes to the manifestation of knee pain and movement compensations.
We used to say rehab and train the knee if the knee hurts. It was simply strengthen the VMO and stretch the hamstrings, calves and IT Band. Slowly, we began looking to the hip as well as the foot and ankle as culprits in the onset of anterior knee pain. The idea of the ankle and hip joint needing more mobility to give the knee its desired level of stability has risen up and seems to have good traction these days.
Likewise, therapists and trainers have known for some time that weak hip abductors play into increased femoral internal rotation and adduction thereby exposing the knee to harmful valgus loading. So, clam shells, band exercises and leg raises have been implemented to programs across the board.
Single Leg Resisted Hip External Rotation
As a former athlete who has tried his hand at running over the past 5 years, I have increasingly studied, practiced and analyzed the use and importance of single leg training and its impact on my performance and injuries. As I dive deeper into this paradigm, I continue to believe and see the benefits of this training methodology for all of my athletes (not just runners).
As a therapist and strength coach, it is my job to assess movement, define asymmetries and correct faulty neuromuscular movement patterns. To that end, I have developed my own assessments, taken the FMS course, and increasingly observed single leg strength, mobility, stability and power in the clients I serve. Invariably, I always find imbalances – some small and some large ones.
What are some of the most common issues I see?
It is common knowledge in the medical community that treating patellofemoral joint pain (PFJP) is one of the most frustrating and difficult tasks to complete as there appears to be no standard way to do so. While clinicians strive to find the right recipe or protocol (I don’t believe there is just one by the way), researchers press on to find more clues.
A new article released in the April 2011 Journal of Orthopaedic & Sports Physical Therapy seeks to bring clarification to a particular exercise pattern commonly used in rehab circles. The three exercises they looked at were:
- Forward step-up
- Lateral step-up
- Forward step-down
In the study, the authors looked at 20 healthy subjects (ages 18-35 and 10 males/females) performing the separate tasks with motion analysis, EMG and a force plate. The goal was to quantify patellofemoral joint reaction force (PFJRF) and patellofemoral joint stress (PFJS) during all three exercises with a step height that allowed a standard knee flexion angle of 45 degrees specific to each participant.
Key point: Previous research has been done to indicate that in a closed chain setting, knee flexion beyond 60 degrees leads to increased patellofemoral joint compression and this may be contraindicated for those with PFJ pain or chondromalacia. Also keep in mind that most people with PFJ complain of more pain descending stairs than ascending stairs.
In the study, the participants performed 3 trials of 5 repetitions of each exercise at a cadence of 1/0/1 paced with a metronome. The order of testing was randomized for each person. The authors used a biomechanical model to quantify PFJRF and PFJS consisting of knee flexion angle, adjusted knee extensor moment, PFJ contact area, quadriceps effective lever arm, and the relationship b/w quadriceps force and PFJRF.
Now on to the results……
Many people like to do lunges in the gym. Many people do them wrong. Some simply do not know proper form, while others have mechanical issues preventing them from executing proper form.
Unfortunately, many clients struggle to keep the knee in line with the foot, and the knee often caves inward. Even with verbal, visual and tactile cues, they may still struggle to master the proper form due to flexibility and strength imbalances. This may have to do with limited ankle mobility, but for the purposes of this post, I want to address the hip. More specifically, people often lack mobility, stability and strength in the hips.
I recently wrote two columns for PFP Magazine featuring two exercises I use to clean up lunge form:
- Torso Rotational Lunges
- Diagonal Hip Flexor Lunge Step
The torso rotational lunge is great for integrated muscle activation of the gluteus medius, while I utilize the diagonal hip flexor lunge step to address hip flexor tightness and limited thoracic spine mobility.
Torso Rotational Lunge
Diagonal Hip Flexor Lunge Step
In these columns, I specifically review regressions and progressions. So, whether you train clients or simply want to take your lunges to the next level, check out the full columns online at PFP below:
Click here for the Torso Rotational Lunges
Click here for the Diagonal Hip Flexor Lunge Step
Looking for more cutting edge training tips and rehab/injury prevention strategies? Subscribe to my members’ only Training & Sports Medicine Update available at www.BrianSchiff.com.
Some people love their calves, while others hate them. Ever see people piling on the weight at the gym (barbells, seated calf press machine, etc.) attempting to build shapely calves? Or maybe you see people performing calf raises on a box with their feet in, straight ahead and out. The question has long been this: is there any real benefit to doing them beyond the neutral or straightforward position to get maximal activation and strength gains?
Why is this important? Well, beyond muscle tone, this question has physiological ramifications with respect to performance and rehabilitation. Consider, for example that as knee flexion angles increase, the medial gastroc becomes increasingly disadvantaged regardless of the ankle position. This suggests inherent functional differences in the muscle architecture and activation patterns of the medial and lateral heads of the gastroc.
In a study just published in the March 2011 Journal of Strength & Conditioning Research, Riemann et al. investigated the impact of all three positions on gastroc activation. They used 20 healthy subjects (10 male and 10 female) with no history of a calf injury and all had prior resistance training experience.
In my last post, I shared some practical plyometric drills with you to help teach proper landing mechanics in an effort to reduce ACL injuries. Yesterday, I presented my comprehensive approach to knee training at our ACL Symposium in Cary, NC.
One of the fundamental errors I see coaches and athletes make is abandoning their pre-season training efforts during the in-season. While athletes need to spend the majority of the in-season focusing on sports skills, they must also maintain the neuromuscular training adaptations acquired in the off-season and pre-season.
In my mind, the phrase “use it or lose it” is applicable for the neuromuscular training effects we see with balance, strength, agility and plyometric training. This is especially true for our high risk female athletes like soccer and basketball players who suffer knee sprains, ACL tears and patellofemoral pain at disproportionate rates.
I often hear coaches say, ” I don’t have time to get workouts done and still accomplish what needs to be done at practice.” While, time management may be difficult, I think coaches could probably squeeze in a single training session lasting 15-20 minutes if they simply knew how important it was to the overall health and performance capacity of their team.
With that said, I like to offer simple, yet effective exercises that can be done on a court or field with the whole team simultaneously without the need for expensive equipment. Exercises should focus on activating the glutes (including the medius and minimus) as well as training the hamstrings more since most female athletes tend to be quad dominant.
These exercises are just as effective for males too. So, in the video below I will reveal some exercises I prefer to do to increase strength and reduce injury risk. Perform 2-3 sets of 8-15 reps focusing on strict form throughout.
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