Today’s guest post comes courtesy of Dr. Michael Mash.
I have a legit man-crush on him ever since I’ve started diving into his online resource Barbell Rehab. As the name implies: Its mission is to help barbell athletes (and aficionados) overcome pain and improve performance WITHOUT being forced into “corrective exercise” purgatory.
In a sense, it’s designed to use barbells (and lifting stuff) to help fix shit. What’s more Tony G than that? Okay, maybe Jason Bourne fight scenes.
Or dragons.
Or an endless cheese plate.
Regardless, Barbell Rehab speaks to my strength coach love language, and as it happens Michael is offering his course to all my readers at $50 off the regular price for this week only.
All you have to do is click THIS link and enter the coupon code TONYG50 to receive your $50 credit.
And even if you’re not keen to saving money (weirdo) you should still give his blog post below a read because it’s riddled with common sense and practical applications you can use TODAY to improve your squat screen or assessment.
When it comes to effectively screening the squat, many personal trainers and strength coaches have different approaches. From not utilizing a screen at all, to performing dozens of assessments prior to implementing a bodyweight squat, what is the best way to screen the squat?
Before we answer this question, let’s first talk about the function of a “screen” in general.
What is a Screen and Should We Use it?
According to John Hopkins…
“…a screening test is done to detect potential health disorders or diseases in people who do not have any symptoms of disease.”
If we apply this definition to the squat, one could say that a squat “screen” is a test performed to detect potential joint, muscle, or movement impairments in those who don’t have any pain.
In order for a screen to be effective, a “failed” test must be highly predictive of future injury or pain. If it’s not, this could create a lot of false positives results (a.k.a telling someone they’re doomed for injury if they really aren’t). So on one side, you want to make sure your client is “safe” to squat before loading them up, but you also don’t want to prevent them from squatting if they don’t really need to.
Oh the dilemma!
It’s Tough to Really “Predict” Pain and Injury
As mentioned, in order to analyze the efficacy of a screen, we need to know if it can indeed accurately predict injury. As it turns out, the research isn’t so sure about this.
In fact, it has been shown that one of the most common movement screens, the FMS, is only slightly better than a 50/50 coin flip at predicting injuries. This doesn’t mean, however, that you need to throw the baby out with the bathwater. While both myself and the authors of this paper note that the FMS can be used to see HOW a person moves, it shouldn’t be used as a way to predict injury.
If the FMS can’t reliably predict injury or pain….what can?
Because pain is a multidimensional experience driven by biological, psychological, and sociological factors, it is really a reductionist mindset to blame pain solely on “tight hamstrings” or “poor form” in general.
In fact, factors such as stress, anxiety, depression, lack of social support, job dissatisfaction, and poor sleep and nutrition can ALL affect a person’s pain experience. This is why we need to zone OUT when it comes to “predicting” injury and really take a comprehensive approach. The WAY someone moves is certainly important, but it’s just one tiny piece of a much larger puzzle.
What is an Effective Movement Screen?
So how should you effectively screen the squat? In order for a screen to be effective, it needs to be SPECIFIC, and there’s no better way to be specific than to actually perform the movement itself. Yep, that’s right. The best way to “screen” the squat, is to actually have the client perform a squat.
This process will give you ALL of the information you need in order to make a decision on whether or not they are “safe” to proceed forward with loading the squat.
And guess what?
It doesn’t involve any kind of joint-by-joint assessment, specific muscle flexibility testing, or any other long drawn out processes either.
While the aforementioned approaches can be beneficial to “dig deeper” if someone already has pain, they’re rather unnecessary as part of a screening process in asymptomatic individuals.
For those without pain, here’s a simple process I recommend in order to determine if they are safe to squat.
Step 1: Show Me Your Squat
The first step of our world’s simplest squat screen is to simply ask the client to “show me a squat.” I like to do this for a few reasons. First, it will give you an idea of what they “think” a squat is and how they move in general. Two, it will also give you an idea of how hesitant they are to move.
Some will just drop it low into a perfect squat and others will hesitate to start and move really slowly. You may see the latter example if someone has a history of pain or has fear with movement in general.
This is all useful data to collect on this important first step. If the squat looks good, congratulations!
Your job is easy today, and it’s time to load them up!
If it needs some work, it’s on to the next step.
Step 2: Coach the Squat
After asking the client to show you their squat, it’s time to coach it. While everyone is going to squat with a different stance width, degree of toe out, and torso angle, it helps to at least have a frame of reference to start from.
I recommend cueing them into a heels shoulder-width stance with a moderate 20-30° toe out, and then asking them to squat as far down as they comfortably can. While this foot placement won’t work for everyone, it’ll work for the majority of people. In this initial bodyweight squat coaching phase, some people may have discomfort or won’t be able to quite get to parallel…and that’s ok.
That’s why we have Step 3.
Step 3: Modify Stance and Depth if Needed
If you coach the client into a shoulder-width slightly toed out stance, and they have pain with this, or they can’t squat very deep, all is not lost yet. Two of the most common pains you’ll see with a bodyweight squat are hip and knee pain. And just because they have pain, doesn’t mean they are injured or need to be referred out to a rehab professional. It may simply just be the way they are built.
For example, if you take someone with highly retroverted hips, and have them try to squat with a narrow stance with minimal toe out, they may get a “pinch” in the front of their hips at the bottom. This can usually be remedied by widening the stance a bit and turning the toes out more. This doesn’t mean anything is wrong with them…it’s simply the way they are built!
Tying it all together, if someone has pain when you coach them into a bodyweight squat, see if it’s relieved with a simple stance adjustment. This is 100% within your scope to do as a personal trainer or strength coach, as you’re not diagnosing, assessing, or putting your hands on the client at all.
Step 4: Change the Exercise and/or Refer Out
Sometimes the squat pattern itself is so sensitized, that a stance or form adjustment isn’t enough to eradicate pain. If this is the case, I’d recommend NOT proceeding forward with having the client squat, and instead, finding a similar exercise like a rear foot elevated split squat or a lunge variation that they can tolerate.
If the client’s goal is to squat, it would also be best at this point to refer out to a qualified rehab professional as well. This is why interdisciplinary care is so important in the health and fitness world. At this point, as the personal trainer or strength coach, you can continue to train your client with what they can tolerate (full upper body workouts and modified lower body exercises) while the rehab professional addresses the pain itself.
A Quick Note on Squat Depth
Sometimes no matter how much you modify stance, degree of toe out, or hip position, your client won’t be able to squat to “depth.” Depth is defined as when the greater trochanter of the hip goes below the top of the patella from a side view.
In this case, you need to find out if it’s simply because they feel “tight” or if it’s limited by pain.
If it’s limited by pain (even after stance adjustments) then you may want to refer out. If they just feel “tight,” then you can proceed forward with loading them up to tolerance….even if it’s not quite to depth. That’s right. There is no evidence to suggest that squatting above parallel is inherently dangerous.
Rather than spending six months working solely on mobility to increase squat depth, you can work on BOTH simultaneously. Train the squat to the depth the client is comfortable with and tease in mobility drills at the same time.
This one-two punch of increasing mobility and loading through it, will help your clients squat deeper (if that’s their goal) much quicker than not squatting at all.
