Stop, step back and take a deep breath. This is what I told myself when I watched a client fall to the floor in excruciating pain, right after a pop that made my gut squirm.
There is nothing that can prepare you for the sight of your client lying on the ground writhing in pain, especially when it feels like your entire fault. Trainers who have experienced this know exactly what I’m talking about. And for those who haven’t, you can thank the gym gods for that! In one split second, you can change the next four months of your client’s life, just by ignoring small mechanical dysfunctions in his or her body.
Here you can see an example of the mechanical dysfunction known as knee valgus.
Over time, this altered repetitive motion causes the joints to change their normal range of motion and can ultimately lead to your very first heart-ripping “pop.”
Unfortunately, knee valgus or knocked knees, is a very common occurrence in the weight room and in sports. Hell, go to any public place, watch the way people walk, and you’ll see knee valgus in some minority of people. Knee valgus is also referred to as valgus collapse and medial knee displacement. It is characterized by hip adduction and hip internal rotation, usually when in a hips-flexed position. (The knee actually abducts and externally rotates.) It can also be thought of as knee caving as you sink down into a squat or landing. When standing on one limb, the opposite side pelvis will usually drop during valgus collapse as well. I will give you 4 quick reasons why a knee valgus might be occurring.
4 Quick Reasons for Valgus Knee:
1. Week Hips-Inadequate gluteal/hip strength (gluteus minimus, glute medius, gluteus maximus, hip external rotators), possibly in conjunction with overactive hip adductors, prevents proper stabilization of the femur.
2. Tight Ankles-Inadequate ankle dorsiflexion mobility along with tight lower leg musculature (gastrocnemius, soleus, and anterior tibialis) prevents the tibia/knee from migrating forward sufficiently.
3. Impaired Quad Function-Inadequate VMO (vastus medialis obliquus) strength will fail to allow for proper knee stabilization, which will cause the knee to track inward.
4. Impaired Hamstring Function-Inadequate medial hamstrings (semimembranosus and semitendinosus) strength will prevent proper stabilization of the knee, which will lead to some medial knee displacement, similar to what happens with impaired VMO function but on the opposite side of the thigh.
I’m not going to explain each test for the list above but if you have any questions about how to figure out which muscle group might be the cause, just comment on the blog, and I’ll respond ASAP.
To help get you started, I put together 5 of my favorite exercises. These exercises will not put your client in a position that will injure them, which means no heart wrenching moments for you. Anyone could start on these right away and only have a positive outcome.
1. Ball Squat & Abduction:
Equipment: Stability ball & resistance band
· Place stability ball against wall while it rests firmly between middle of the back (below shoulders and above hips).
· Place resistance band over both legs raising it above knees until it is in the middle of quad (half way between hips and knee).
· Tuck hips (posterior pelvic tilt), engaging core, and widen the stance until feet are hip width apart.
· Slowly descend until knees are at 90 degrees, and abduct both knees roughly 3 inches.
· Return knees to starting position, rise back up to starting position, and repeat.
2. Wall Internal & External Femoral Rotation:
· Place hand on wall making sure it always stays straight.
· Have both feet facing forward to start.
· The leg farthest away from the wall is the leg that will be rotating.
· Internally rotate right foot so toes are pointing at the toes on stable leg.
· Heel is facing away from body.
· Keeping the arm on the wall straight, slowly raise heel off the ground and abduct right leg away, keeping it internally rotated.
· Once abducted, rotate right leg externally (now the right heel is facing the body) left arm straight, bring right heel to the back heel of stable leg.
· Repeat the external and internal rotation of the femur.
3. Glute Bridge On Foam Roller & Medball Wedge:
Equipment: small medball (MB), mat and foam roller.
· In the supine position (back against ground), place foam roller right below back of knees.
· Place small MB on top of right hip flexor (pelvic area).
· Extending opposite arm out (shoulder height), bring right knee towards chest.
· Squeezing MB with the thigh of right leg so it locks the MB in place in between the quad and hip.
· Slowly bring foam roller down to the left foot (resting the arch of the foot on the foam roller).
· Lift hips and glutes off the ground trying to balance while continuing to squeeze the MB between leg and hip.
· Hold this position to contract glutes and keep hips up. The tension between right quad and hip created by holding the MB in place will keep the pelvic bone posteriorly tilted.
4. Hip Abduction:
· Place left knee on bench and right knee a little off the bench.
· Both knees should be bent at 90 degrees.
· Engaging the core/glutes and slowly abduct right leg away from the body.
· Slowly adduct right knee back towards left knee.
· Repeat movement and then switch sides.
5. Resisted Knee & Abduction:
· Take the resistance band and attach to a stable object.
· Put farthest leg into resistance band.
· Extend left leg out keeping lower back against the ground by tucking hips and engaging the core.
· Resistance band should be right below the back of the right knee.
· Bend the right knee to 90 degrees.
· Slowly rotate the right bent leg toward the midline of the body while adducting the hip (the knee should be across midline of the body).
· Rise opposite arm over head. Flexing opposite shoulder to 90 degrees.
· Bring back to center and hold the knee at 90 degrees and keep tension on the resistance band.
This is our moment to change the way personal training is done. Don’t follow trends that sweep through America from Facebook page to Facebook page. Stop and think about how exercise is really supposed to be done.
It’s easy to take for granted when your clients walk out of the gym just as healthy and unimpaired as when they walked in. But as I hope I’ve made clear, this is something we need to strive for alongside the gains. Believe me, all it takes is one “pop” to drive that point home.
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