Do We Really Need Corrective Exercises?

This past weekend, I was speaking at the Elite Training Workshop that we hosted at Champion PT and Performance in Boston on the topic of Integrating Corrective Exercises with Performance Enhancement.  As I was going through my slides, I actually tweaked it a bit and added one new slide with a simple statement:

 

Stop Trying to Correct and Start Trying to Enhance

Do We Really Need Corrective ExercisesAt the beginning of the talk, I discussed what some people would use to define the term “corrective exercise.”  I even asked around the room.  In general most people refer to corrective exercises as an exercise designed to improve poor mobility, strength imbalances, and altered motor control.

But there are some people that still refer to corrective exercises as exercises designto “fix” someone or “reduce pain.”  I would argue, this is not what corrective exercises are supposed to be utilized for within a training program.  Fixing injuries uses rehabilitation exercises, not corrective exercises.  They are different.

This may be why you see people doing a squat on an unstable surface and calling it a “corrective exercise.”  What are you trying to correct with that exercise?

One of the major components of using corrective exercises is a thorough assessment.  Without an assessment you are just taking a stab at something.  Without a through assessment, you are looking at an incomplete picture.  This may be OK to try on some people, but will be ineffective with many people, and could actually be detrimental with people in pain.  I’ve talked about this before in what I call The Corrective Exercise Bell Curve.

corrective exercise bell curve

I would define corrective exercises more like this:

Corrective exercises are designed to enhance how well you move and perform.  [Click Here to Tweet This]

 

So Do We Really Need to Use Corrective Exercises in the Fitness and Performance World?

I still think we do, but perhaps we should really change our focus.  Corrective exercises shouldn’t be used to “fix” people.  That implies there is a problem.  Don’t think of it as taking someone that is below their baseline capacity and getting them back to baseline, think of it as enhancing someone’s baseline and raising their capacity.

“Corrective exercise” is probably not the best terminology, perhaps that is part of the problem.  Incorporate corrective exercises to help enhance people.   Again, I’ll go back to that original phrase from my new slide:

Stop trying to correct and start trying to enhance.  [Click Here to Tweet This]

Use corrective exercises to enhance someone’s mobility, or improve someone’s movement pattern, or to add a strength emphasis to an area that is weak.  In this last example, if someone is quad dominant, has poor glute strength, and overuses their low back instead of their hips to hips, a “corrective exercise” may be a deadlift variation!  That doesn’t seem like rehab to me, that seems like performance enhancement, doesn’t it?

 

Learn How I Integrate Corrective Exercises with Performance Enhancement

 

If you are interested in learning how I integrate corrective exercises into our performance enhancement programs at Champion, I have an Inner Circle webinar on the topic.  In the presentation, I discuss:

  • What corrective exercises really focus on
  • How to  classify corrective exercises into specific components
  • My system for determining which corrective exercises to perform
  • What you can do to maximize the effectiveness of your corrective exercises
  • How and when to integrate corrective exercises into your rehabilitation, fitness, or performance enhancement program

To access the presentation:

 

 

How “Movement Age” Impacts Program Design

Any half way decent strength and conditioning program must be individualized to the unique needs and goals of the trainee.  Developing programs that specifically address our clients’ “goals” is fairly straightforward, however, mastering how to design programs that also consider their “needs” can really take you to the next level as a personal trainer or strength coach.

When designing training programs, we often begin individualizing based on age.  That’s a great place to start, but there are many limitations with just using age.  I want to review how we design programs using “age” by starting with a review of chronological, biological, and training age.

More importantly, I wanted to introduce a new “age” we use at Champion called “movement age.”  This may be the most important, yet most neglected as well.

 

Chronological and Biological Age

Movement Age Program DesignAt the very beginning of the spectrum when discussing the “age” of your client is their actual chronological age, which is their precise age.  While this probably isn’t as big of an issue when discussing the training program of two people aged 34 and 38, it is much more relevant when comparing two people aged 14 and 18.

Chronological age is a good place to start, obviously, but their biological age is far more important. The anatomical maturity of a 14 year old is quite different from an 18 year old and does become a variable that must be adjusted for within your program design.

Line up 6 kids that are aged 14 and you’ll see the difference.  One looks like he is 10 years old, another looks 18, and the rest all fall somewhere in between.  According to the data accumulated at Wikipedia, girls will go through puberty between the ages of 10 and 16, while boys tend to go through puberty between the ages of 11 and 17.  That’s a 6 year range!

Our focus with those with a low chronological age is different that the older high school athletes.  While strength and power tend to become more of the focus in the older trainee, we focus on what we call the ABC’s of movement with our younger trainees, focusing on Agility, Balance, and Coordination.  Strength training is included but the results are obviously going to be limited by the hormonal and skeletal maturation differences.