Tying it All Together
The squat is one of the most beneficial lower body movement patterns to coach your clients through. While everyone will squat with a different stance, degree of toe out, and variation, there’s no need to take clients through an extensive “screening” process prior to loading them up.
Instead:
1️⃣ Ask them to “show me a squat” to get an idea of how they move to begin with
2️⃣ Coach the squat. Cue them into a moderate stance with slight toe out and ask them to squat as deep as they can
3️⃣ If they have pain, see if you can find a stance width, degree of toe out, and depth that is tolerable for them. If so…it’s time to load them up!
4️⃣ If they still have pain after a stance adjustment, it’s probably best to hold on squatting for now and to refer out to a rehab professional for further assessment.
About the Author
Dr. Michael Mash is the owner and founder of Barbell Rehab, a continuing education company dedicated to helping fitness and rehab professionals improve the management of barbell athletes. Check out his CEU approved online course, The Barbell Rehab Workshop at this link and use coupon code TONYG50 for $50 off.
The third and final installment of my “30 Days of Shoulders” series went live today over at T-Nation.com. All three parts cover everything from shoulder assessment and tips on shoulder friendly pressing t0 how to improve shoulder health and performance.
Collectively it’ll make all your hopes and dreams come true.
I’m writing this from my most favorite place in the world…
…a room full of cute and cuddly kittens.
Just kidding, I’m in London.
I’m here because I have a few speaking engagements lined up – a half-day Shoulder workshop for a crew of Equinox trainers in Kensington on Saturday, my Coaching Competency Workshop in Dublin on Sunday, and then mine and Luke Worthington’s Strategic Strength Workshop back here in London next week.
Spots are still available for both the Dublin and London events (wink, wink, nudge, nudge).1
I just checked into my hotel after an overnight flight from Boston and I feel like a zombie.
Needless to say I am not in the writing mood, but I do\ have a little sumthin, sumthin to share today.
This is Part II of my latest series over at T-Nation.com dealing with anything and everything shoulders: How to make them bigger, how to make them feel less like a bag of dicks, you know, the usual.
You can check it out —> HERE (also includes link to Part I in case you missed it).
Enjoy and keep your eyes peeled for Part III coming next week!
I’m willing to bet that if you’re reading this if you have two shoulders.2
I’m also willing to bet that, given the two shoulder scenario, and given this is a blog dedicated towards strength & conditioning, you’re interested in:
Keeping your shoulders healthy.
Making your shoulders stronger.
Building shoulders that resemble boulders.
Argon. You know just because it’s a cool element.3
It’s a common tactic for fitness professionals, especially during an initial session or assessment, to go out of their way to demonstrate just how dysfunctional someone is.
“Okay, so, after everything we’ve gone through and discussed it seems you have an internally rotated right shoulder, a bit of anterior pelvic tilt, upper back kyphosis, you lack thoracic rotation on your left side, you need to clip your toenails, and one eye is lower than the other.
We’ve got some work to do to fix everything.”
Now, I’m not going to sit here and say I’ve been perfect my entire career and that I never did the same thing.
I did.
And while hindsight is 20/20…I can’t even begin to imagine how much business I lost because I felt it a good idea to showcase to potential clients how much of a walking ball of fail they were on Day #1.
To that end, I do believe there’s a natural growth or maturation (that only comes with experience) of any fitness professional where you begin to understand and appreciate this train of thought.
Of course it’s our job to “audit” movement and to ascertain, to the best of our ability, what will set people up for the most success possible given their goals, injury history, and ability level(s).
But I adamantly feel that one of the worst things you can do as a fitness professional is to highlight dysfunction and to make people feel broken out of the gate.
Take scapular winging for example, where the shoulder blade lacks congruency with the ribcage (I.e., it peels off the rib cage).
Is it actually a dysfunctional thing?
Now, admittedly, the picture above is a little a lot fucked up.
This is TRUE scapular winging, an actual medical diagnosis where the long thoracic nerve is not doing its job innervating the Serratus Anterior.
No amount of Prone Trap Raises or Forearm Wall Slides is going to fix that dumpster fire. It’s going to entail meticulous manual therapy and someone with a keener sense of neurological wizardry to fix it.
However, many people walk around thinking they have “scapular winging” (HINT: pretty much everyone has it to some degree) and that they’re doomed to a laundry list of corrective exercise purgatory.
I have news for you.
Most people’s long thoracic nerve works just fine and most people are NOT in a state of dysfunction.
In fact you can fix scapular winging pretty quickly by adding LOAD and by getting people to TRAIN.
Load helps nudge people into better positioning and training just helps people not want to jump in front of a bus (trust me: corrective exercise purgatory is no fun for anyone).
There are a litany of ways to accomplish this.
In this short video, I outline some of my thoughts and manage to not swear the entire time.
This is a short clip from mine and Dean Somerset’s new series Even More Complete Shoulder & Hip Blueprint, a brand new product with entirely new content from the version 1 workshop, which is on sale until Sunday for $70 off the regular price, and digs into individualization concepts like this, plus so much more to help you get the best possible plan of action for your clients in order to get them results in the fastest, easiest and safest manner possible.
It’s more like an amuse bouche or bite-sized commentary on a pet peeve of mine: Fitness professionals who place waaaaay too much emphasis on it (often times to the detriment of the client/athlete).
As well as a scenario where we might pay a little closer attention to it.
A more downwardly rotated scapular position (depression).
An “interesting” shade of blue on the walls.
Now, to be clear: I am NOT someone who places a ton of credence on one’s static posture. While we’re getting better of late, I think the industry as a whole has gotten into a bad habit of placing all if its eggs into the posture basket…
…labeling people as dysfunctional the second we see forward head posture or a hair that’s out of place.
I’ve witnessed some coaches reaching for their “corrective exercise” bag of tricks before they’ve even seen the person they’re assessing do anything:
“Okay Mr. Smith, I notice you exhibit a slight kyphosis in your upper back, your right shoulder is a bit internally rotated, and it looks as if your left eyeball is lower than the right.
Weird.
But here’s the deal: You should purchase a 424 pack of training, and maybe, just maybe, after 62 weeks of dedicated corrective training where we dive deep into some transverse fascial line reactive neuromuscular breathing techniques we’ll be able to progress towards looking at a barbell.
This is not to short-change the importance of someone’s static posture and the information you can glean from it. Of course, if someone walks in with a lengthy injury history and it hurts to blink, then, yeah, it’ll have a bit more weight.
However, we can’t assume that just because a particular person presents with “y” – posturally speaking – that that automatically means “x.” I’ve seen some individuals walk in for their initial assessment with questionable (textbook) posture only to reveal the cleanest health history you’ve ever seen.
Zero injuries. Zero discomfort. Zero fucks to give.
Static posture is nothing more than information.
No one is a walking ball of fail because he or she presents a certain way.
Besides, we also need to respect that “good” or “bad” posture is relative to the load in addition to the task at hand. The latter point is especially cogent to the conversation because as my good friend Alex Kraszewski notes in presentation for The Trainers’ Toolbox:
“Posture/position will govern where motion is available from, as well as who much and where load is distributed. The task will dictate the appropriate range of posture available.”
How I want someone to “look” when attempting a challenging set of deadlifts is quite different compared to someone who’s just sitting there in front of me, sitting.
What’s more,
Anyway, back to the original picture above.
You forgot didn’t you?
