UNDERSTAND YOUR MOVES : PART 1 : WHY THE “KNEES OUT” CUE IS JUST NOT HITTING THE MARK and WHY YOUR H
How good is the human body!
In case you were wondering, it is pretty darn good. Whether your feel that way about yours is a different story and maybe something you should think about while you read this blog.
Also before jumping into why the human body is so good and how a few simple little tricks will get your body firing better than ever before I want to lead with a few major beliefs that should be a constant as an allied health professional and especially being an Exercise Physiologist.
I have one major rule. If you are seeing an allied health professional (Chiro, Physio, Osteopath, Exercise Physiologist etc) and they believe they are the ONLY singular practitioner you should ever see for your pain, dysfunction or to increase quality of life, then maybe you should consider seeing somebody else.
As an allied health professional it is up to us to interpret, understand and communicate the benefit of different styles of training, different forms of therapy and truly appreciate the different benefits that other individuals and practitioners can have for the client/patient as an overall approach to health and wellness (for lack of better term). It is not part of our job to belittle other therapy styles to ensure our patients stick with us as a sole provider of health. The way we view you as a client or patient should be from a neurological, psychological, hormonal, psychosocial, physical and physiological perspective. No doubt I missed a few extra ones in there but I didn't want to keep rambling.
Keep learning. Appreciate all new information whether from evidence based practice or practice based evidence – all future fact has to start as a theory based approach. Right?
So. Where to start. Let’s start here.
HIPS CONTROL YOUR KNEES – NOT THE OTHER WAY AROUND
People love to focus on pain, whether they realise it or not. Sadly, as humans we tend to respond to pain instead of doing our best to keep it away; it is something we call “human nature.” A good friend of mine and very good Chiropractor once reminded me in a very succinct fashion that “pain is the last thing to come, and the first thing to go.” This means that our body does its best to keep us away from any form of painful state but after a long period of time it can get a little fed up and then delivers us a small (or possibly large dose of pain. This kind of pain is something that takes a while to build up and also tends to take a little while to ease off too. This is in contrast to a trauma injury which happens from some form of direct blow or injury. A good example of “ chronic pain” is patellofemoral pain, or runners knee.
Let’s keep this simple and applicable.
1. If your knees go in, it’s your hips fault: if your knees push out then it’s also your hips fault.
When I say fault, I mean your hips are responsible. They can either take charge of what’s going on or they choose (or are directed not to). This control of your hips and downstream control of your knees will influence every movement you decide to do whether it is squatting, running, swimming, rowing or simply standing up.
2. Getting yelled at to push your knees out is a simple quick fix: but it is missing a very major element in the plan of teaching the body to be stronger.
There is no doubt with the help of Instagram and Facebook that everybody thinks using a colour band around your knees is teaching you to squat better and building you a more functional booty. Getting the knees to be wider than the feet is the first simple step to teaching your hips to communicate with your knees a little better. Let’s say it’s like getting your L Plates when you start learning how to drive.
The whole point of “knees out” is based on a combination of external rotation of the femur in the acetabulum (ball and socket joint) with control of your legs not dropping inwards, more so being controlled in a stable position with your arches up and activated. One of the amazing things about the femur is it is able to rotate on an axis, which means it is able to influence the muscles to generate different amounts of power and stability at different rotation angles (whether internal or external). Yes this can definitely positively influence your squat, your knee health, and everything else you might be doing.
So Why is External Rotation Good For Me and What Muscles Control This?
Externally rotating your femur by utilising...wait for it... NOT just the gluteal muscles is what allows other muscles to do their thing…properly. By externally rotating the femur we get the benefits below. So what are these magical muscles we are apparently not turning on or have no idea about? Have you heard of the deep 6? Most ballet dancers have and you can read more about them in our next blog. So what are their names - piriformis, gemellus superior, obturatur internus, gemellus inferior, obturatur externus, quadratus femoris.
Increased activation of quadriceps group (especially VMO – the one on the inside of your knee)
Increased aligned activation of the hamstring "group" as an antagonist muscle group to the quads and encourages increased dual recruitment of glutes and hamstrings for hip extension.
Increases natural congruency of the patello-femoral joint and knee hinging during any movement that require this.
Clear the front of your hips out so you can reduce or remove that “pinching” feeling at the front of your hip when you squat.
It assists even further downstream to influence your foot arch support and muscle activation – a very important thing for you runners out there. (this is up in a couple of blogs time so make sure you stay tuned in for that).
It increases the “family” effect of muscles activating/recruiting together to increase your overall strength and most importantly structural stability.
Then How Do I Do This External Rotation Thing.
Stand with your feet at shoulder width apart – and slightly turned out (natural external rotation of the hip/knee/foot is between 7-15 degrees).
Feel down your sides just below your hip height until you feel your hip bones. Now stare at your feet.
So “knees out” means we usually just roll onto the outsides of our feet. This is not exactly what we want to do. We want to attempt to turn the feet and knees out but not let the feet actually go anywhere.
Imagine you are going to turn your feet and knees outwards from where they are until you end up in plie ballet position with your feet (with no knee bend). BUT the catch is you aren’t going to let your feet actually move from the position they are in.
Initiate this action and watch your knees turn outwards, your toes curl up and your arches come up a little (or a lot) and feel really strong and stable. You should have also felt something happen where your fingers are which is part of the femur externally rotating. This is you turning your muscles on to communicate with your knees and even your feet and ankles to create a strong and stable leg. Pretty cool right?
Practice turning this on and off for 20 reps without bending your knees with a nice tight squeeze of your bum at the outwards position, you should also feel your quads (front of legs) squeeze on also. Do this when you are standing and talking to someone, brushing your teeth, waiting for your coffee or any other standing position you find yourself in.
From there do this before you squat, before you lunge and watch your body start firing better. The body and muscles are designed to fire and communicate with each other and you just learned a very important little language.
Remember this is just the first step, well let’s just say “a” step in the constant, fun and everchanging battle to understand the way our body works. Remember, I am just one guy obsessed with movement and doing my best assisting people to move better. I am constantly learning as the people teaching and inspiring me are also learning. If you have any more questions or want to book in for a consult regarding your current pain, dysfunction or simply want to move better then touch base at firstname.lastname@example.org or email@example.com. Stay tuned for the next blog about the feet and ankles relationship with your hips and knees.