But, I urge you to not downplay this stage of athletic development.  Developing the basics of movement skills is important and unfortunately this generation of children are not getting the same development as past generations.  In fact, our younger athletes at Champion see some of the biggest changes in athleticism.  These programs are impactful.

Here are my 2 and 6 year olds working on their athleticism!

So it’s apparent that chronological age has limited usefulness and biological age is a much better place to start.  However, chronological age does not take into consideration the experience of the trainee.

 

Training Age

As chronological age becomes less relevant with older trainees, the next variable to consider is their experience in training.  Image the difference in two individuals:

  • Trainee 1 – 28 year old – Wants to lose 10 pounds – Did not participate in athletics growing up, has never participated in a strength and conditioning program, currently has desk job.
  • Trainee 2 – 28 year old – Wants to lose 10 pounds – Was athletic growing up playing multiple sports in high school, and club sports for fun in college, trained at a sports performance center through high school, hasn’t trained consistently in 10 years.
  • Trainee 3 – 28 year old – Wants to lose 10 pounds – Was athletic growing up playing multiple sports in high school, and club sports for fun in college, trained at a sports performance center through high school, consistently trained through college and has continued since college.

We have people that are 28 years old and want to lose 10 pounds.  Same age, same goal.  Do they all start with the same program?  Of course not.

Training age takes into consideration the experience of the trainee.  Have they strength trained before?  Do they know how to perform the lifts with proper form?  Do they know how to exert force with intent (more on this in a future post…)?

Remember the success of your programs are based around how the body adapts to the stress applied.  You can pretty much do anything to Trainee 1 to stimulation enough stress to make a change, which is good because they have a lot to learn!  On the other end of the spectrum, Trainee 3 has a great understanding of how to train and has been exposing his body to different stresses for years.  To make progress in this trainee, you’ll likely need a more complicated periodization scheme to create a different stimulus for their body.

I have discussed these concepts in the past in my article Does Periodization of a Program Help Improve Strength and in more detail in an Inner Circle Webinar on Periodization for Strength Training and Rehabilitation.

There is one HUGE flaw with training age.  Just because you have been training for several years does not mean you understand how to train, or even that you know proper technique!

Don’t assume that since someone has been training consistently for years that they have been training correctly!

This is a common finding in people that have dabbled in strength training in the past and are starting a formal program or starting to work with a personal trainer or strength coach for the first time.

 

Movement Age

Poor Movement SkillsThe last age we consider when designing strength and conditioning programs is one of the most important, but often neglected.  We can have an advanced trainee in regard to chronological age, biological age, and training age, however, can they move well?  At Champion, we’ve started to use the terminology “Movement Age” to discuss someone’s ability to move.

We don’t even have to make this too complicated – can they hinge, squat, lunge, step, rotate, push, and pull?

We simply define the ability to “move” as using proper form through the movement’s full range of motion.  This then becomes a scale:

  • Can they move with assistance?
  • Can they move without assistance?
  • Can they move without assistance with load?
  • Can they move without assistance with load and speed?

When it comes to program design, “movement age” trumps training age every time. [Click here to tweet this]

It’s amazing how our movement skills have deteriorated.  How many of your high school athletes can touch their toes?  Isn’t it amazing?!?

In order to advance from beginner, to intermediate, to advanced trainee in our Champion program design system, you need to demonstrate maturation of your chronological, biological, training, and movement age.

On the Performance Therapy side of Champion, we work with a lot of athletes that want to optimize themselves and get the most out of their bodies.  It’s amazing how many of the “advanced” athletes we see have poor movement skills.  They don’t hinge well, or squat well past neutral, or can’t even balance themselves in a half kneeling position!

This can lead to imbalances, asymmetries, and compensation patterns that can suck performance, lead to tissue overuse, and eventually breakdown.  This is especially true if you try to just blast through your poor movement skills and add load and speed to your lifts.

Sometimes we don’t need an advanced and complicated strength training periodization scheme, sometimes we just need to clean up movement patterns.  Consider this taking one step back to take 5 huge steps forward.  Movement age may be the most important variable to consider when designing strength and conditioning programs.

 

 

 

4 Keys to Staying Healthy During the Baseball Season

The latest Inner Circle webinar recording on my 4 Keys to Staying Healthy During the Baseball Season is now available.

4 Keys to Staying Healthy During the Baseball Season

4 Keys to Staying Healthy During Baseball SeasonThis month’s Inner Circle webinar is on 4 Keys to Staying Healthy During the Baseball Season.  In this webinar I’ll discuss:

  • How and why injuries happen in baseball
  • What you should watch out for in regard to loss of mobility
  • My criteria you should achieve before picking up a ball everyday
  • The #1 thing I see youth players do wrong that causes injuries
  • How to maximize performance by minimizing overuse

To access this webinar:

How to Improve Overhead Shoulder Mobility

The latest Inner Circle webinar recording on my How to Improve Overhead Shoulder Mobility is now available.