Here, this one:
This is a very common theme or resting “presentation” amongst athletes – especially overhead athletes – as well as fitness professionals who 1) stand a lot during the day and 2) lift heavy things for a living.
Again, nothing is cemented as an absolute here, but if an individual walks in complaining of shoulder pain, and you ask him/her to take off their shirt (don’t be creepy about it) and their shoulder blades rest in a more retracted and downwardly rotated position, we can deduce that said individual (may, not always) need to work on more protraction to nudge them back to a more neutral position.
Neutral Scapular Position = Superior/inferior border of the scapulae rests between 2nd-7th thoracic vertebral levels, medial border is ~1-3″ from midline.
Photo Credit: MikeReinold.com
Someone “locked” in a more downwardly rotated position will almost always have a hard time achieving ample scapular UPWARD rotation (protraction is part of this equation), which is kind of a big deal for overall shoulder health & performance.
But don’t assume, you should check.
This is why it’s crucial to include both load AND movement in the initial assessment; sometimes scapular position will clean up on its own with minimal intervention.4
But let’s assume it doesn’t, and the person has been complaining of shoulder ouchies.
What then?
Here are a few drills I like to use and I offer for your consideration:
NOTE: I will say the bigger umbrella theme here is addressing ribcage/thorax position. The position of the shoulder blades are at the mercy of the T-spine.
1. Deadbug w/ Reach
I have a crush on deadbugs and their infinitesimal variations.
They’re a bonafide rockstar when it comes to improving anterior core strength and lumbo-pelvic control (which comes in mighty handedly when you’re working with someone who’s stuck in a more extended position).
Simply “reach” towards the ceiling as you extend your legs towards the floor and perform a FULL exhale with each repetition.
2. Deadbug w/ Loaded Reach
Same as the above, but now we add a smidge of load in the form of a med ball, kettlebell, dumbbell, a basket of He-Man figures, anything.
Sometimes adding a very slight load here can help clients/athletes “feel” the protraction more.
3. Quadruped Band Protraction – off Foam Roller
This is a drill I stole from my good friend and business partner, Dean Somerset.
He’s Canadian.
4. Forearm Wall Slides – off Foam Roller
1. You can blame my buddy Justin Kompf for the verticalness of this video.
Amateur hour.
2. This was/is a staple exercise from my days at Cressey Sports Performance. Start with a foam roller against the wall with your forearms against the foam roller. Protract (push away) from the foam roller and then slide up the wall making sure not to crank into your lower back and flair your rib cage.
Today’s guest post comes courtesy of TG.com regular, Travis Hansen.
It mirrors a sentiment I’ve been championing for a few years now: That we don’t have to start hyperventilating into a paper bag the second we notice asymmetry in our clients/athletes.
It behooves us to maybe lean into it a bit more.
Not always, of course. But certainly more often than we think.
I’m sure there are many who read this article title and immediately wanted to grab their pitchfork.
Hear me out.
There are many times when you actually need to embrace the notion that our body’s natural anatomical design consists of several structural asymmetries perfectly balanced to allow us to perform at a higher level.
Cue dramatic chipmunk here.
https://www.youtube.com/watch?v=a1Y73sPHKxw
Moreover, there are even times when you can implement an imbalanced approach both through a direct exercise, but also through how much volume you incorporate, to help neutralize a dysfunction that currently exists.
And lastly, even in the presence of elastic/power, strength, and even limb length disadvantages, the body routinely seeks a way to remain healthy and perform at a higher level.
Note From TG:If you’re interested, HERE‘s my take on why leaning into asymmetry is likely the right branch to bark up.
Lets take a look at the first element of asymmetry that exists in the human body beginning at the foot.
I don’t think anyone would argue at this point that the various plantar flexors of the foot responsible primarily for propulsion in human movement vastly out-weight and out-perform the smaller and less powerful dorsiflexors of the foot.
Why would this be the case though?
If one group, which primarily lies on the backside of the lower leg, dominates the front side of the foot, wouldn’t there be tearing that would occur on the front eventually regardless of how much of an attempt to balance the leg is achieved?
The shin muscles do indeed tear from (mainly) eccentric overload and weakness but this can be solved.
Regardless, a balance exists at the lower leg just like many other areas, and there is just enough size and strength present in the leg in healthy individuals to allow this imbalance to occur without any problems.
Another example, can be seen at the shoulder.
Consider that your Latissimus Dorsi, teres major, biceps, anterior deltoid, and pecs all have the capacity to drive the shoulder into horizontal adduction and accelerate the arm explosively, while everything on the backside, which isn’t much, is stuck with the job of having to slow this arm action done.
Of course, the posterior muscles will fail to match the strength output of the powerful anterior shoulder group.
However, we’re designed pretty miraculously.
Our shoulder, specifically the posterior cuff, can slow “things” down just enough to bridge the large gap between front and backside and allow us to remain healthy and continue to increase throwing velocity without much issue.
Note From TG: Another way to think of it is that if the body WAS designed symmetrically or if we went out of our way to seek it, that would likely inhibit an athlete’s ability to throw a baseball in the first place. As a thrower throws, particularly at a young age, there’s a bony adaptation that occurs (retroversion) which then allows for an aggressive layback position to throw a baseball faster and faster.
If we tried to “fix” that or if the body was designed to be “equal” we’d have a lot of 72 MPH fastballs out there.
Of course, this isn’t to say there aren’t certain training modalities and manual therapy approaches we can implement to help “offset” this imbalance; there are many.
That being said, from an athletic development standpoint, the late Charles Poliquin even pointed out that elite sprinters carried a much more powerful posterior chain than anterior chain in attempts to sprint faster.
Charles declared a 100% ratio, but whether or not that figure is valid remains unseen.
To support his statement and raw figures aside, the body cannot run faster after initial phases of sprinting since vertical forces stagnate and any further increase in running speed stems from increased hamstring, glute, and horizontal force production.
The Second Layer of Asymmetry
The next example where we can begin to appreciate imbalances deals with a particular approach to program design in those people with “severe” asymmetries.
Take an anterior pelvic tilt for example.
If this message hasn’t been driven into your brain enough already, it’s worth repeating one more time since its still so prevalent:
…and that is utilizing a pre-dominant training ratio hip to quad exercises.
There is naturally a slight lordosis and anterior pelvic tilt that does and should exist in athletic and power-based postures, but excessive imbalance is what becomes problematic. The same scenario can be seen at the shoulder like was previously mentioned, anterior versus posterior core, and in other planes of motion as well.
Along these same lines, you will see training tactics such as RNT, PAILs, and RAILs all seeking to address imbalances by subtly or substantially inducing imbalances.
Alwyn Cosgrove first coined the idea of creating an imbalance to cure an existing one.
For example, if you present with a common lateral weight shift during a squat you can actually add increased poundage towards the side of the shift or set up a resistance band to pull you in that same direction to built an instinctive reflex to get you back towards center.
More importantly, it will create a tactile awareness of the issue that you will have memory of in the future in case that same issue decides to manifest again and you will know precisely how to correct it.
Third Layer of Asymmetry
Lastly, is the issue of seeking to reduce or even eliminate according to some, the effect of having one limb stronger or more powerful than the other.
In the most extreme cases, you can witness the damaging effects of strength discrepancies with common orthopedic evaluations such as the 90 degree isometric lateral raise test.
