Thursday, April 2, 2009

Knee Pain - How do you bend?

Image from - Don't even click on that link unless you're prepared to laugh uncontrollably and waste about 2 hours reading that stuff!

During Hard Style Hanguk, one of the participants cautioned me strongly that he wouldn't be able to do much because his knee was injured. I asked him about the mechanism of his injury, and the history he gave me sounded like it had nothing to do with his knee.

What he did say was that after he'd go running, his knee would balloon up and be sore for days afterwards. He also demonstrated very obvious valgus tendencies just as he stood talking to me. The foot on his affected side was rotated externally to 90 degrees from the centerline.

While there are certain pains that are undeniably caused by structural misalignment and shock-based displacement, most such knee pain is simply the result of long-standing faulty movement patterns, as taught by FMS founder, Gray Cook.

Those people who tend to walk with their toes turned outward also tend to allow their knees to collapse inward when they bend. That allows the muscles on the lateral aspect of the leg to get too strong and the muscles on the medial aspect of the leg to get too weak. Some of the external rotators of the hip are also turned off, as the person in question has figured out how to move without engaging those muscles for proper leg stability.

As a result, the connective tissue along the inner part of the knee (near the MCL) gets strained, and the lateral meniscus has to bear more pressure.

What's the solution?

I've called it the "3 Prys" and it's one of the teaching tools we use at KBLA.

While squatting down or bending, think of prying 3 parts of your body open simultaneously. The trick here is that you MUST keep your feet flat on the floor the entire time and in strict parallel position. If they rotate, slide, or tilt, start over again! The best thing to do is to train this in bare feet so that the mechanoreceptors of the feet can "hear" the differential pressure information coming from the floor without the muffling effect of cushioned shoes.

1. Pry the knees apart and pick your toes up off the ground. That forces you to load your heels properly while you push your knees outward until they're tracking in the same vertical plane as your feet.

2. Pry your butt backwards & downwards. That, too, forces you to load your heels and engage your posterior chain instead of wallowing in quadricep dominant movement patterns. It also strengthens your lumbar muscles by forcing them to engage in a strong extension pattern.

3. Pry your chest open vertically. Keeping your head pulled upward and your eyes looking forward, squat down with the feeling of lengthening your neck and prying your chest forward. That helps create thoracic spine mobility that you may have lost, as well as adding to the stability in the lumbar region.

If you can't go down very far without losing form, DON'T go any further. Work back & forth in the region in which you get stuck to create the simultaneous mobility and stability needed to re-pattern your squatting movement.

Once you've done that, then go back & revisit the Hard Style Lock. We did this with the guy who was certain that his knee wouldn't hold up during the kettlebell workshop, and he excitedly told us after a 7 hour day of training that his knee no longer bothered him.

You may well find that your chronic knee pain wasn't so unfixable after all!


SG Human Performance said...

Terrific post Dr. Cheng! I have been telling my followers and clients to pull themselves down with the hip flexors and pull their knees apart. I love the idea of prying and especially the aspect of the chest out. Keep up the great work. I am definitely going to push my readers over to this post!

Sandy Sommer, RKC said...

Dr. Mark,

Another elegant response to an inelegant challenge. I used all the mechanics you mentioned to improve my own movement patterns and continue to use the 3 "prys" each kettlebell practice sesssion of mine as well as of my students.

Unknown said...

Thank you for your feedback, Gentlemen. There is far more to come. :-D

Coach RJ said...

Excellent post Doc, and I can't agree more. People really underestimate the importance of a simple squat! The more I learn about KBs, the more I realize how important the basic biomechanics are BEFORE loading ballistically. I bet 98% of the people I work with initially cannot do a proper squat with compensation! Your "3 pry" system is a big plus for teaching.

Unknown said...

Thank you, Coach. It took me a while to realize how correct on how many different levels Gray Cook was when he said "Never add strength to a dysfunction."

As I've said over & over countless times in several countries, he & Pavel have revolutionized my view of clinical medicine.

Max Shank said...

"wallowing in quadricep dominant movement patterns"

Pure gold.