It’s been stated that if there is a strength imbalance or pain response that results in one arm being over +50 percent stronger than the weaker arm that could be indicative of a full thickness tear to the supraspinatus muscle.
So yes, there does need to be at least some balance or an attempt to balance out joints for an athletic performance standpoint to prevent scenario’s such as this one.
But is it fair to ever think that we could actually fully restore joint strength so that we are equally strong everywhere?
No.
1) For the reasons that were mentioned earlier based on our anatomical design, and 2) you just won’t see it happen.
If you truly test single leg strength with optimal testing selections such as pistol/single leg squats, or Bulgarian drills for strength capacity, or advanced bounding plyometric variations for power, you will witness differences in volume, endurance, and intensity more times than not.
A handful of my coaching colleagues have been posting rad videos recently of their young athletes doing rad things.
On a final note, consider that Usain Bolt has one leg that is inches longer than the other but contributes to key characteristics of sprinting speed, and this notion of imbalance is further perpetuated.
Maybe it’s time we start to look at imbalance differently when necessary and start embracing the notion rather than trying to erroneously fight it, and see what happens.
About the Author
Travis Hansen has been involved in the field of Human Performance Enhancement for nearly a decade. He graduated with a Bachelor’s degree in Fitness and Wellness, and holds 3 different training certifications from the ISSA, NASM, and NCSF.
He was the Head Strength and Conditioning Coach for the Reno Bighorns of the NBADL for their 2010 season, and he is currently the Director of The Reno Speed School inside the South Reno Athletic Club.
He has worked with hundreds of athletes from almost all sports, ranging from the youth to professional ranks. He is the author of the hot selling “Speed Encyclopedia,” and he is also the leading authority on speed development for the International Sports Sciences Association.
Kevin knows how to train hockey players. However, the information below can be applied to any athlete. In short: when it comes to making someone faster the answer is rarely “just go do some sprints.” Digging deeper and understanding inherent limitations from athlete to athlete needs to be considered.
Speed is one of the most highly coveted physical attributes in almost any sport, but particularly in ice hockey.
Unfortunately, many speed development programs take a bunch of dynamic warm-up and sprint exercises from track and field, scramble them together, and assume players will get faster.
There are two fundamental flaws in this line of thinking.
First, there is a lot more to speed development than simply sprinting.
Second, the assumption that all players (regardless of age, training background, physical development, etc.) will respond favorably to this type of program is clearly misguided.
The “this is what most people need” logic leading to this type of program is unique to the fitness industry and clearly unacceptable in almost every other area. For example, can you imagine picking your car up from a mechanic, and having he/she tell you…
“I rotated your tires, changed your oil, and topped off your windshield wiper fluid.”
“Why’d you do that?”
“Well that’s what most people need.”
“Yes…but I came in because my car is leaking transmission fluid.”
Having a diagnostic system to help identify limiting factors to speed development will help you avoid both of these mistakes by providing clarity on which physical qualities need to be the focus of a training program, and by tracking progress to ensure the training is actually leading to the results you desire.
Limiting Factors to Speed Development
Below is a slide from a talk I gave at the NSCA’s Training for Hockey Clinic a few years ago. While this is overly simplistic, it provides a starting point for understanding the key elements that underlie performance in each area, and therefore what areas need to be “tested.”
Focusing in on speed, there are 4 key areas that contribute to speed development and expression.
1. Technique/Pattern
Speed can be limited by a player’s technique or skating pattern. This is why skating coaches are so important – if players aren’t taught to skate efficiently, to find their optimal skating depth, feel comfortable on their edges, learn optimal transition mechanics, etc., they’ll inevitably be wasting energy and skating slower than they could if they improved their mechanics.
2. Mobility/Stability
That said, from an off-ice training perspective, one of the major goals of training is to remove barriers that may be preventing a player from skating with optimal technique, which brings us down to the rest of the items on this list.
From a mobility standpoint, if a player doesn’t have the ankle and hip mobility to get into an optimal skating position and execute an effective stride, they’ll be leaving speed on the table.
In support of this concept, Upjohn et al. (2008) compared the skating patterns of high and low caliber players, and found that high caliber players set up with their hips, knees, and ankles all flexed more, and this allowed them to have a longer and wider stride length, and greater knee and ankle extension during the push-off phase of skating. In other words, a lower skating position translated into a longer stride length, which allowed for a more powerful push-off with each stride.
In this way, ensuring that the player has the adequate range of motion to get into a deeper skating position can be viewed as speed training.
This research is insightful because it highlights the importance of having adequate ankle mobility. A lack of dorsiflexion, or knees going over the toes, will limit your skating depth, and a lack of plantar flexion, or pointing the toes away from the ankle, will limit your power through the end of the push-off. What isn’t as readily apparent, is how a deeper skating stance will require increases in other components of hip mobility, notably hip abduction or moving the foot out to the side away from the hip.
Another way to illustrate this is to consider the lateral split.
The further apart the feet spread, or the further the hips move into this abduction position, the lower the hips drop. So if someone doesn’t possess the hip mobility in this direction, they’ll have to stand up higher to allow for a full stride.
This, along with a lack of ankle mobility, is one of the major reasons players will adopt a higher skating position. Again, all of this just illustrates that mobility in very specific areas can improve skating position, stride length, power through push-off, and ultimately speed. In other words, mobility work IS speed training, and if a player with a mobility restriction just runs more sprints, they’ll be missing out on a huge opportunity to improve their speed.
Note how greater hip abduction range of motion allows the player in red to achieve a much lower hip position, despite being several inches taller than the player in gray.
3. Muscle Size/Strength
Within a similar context, one of the major limitations to skating speed, particularly in high school and younger aged players, is a lack of lower body strength. Strength is a function of both how large the muscles are, listed as “muscle size” on the chart, and how effectively the brain can activate those muscles to produce force.
Strength can limit skating speed in two important ways.
First, if a player doesn’t possess the strength and local muscular endurance, listed in the stamina column, to maintain a low skating position, they’ll start to stand up taller as fatigue sets in. As they stand up taller, their skating stride shortens, they produce less push-off force with each stride, and they slow down.
Secondly, speed is largely determined by how much force a player can put into the ice with each stride. The more force that pushes into the ice, the further the player is propelled forward. By improving the player’s ability to produce high levels of force, you allow them to increase their propulsion with each stride, which simply means that each stride will push them further forward, allowing them to cover more ice with the same number of strides. Force is really just another way of saying strength. So in this way, strength training is really speed training.
Great example of a player possessing significant relative strength in a single-leg pattern.
4. Rate of Force Development
Lastly, ROFD stands for rate of force development. If a player produces the same amount of force, but does it faster, it will shorten the time it takes for them to complete the stride, allowing them to initiate their next stride sooner.
I don’t see this a lot, but in some players that have spent a lot of time developing strength using traditional bodybuilding or powerlifting methods, they’re capable of producing high levels of force, but they do so slowly, so the thing that’s limiting their speed the most is their ability to produce that force at a faster rate.
This is really the first time in this discussion where sprinting, plyometrics, and other more traditional speed and power work has a place in improving a limiting factor to speed.
That isn’t to say that these methods aren’t important in a comprehensive speed development program, but hopefully you now have a better appreciation for how speed training is MUCH more than just simply running.
Relevant Tests for Tracking Progress
There are a lot of performance tests available to help provide insight into limiting factors to speed development, and many of them have merit. Below are a few that I’ve found particularly effective, both in terms of the information they provide and the ease of implementation.
Mobility/Stability
This section could easily be its own article, but in the interest of simplicity, players should have some assessment of ankle mobility, hip range of motion, and single-leg stability. I’ve used several tests over the years to accomplish this, but want to highlight the Y-Balance Test, which has a few notable benefits:
Performance in this test correlates with ankle dorsiflexion and hip flexion range of motion, two important areas for achieving an optimal skating depth
The test serves as a reasonable off-ice assessment of stride length
Some studies have found a relationship between performance in this test and injury risk
The Y-Balance Test is really designed to be an end-range stability assessment, but if you watch how the player goes through it closely, you can get a sense of what may be limiting them from going further. For example, if the knee doesn’t smoothly drift forward over the toes without the heel popping up, the player may have an ankle mobility restriction.
Addressing mobility restrictions and improving single-leg stability should improve performance in this test AND stride length on the ice.
Speed/Acceleration
20-Yard Sprint with 10-Yard Split Time: The body positions, movement pattern, and ground contact time in the first few strides of acceleration more closely resemble the characteristics of skating than top-speed running.
With this in mind, a 10-yard sprint provides valuable information about a player’s ability to accelerate.
However, because hockey players aren’t the most polished sprinters (and they don’t need to be, as mentioned above), there can be a lot of variability in the start. Extending the sprint 20-yards gives a great indication of the players early and late phase acceleration while minimizing the impact a variable start will have on the overall time.
Lower Body Power
Vertical Jump: The vertical jump is one of the most commonly used tests to assess lower body power, and has been shown to moderately correlate to on-ice sprinting speed.
Aside from published research studies, I’ve personally been involved with testing a wide range of players both on and off the ice (youth players, junior teams, NHL Development Camps, NHL Training Camps, Olympic Training Camps, etc.) and the relationship between VJ height and on-ice speed is consistent across all of these groups, making it a suitable option for all players.
Part of the value of the test is that it’s so heavily used that it’s fairly easy to find normative data to look at how a given player compares to others in his or her age group, playing level, etc.
Equipment can be a limitation for some, so using a broad jump (or long jump) is a reasonable alternative. However, I’ve found that broad jump distance correlates with height, so ideally you’d divide the jump distance by height to get a scaled number to track over time.
Lateral Bound: This is a movement included in most hockey training programs, but not one many players are using to track progress.
Compared to the vertical and broad jump, this tests power in a lateral/horizontal pattern, which is more specific to skating, and provides an opportunity to identify side to side imbalances. I’ve also found that in players that are quick on the ice, but don’t have great vertical jumps, they tend to perform well in this test. Including both tests gives a more complete picture of the power profile of the player.
Leg length also plays into jump distance in this test, so it’s important to take a quick measurement of that (or split distance) as well.
I’ve published normative data for players in different age groups here: Hockey Power Testing.
Lower Body Strength
Dumbbell Reverse Lunge (5-RM): For strength testing, it’s possible to get a really good snapshot of the player’s ability to produce force through their lower body with this test.
Similar to the lateral bound, the reverse lunge is a unilateral exercise requiring single-leg stability and dissociated movement between the two legs, two fundamental characteristics of skating. It’s also a fairly easy movement to teach, so it’s safe to implement with players across all age groups.
Strength will fluctuate across developmental years, but by the time players hit high school, they should be able to use at least their body weight in external load (e.g. 90lb dumbbells for a 180lb player).
Wrap Up
There are two major points I want to leave you with.
First, developing speed involves a lot more than running sprints. It’s important to recognize the potential limiting factors to a player developing and expressing higher levels of speed to ensure these are being addressed through a comprehensive training program.
Second, running through these (or similar) tests can be helpful in both identifying individual areas for improvement and ensuring that a player’s training program is leading to the desired results.
The ability to produce force is the foundation for producing force quickly, the recipe for speed. If a player does not have adequate strength, that should be the primary focus. If the player is very strong, but doesn’t perform well in the jumping or sprinting tests, then exercises to improve rate of force development and acceleration should be the primary focus.
A well-designed, comprehensive speed training program should lead to improvements in all of these areas. Addressing a player’s limiting factors is the key to optimizing his or her speed development.
This is a no-brainer if you happen to work with hockey players.
What’s refreshing about this resource is that, while Kevin works with NHL players and has worked with many elite level hockey players throughout his coaching career, this is about keeping things simple and honing in on the basics.
This is about making better athletes.
Speed Training for Hockey is currently on sale at a hefty discount for the next two weeks, so act quickly before the price jumps up.
I had a new client start at CORE recently who, before we even met in person, let it be known that 1) he hated techno and 2) he hated squats.
Well, why don’t you let me know how you really feel?
Personally, whenever I email someone for the first time, my approach is to just, you know, introduce myself, say I’m a big fan, and maybe butter them up with a savory compliment like “oh, and your cat’s adorable.”
I generally refrain from taking a proverbial shit on the things the person on the other end enjoys:
“…and while I’m at it, Tony, I also hate 8o’s cartoons, cheese, rainbows, and your kid.”
I’m exaggerating of course, but once I dug a little deeper and had a bit more back and forth with this individual I got a better sense of his lack of enthusiasm towards squatting.6
When “Ken” came in for his initial assessment he noted that he had, at one point, enjoyed squatting.
Admittedly, those days were more than a decade ago, and despite his current disdain for all things squatting, he was still very much interested in putting them back into his training repertoire and giving them a go again.
The obvious question from me was, “why?”
“If you don’t like back squatting and more to the point, they hurt, why insist on doing them? We can also perform other variations – Goblet, Front, Zercher – that may be a little more back friendly.”
“That’s the thing,” he said, “they didn’t always hurt. When I trained all through college and into my early 30s I never had any issues.”
“But then, you know, I became more sedentary due to life, was stubborn and not taking into consideration I wasn’t 25 anymore, and things just fell apart.”
SIDE NOTE: “Ken” is 47, works long hours mostly at a desk, and I can’t stress this enough, hates techno…;o)
To speed things up all I’ll say is that, while Ken isn’t the most supple person in the world, nothing during his initial assessment came up as a stern red flag or required an exorcism. Sure, he had a few aches and pains, but nothing outside of the normal “niggles” that come with the territory of lifting heavy things for a large portion of one’s life.
I did notice with his passive vs. active squat screen that his active ROM was limited (while his passive ROM was pretty darn okay).
Pertinent information. And if you want to know why that’s pertinent information read the article hyperlinked a sentence above this one.
He also noted he had worked with several trainers in the past who, like me, noticed his lack of ROM with his active squat.
Seriously, read the article.
It’ll help.
As a result he was used to being given a laundry list of hip mobility drills in addition to a plethora of aggressive soft tissue “smashes” to perform daily:
A1. Take a 88 lb barbell and roll it over your thighs. Have someone stand on it and jump up and down for added pressure. Doesn’t that feel great!?
A2. Take a lacrosse ball and poke around in your glutes. If you feel nothing, glue on some razor blades to make it more challenging. Splendid!
A3. If neither of those work, go get a chainsaw. RELEASE.
brb
Moreover, Ken was also given poor advice and told to arch his lower back aggressively whenever he squatted because, #powerlifting.
As a result, whenever he hit a certain depth – usually juuuuust as he passed 90 degrees of hip flexion – he’d compensate with more lumbar flexion and exhibit what’s often referred to as “butt wink.”
Photo Credit: GirlsGoneStrong.com
Again, pertinent information.
No wonder his back always hurt when he squatted:
His issue wasn’t a mobility issue, but rather a POSITIONING issue.
Squat cues that work for powerlifters usually don’t work well with non-powerlifters.
Alignment Affects ROM
To be clear: I am not some anti-anterior pelvic tilt lobbyist.
Anterior pelvic tilt is normal.
There’s a natural lordotic curve to the lumbar spine which is accompanied with a slight forward/anterior tilt of the pelvis.
It’s when it becomes excessive – or people are encouraged to seek it out – that it can (not always) elicit negative repercussions.
Ross et al (2014) noted that:
In 3D modeling of pelvic motion from x-rays of test subjects an increase of anterior pelvic tilt of 10 degrees resulted in:
In short: more anterior tilt (may) require more spinal motion during squatting exercises compared to more posterior tilt.
The dotted section(s) to the left represent the acetabulum (or hip socket). As you move down from A to C we lose site of the acetabulum due to increased anterior pelvic tilt. This will incite increased bone on bone contact – or impingement – sooner as we go deeper into a squat.
Now, I am not suggesting we all walk around in more posterior pelvic tilt like a bunch of Ed Grimley wannabes:
However, what I am suggesting is that nudging a little more posterior pelvic tilt so our clients/athletes get out of their aggressive anterior pelvic tilt (and closer to neutral) may be the more appropriate long-term play.
Sure, it may entail “some” releasing of this and “some” mobilizing of that…but not as much as most people think.
Much of the time the more pertinent approach is to have your clients adopt a better bracing strategy in addition to spending more time strengthening the anterior core and glutes (both of which aid in posterior pelvic tilt).
Likewise, I don’t feel cuing people to “arch their lower back” during a squat is beneficial. As pointed out above, increased anterior pelvic tilt resulted in increased impingement of the hip. Once someone runs out of room in his or her’s hips, in order to squat deeper they have to gain ROM elsewhere.
Their soul lower back.
Moreover, the reason many powerlifters adopt a hard arch when they squat is more out of necessity than because it’s better.
They wear gear/squat suits (that require an aggressive arch in order to hit passable depth).
Photo Credit: EliteFTS.com
People who don’t compete, don’t wear squat suits (and “passable” depth is arbitrary and highly individual anyway).
Circling back to Ken (remember him?), all I had him do in our initial session(s) was to appreciate POSITION. I took away the cue to arch his lower back, and instead had him focus more on posteriorly tilting his pelvis to scoot him closer to neutral (which, remember, is STILL an anterior tilted position).
He was able to squat pain free AND was able to squat deeper without “falling” into that butt wink posture.
It’s been a bit, but Part III of Kevin Mullins’ “Corrective Exercise” series is finally here.
I’d sorta mirrors the anticipation everyone had for the Game of Thrones season premiere this past week, except not even close.
Sorry Kev: dragons will always reign supreme over ankle dorsiflexion…;o)
NOTE: Stressing the word “finally” above had nothing to do with Kevin actually writing the article (which he submitted weeks ago), but everything to do with ME and my nincompoopness in actually publishing it.
You are a fitness professional who wants to train people – AKA provide them with enough of a fitness stimulus to generate the results they’ve paid you for. You also want to help them overcome pain and dysfunction in their body.
Thankfully, this series of blogs have got you covered and smothered like Waffle House hash browns.
Which brings us to the final piece of the puzzle – corrective exercises for the knee and ankle.
Many people who would consider personal training deal with some level of knee or ankle problems. In fact, it could be argued that everyone walking around this beautiful Earth has dealt with knee or ankle pain/dysfunction at some point in their lives.
(Tony raises hand. I spent the better part of two years in the early 2000’s working around a cranky left knee.)
A proper discussion of these two joints, one mobile and one stable, would not be complete without a discussion about the role of the hips and feet in the function and performance of the knee and ankle. Our feet are our first and only contact with the ground during much of our lives. Any disruption of their optimal function is going to send dysfunction up the kinetic chain into the ankles and knees.
Just the same, the hip, and its multitude of muscle attachments, functions, and movement possibilities can have a dramatic impact on knee function. Tight hip flexors or imbalanced anterior/posterior chain development can change how the patella tracks over the feet – a recipe for pain or less than desirable movement outcomes. As a proud fitness professional, you should be capable of assessing, correcting, and training clients past many of the common problems that might land on your doorstep.
In this post we’ll explore the anatomy and physiology at play when knees and ankles are the weakness in someone’s kinesiology. We’ll discuss the interplay between the hip-knee-ankle-foot. Then, like the other articles, we’ll discuss five specific issues that most trainers encounter and show off a few new exercises that you can use today.
And then we’ll tie a fancy bow on this corrective series, gather all our jackets and move towards the exits. I hope you’ve found a friend
Basic Knee and Ankle Anatomy – Skeletal
(nerds only)
When looking at the knee joint, we are only considering four specific skeletal structures:
The Femur – the longest bone in the human body is also our primary weight bearing skeletal structure. The femur’s entire function occurs at the hip. It can move through flexion and extension, abduction and adduction, external rotation and internal rotation, and circumduction.
The Tibia and Fibula – load bearing bones of the lower leg. Their design allows for weight transfer in gait and for optimal loading of the lower body during any exercise that creates knee flexion or extension.
The Patella – a bone unlike most others in the body, the patella is interwoven with the tendons that cross the knee joint and serves as a cover for those tendons. The structure of the patella also improves the mechanical efficiency of these tendons.
The ankle joint is a bit more complex though. We must consider the bones of the foot to some degree.
The Tibia – The load bearing bone from earlier is also a major contributor to ankle function. The medial malleolus, a bony growth on the inside of your ankle is located on the tibia. At the ankle, the medial malleolus plays a role in ankle eversion and inversion.
The Fibula – Like the tibia, the fibula is a load bearing bone that also functions during ankle eversion and inversion. It’s bony process, the lateral malleolus, is located on the outside of the ankle.
The Talus – a unique bone in a variety of ways, the talus serves as the base for the tibia and fibula to plant upon. Both dorsiflexion and plantar flexion involve the talus changing position in relation to the rest of the foot. The talus also plays a role in eversion and inversion.
The Calcaneus – connected to the talus via the subtalar joint – the calcaneus functions as a base of support for the structures above it. It hosts insertion points for a variety of muscles and tendons – most notably the Achilles tendon. It is the largest bone of the foot.
(Foot) Metatarsal – critical bone structures that connect the toes (phalanges) to the larger structures of the foot. The metatarsals are critical for weight transfer and distribution and while they don’t move like other bones in the body – their ability to adjust to pressure is critical for elite performance.
(Foot) Phalanges – the toes are the final element of this puzzle. Understanding that the toes can and should flex and extend as a result of ground force reaction or conscious neural action is critical to optimizing the foot’s function. While there may never be a “toe day” – we need to train the function of the phalanges to ensure their relationship with the other foot bones, the ankle joint, and even the knee and hip, are optimal.
Basic Anatomy of the Knee and Ankle – Muscular
It is important to discern the muscles that act on the knee and the ones that act on the hip.
Sure, both are in the thigh and run the length of the femur. However, since the knee joint is designed for flexion and extension – we are only considering the muscles that do just that. With that said, realize that the muscles that do function at the hip must do so properly. Otherwise, the knee joint will act to compensate for dysfunction at the hip and that will cause a host of problems too.
The following addresses strict flexion and extension of the knee joint.
The primary flexors of the knee are:
The muscles of the hamstrings (biceps femoris, semitendinosus, semimembranosus)
The gastrocnemius, popliteus, gracilis, and sartorius are synergistic muscles
The primary extensors of the knee are:
The muscles of the quadriceps (rectus femoris, vastus lateralis, vastus intermedius, vastus medialis)
Now, when looking at the ankle we find simplicity and complexity at the same time. On one hand, there are a bunch of muscles that control the toes and ankle joint that aren’t needed in the typical fitness professional’s vocabulary. Simply put, most trainers don’t need to know the minor details of how the fibularis brevis functions, or where the insertion point of the flexor hallucis longus is.
But they need to know they exist.
(Although, more knowledge is never bad and anyone with an interest in self-myofascial release therapy should understand the interplay between these lesser known tissues).
We do need to know that ankle and foot function relies on many more players than just the prime movers. We do need to understand that dysfunction at the ankle could be a myriad of things and not just a blanket statement about someone’s gastrocnemius.
So, we will address the for major movements of the ankle and point out the muscles for each.
** Take note of just how many more plantar flexors there are compared to dorsi flexors. This could explain why we are so strong with our “calf-raise” exercises and why we typically can access a greater range of plantar flexion under control than we could with dorsi flexion. **
Primary Movers of Eversion
Fibularis and extensor digitorum longus
Primary Movers of Inversion
Tibialis anterior and posterior
When looking at this from a slightly higher viewpoint – we see that we have significantly more muscularity driving both flexions of our ankle joint. The lack of muscularity controlling eversion and inversion explains why we don’t load up on an exercise that challenges that motion. Moreover, it probably explains why “rolling” an ankle can be so devastating – we have so little musculature to control that motion.
Going a little broader, we see that muscles of the lower leg have multiple functions. The tibialis anterior dorsi flexes and inverts the foot while the tibialis posterior contributes to plantar flexion and inversion. The extensor digitorum longus everts the foot while contributing to dorsi flexion. These functions are not accidental – they are essential evolutions and developments of our anatomy to meet the demands of our life.
If we are to succeed in our experience as human beings, then we must be able to communicate with the ground effectively. Thus, the muscles that control our foot, ankle, and knee become our first point of contact with outside world.
Understanding their function, their interplay, and their contribution to elite performance is critical to maximizing the impact you’ll have on your clients and your purpose as a coach.
Basic Movement Physiology
The function of the knee and ankle are highly dependent upon the task we are trying to perform and whether the hips are involved.
For example, the knee will flex and extend during traditional deadlift, but not at the same degree that they would during a front squat. The same logic also applies to the amount of dorsiflexion needed from the ankles to meet that demand.
A different example points to our running stride.
The gait pattern that most elite distance runners take involve very minimal action at the ankles and toes. This sort of “hammer-foot” stride is highly efficient and puts the emphasis on the hips and knees to generate all forward locomotion. Sprinters, however, require maximum action from all the joints of the foot and ankle in order to increase velocity and compete successfully.
Thus, understanding physiology of these structures requires an understanding that optimal function is dependent upon the demands of the task.
Still though, a few notable things exist:
1. When the ankle is in full eversion or inversion – there can be an issue with one’s ability to flex and extend the knee. This is because of the change in position of the inferior aspects of the tibia and fibula creating an up-chain manipulation in their superior aspects (which form the knee joint). It is minor in most but could explain why individuals who live in eversion or inversion find discomfort in their knees.
2. Triple-Flexion (hip, knee, and dorsi-flexion) is the most loaded position of the body because of the major muscles that have created force (tension). In most populations, the greatest power will come from individuals in this position. The stacking of joints lowers the center-of-mass and improves the ability to generate tension.
3. Triple-Extension (hip, knee, and plantar-flexion) is the “tallest” the structures of the lower body will get. The process of going from triple-flexion to triple-extension typically generates the greatest joint velocities.
4. The running stride requires a rhythm between hip-knee-ankle-toe action. Upon foot strike, the toes should flex, which drive the ankle joint into plantar-flexion, assist in driving knee extension, and hip extension. The cycling leg does the exact opposite as it returns to the pre-strike position.
The Major Issues
The knee and ankle joints can be seriously injured during sports and accidents in life. None of the issues discussed below involve torn ligaments, broken bones, or even severe tendonitis. The conditions listed are ones that routinely plague clients who are either inactive or too active with poor function.
In fact, many of the issues of the knee come from overuse of the joint without proper interaction with the hip and ankle. Runners and lifters alike may experience knee pain when their form is off. Likewise, many untrained or detrained individuals deal with knee and ankle dysfunction as a result of their sedentary lifestyles.
And don’t forget about footwear.
There is a cost and benefit to each type of footwear that you and your clients are wearing.
Dress Shoes and Boots – great for making a suit look dapper, or kicking tail on a job site, but atrocious for allowing mobility in the foot. Basically, you feel like you are walking inside of bricks.
High heels – an entire day spent into plantar flexion is not good for anyone. Spending additional time walking in them can hurt the wearer’s ability to distribute their weight once they are out of the heels. Great calves though.
Flip Flops – If you are wearing these, then you are probably at the beach. Sweet. However, that sliding and gliding motion that you are using to keep them on is wreaking havoc on your ankle function while also driving too much knee extension.
O-Lifting Shoes – Having your heels elevated when driving your heavy squats or cleans is awesome – can you say performance? However, if you spend most of your day in these shoes than you can bet your bottom that you’ll begin to lose optimal ankle function since you aren’t feeling the ground.
With all of that said, let’s focus on the five most common things you’ll see in your clients and discuss exactly what is going on.
Lack of Dorsi-Flexion
A lot of people struggle to dorsi flex their ankle in response to loading. In fact, a lot of great coaches, including Tony, have pointed out the importance of adequate dorsi flexion for someone to succeed in a squat pattern.
High quality athletes and desk jockeys can both suffer from this issue. It isn’t simply limited to an inactive or undertrained population. It must be dealt with though if someone is going to optimize the function of their hip-knee-ankle and drive greater results in their programs.
Strengthening the muscles that drive dorsi-flexion while also “stretching” the ankle into these positions with bands or straps is usually the best intervention. We aim to increase mobility, improve strength and stability, and begin providing context and practice with traditional strength training movements such as the squat or lunge.
Runner’s Knee (Patellofemoral Pain Syndrome)
A sort of unofficial name, runner’s knee refers to the over-development of the quadriceps (knee extensors) while also keeping the hamstrings (knee flexors) and glutes underdeveloped. In addition, tightness and exhaustion of the plantar flexors can lead to instability and pain at the knee joint.
In fact, there is some evidence out there that shows that some runners experience a mild shift of their patella in space. Only a few millimeters – this shift can cause significant pain and contribute to the official name of the condition (patellofemoral pain syndrome).
The training for individuals presenting this issue is quite simple:
Release and relax the muscles that plantar flex the ankle and extend the knee.
Strengthen and tighten the muscles that dorsi flex the ankle and flex the knee.
Train the glutes to improve hip drive in the running stride
Traditional strength training and myofascial release typically take care of the problem, although a cessation of running in the short term is almost always a good idea.
Knee Valgus
One of the most misunderstood dysfunctions of “the knee” is a hip issue. Many trainers can coach “knees out” until they’re blue in the face and still get no change in the performance of their client.
First, knee valgus refers to the inability of the hip abductors and external rotators to fire appropriately, thus causing a collapse once tension reaches a certain threshold (such as the bottom of a squat).
Image Credit: prehabguys.com
Now, sometimes this only requires good coaching as the client or athlete simply doesn’t know they are doing it or that isn’t ideal that they are doing it.
We must be wise though. Coaching knees out could be driving excess ankle inversion, which changes the relationship of the tibia/fibula with the knee and could lead to torque being experienced in the knee joint as the body seeks to overcorrect the inversion. This isn’t a common worry – but it is possible.
The training cure though will involve strengthening the abductors and adductors of the hip to improve knee tracking in a variety of exercises. It is important to keep in mind that overtraining the abductors can lead to other problems that only arise when the adductors are forgotten about.
There could also be something going on at the ankle too…
Inappropriate Eversion and Inversion
This one sounds a little silly, doesn’t it?
Inappropriate sounds like someone left their pants at home.
But it points out a deficiency that a lot of people have. Whether it be from a lack of coaching and training, or the development of patterns by accident through sport and training – many people lack the right ankle position to complete the task they are attempting.
Think of that client that can’t stop squatting without eversion. Every repetition pushes them into their toes and insole (often leading to valgus). It could be coaching (or a lack thereof), it could be muscle weakness, or it could be a neural disconnect between their brain and their ankles (they don’t know they are doing it).
Just the same, there are people who can’t seem to run on their big toe. They’ll stride flat footed, especially on the outside of their heels, and wonder why they aren’t getting any better at running. These people have not unlocked enough plantar flexion or awareness of their inversion.
It is exceptionally common to see in long distance runners.
Having the wrong ankle position is coachable and trainable. You must relax what is overused and overworked and strengthen what is left behind. There will be specific protocol for whatever you are seeing. Simply look back at the muscular anatomy and select exercises and interventions that are appropriate.
Disconnect of Hips from Knee/Ankle Function
The final issue that people have with their knees and ankles is that they have no idea they have a pelvis. It is as if they believe their lumbar spine connects to the back of their legs…
No really, you probably have a client or twelve who seem to have no idea how to flex and extend the hips. As a result, everything hurts their knees and ankles. Squatting hurts, running leaves them achy, and they absolutely despise lunges.
They aren’t broken thankfully.
They just need to discover their glutes.
They need to learn how to flex and extend the hip with a lot of exercises that leave the knees out of it. So, deadlifts, hip thrust, banded abductions, Copenhagen side planks, and some anterior core work will do wonders to wake up their hips, stabilize their core, and allow them to excel and knee-dominant and gait patterns. Want to learn more about this? Check out my last installment on the hips.
The Exercises
1. Bulgarian Split Squat to Ankle Glide
https://www.youtube.com/watch?v=2WO3-DQenTI
Your goal with this bodyweight exercise is to create a crossover effect between knee flexion and dorsi flexion. By working with the single leg variation – you’ll enhance your clients focus on one specific ankle while simultaneously exposing them to pause reps for the single leg squat variation. You can train them and correct them at the same time.
2. Banded Dorsi to Heel Raise
https://www.youtube.com/watch?v=qrMjjZKkQ8Y
Great for runners and athletes, but effective for everyone, this ankle exercise only requires a band and a seat.
The goal here is to maximize both dorsi flexion and plantar flexion in the same movement cycle. This sort of training allows for you keep the muscles that control both actions in relative balance. This is not unlike being on a calf raise machine and allowing your heels to dip below the step.
3. Barbell Hip Thrust w/ Banded Abduction
One day I want to call Bret Contreras and thank him for his research on the glutes. (Although this video is of Ben Bruno – a stud coach in LA who does NOT like burpees). Discovering that the hip thrust provides more activity of the glute muscles than other exercises is critical for the development of aesthetic and athletic glutes.
Adding in the abduction component at the top is a sure-fire way to ensure your “knees-out” coaching cue for valgus hits home. The band ensures they move from the hip joint instead of just torqueing at the knees. Add in the isometric hold of the glutes and you’ll be sure to work the hip component of knee stability.
4. Duck Walks
https://www.youtube.com/watch?v=beIn56rJGmU
This is an absolute torture device. Duck Walks, loaded or unloaded, drive the body into that triple-flexion position we discussed earlier in the blog. This coiled position strengthens the posterior chain and improves dorsi-flexion by keeping our feet in a set position.
A highly integrated exercise – the duck walk can be used for neural prep or as a burn out after your primary work is done. Sure, its goofy and it doesn’t “seem” like it is going to do your body any favors, but try it and feel how your systems work together to hold isometric tension.
5. Reverse Nordic Curl to Nordic Curl Superset
https://www.youtube.com/watch?v=H-WpX-dnBuY
We want the quadriceps and hamstrings to be in relative balance for optimal knee function. Depending on our choice of sports or training – one may overpower the other a little. That discrepancy though shouldn’t be a chasm.
Hitting both versions of the Nordic curl in a single superset provides an opportunity to train the muscles in a unique way using only bodyweight.
BONUS: Sprinting
https://www.youtube.com/watch?v=3YqQum4emVw
The act of sprinting is one of the most athletic things the human body can do. The whole body must get in on the act if we are to excel.
Specifically, for the knee and ankle, sprinting helps drive a low-level of eversion while demanding quality cycles through plantar flexion and (mild) dorsi flexion and knee flexion and extension. Add in the function at the hip and we’ve found the perfect lower body exercise for improving someone’s function and interplay between these regions.
Obviously, not every client could sprint or should sprint. Be wise with your prescriptions and coach who you are with, not who you wish they were.
Finding the Exit
So, once again we conclude that we can intervene in our client’s discomfort and dysfunction with exercises that not only correct issues, balance muscles, and improve coordination, but also drive a fitness stimulus.
The knee and ankle are interesting joints in a sense that they have less muscle mass around them than the hips and shoulders. But that doesn’t make them any less important. In fact, their proximity to the ground – a constant in our lives – makes them more important than most trainers think. Everything that is dysfunctional at the foot, ankle, and knee will run up the chain into the hips and spine and even the shoulders.
Help your clients discover their foot stability, ankle mobility, and knee stability and you’ll help them discover a better body – both in performance and in aesthetics.
Thank You
Thank you for your time.
Thank you to Tony for allowing me to share my ideas on his website – a treasured space on the internet.
Whether you visit him for his pop culture references, his biceps veins, or his absurd level of knowledge about the body – you’ve made a great choice.
I truly hope you have learned something from this series and enjoy my writing style. I poured a lot into this, and into my book, Day by Day. I hope I can download everything I have learned (good and bad) from me to you every chance I get.
Like I say to my clients, “let’s get just a little bit better every day.”
Check Out Kevin’s Shit
You can read more of Kevin’s stuff at his website HERE.