 

How to Improve Overhead Shoulder Mobility

Improving Overhead Shoulder MobilityThis month’s Inner Circle webinar is on how to improve overhead shoulder mobility.  In this webinar I’ll discuss:

  • We we are losing overhead shoulder mobility
  • Why it matters
  • The 4 main reasons why we lose overhead mobility
  • How the body compensates when we lose overhead mobility
  • How to assess for a loss of overhead shoulder mobility
  • What you MUST stop doing immediately with people that have lost overhead mobility – you are making them worse!
  • Corrective exercises to enhance overhead position
  • Manual therapy techniques to improve mobility

 

To access this webinar:

4 Ways to Improve Overhead Shoulder Mobility

4 Ways to Improve Overhead Shoulder MobilityOne of the most common areas we attempt to improve in clients at Champion PT and Performance is overhead shoulder mobility.  If you really think about it, we don’t need full overhead shoulder mobility much during our daily lives.  So our bodies adapt and this seems to be an movement that is lost in many people over time if not nourished.

I’m often amazed at how many people have a significant loss of overhead mobility and really had no idea!

That’s not really the issue.  The problem occurs when we start to use overhead mobility again, especially when doing it during our workouts and training.  Exercises like a press, thruster, snatch, overhead squat, kipping pull up, toes to bar, handstand push up, wall ball, and many more all use the shoulder at end range of movement.  But here are the real issues:

  • Add using the shoulder to max end range of overhead mobility and we can run into trouble
  • Add loading during a resisted exercise and we can run into trouble
  • Add repetitions of this at end range and we can run into trouble
  • Add speed (and thus force) to the exercise and we can run into trouble

 

4 Ways to Improve Overhead Shoulder Mobility

In this video I explain the 4 most common reasons why you lose overhead shoulder mobility and can work on to improve this movement:

  1. The shoulder
  2. The scapula
  3. The thoracic spine
  4. The lumbopelvic area

The first three are commonly address, but not so for the lumbopelvic area, which is often neglected.  I’m going to expand on this even more in this month’s Inner Circle webinar.  More info is below the video:

 

Improving Overhead Shoulder Mobility

This month’s Inner Circle webinar is going to expand on this topic and discuss how and why you want to improve overhead shoulder mobility.  In this webinar I’ll discuss the importance of overhead mobility, how to assess the 4 most common causes of loss of mobility we discussed above, what corrective exercises to perform, and tips for manual therapy.  The live webinar will be on Monday April 20th at 8:00 PM EST, however will be recorded for those that can not attend live.

 

 

 

How to Enhance Recovery Beyond Nutrition

Today’s guest post comes from Kamal Patel and the team at Examine.com.  If you haven’t heard of Examine.com just yet, you’ve been missing out!  Examine.com is the web’s best resource for evidence-based information on nutrition and supplementation.  They are completely unbiased and only report on scientific fact, not speculation.  The nutrition and supplement fields are filled with anecdotal information, false beliefs, and downright inaccurate claims about efficacy.  Examine.com helps us sort through what is fact and fiction.  Be sure to check out the special offer from Examine.com at the end of this article.

 

How to Enhance Recovery Beyond Nutrition

Training sounds pretty simple on paper. Just eat right, sleep well, and lift a little bit more weight every workout. But every workout takes place in real life, and real life can make training pretty hard.

To improve at the rate that you read about on internet forums – hitting a 315 pound squat or 225 pound bench press after a year of training – you need to train like an athlete. That doesn’t just mean going to the gym three times a week and downing a protein shake afterward. Optimal training only occurs when daily life doesn’t get in the way.

Training like an athlete while working a full time job or going to school is not easy, but fixing weak points in your habits and lifestyle can help avoid training setbacks and plateaus.

Alleviating Soreness and Joint Pain

Exercise causes muscle and joint pain. The severity of the soreness and how long it takes to recover depends on diet and lifestyle, as well as the kind of exercise performed.

The basics

A high-carbohydrate diet is the first step to alleviating post-workout joint pain. A low-carbohydrate diet, while potentially useful for fat loss, is not ideal for resistance training.

People on a low-carb diet should eat the majority of their carbohydrates in the post-workout period. Going into a workout with low glycogen is not ideal for strength training, but if joint pain is interfering with exercise, fixing the problem should be a priority.

Magnesium deficiencies can also exacerbate joint pain and cause muscle cramping in athletes. The lack of other electrolytes, like potassium, can contribute to pain. Potassium deficiencies must be alleviated through dietary changes, since too much potassium on an empty stomach can cause potentially fatal cardiac arrhythmia.

 

Troubleshooting Joint Pain

If dietary changes don’t alleviate persistent joint pain, anti-inflammatory supplements may be able to help.

Anti-inflammatory supplements are not as potent as pharmaceuticals like aspirin, acetaminophen, and aleve. However, curcumin and fish oil are both used to alleviate joint pain in athletes. Though the research on these two supplements is done in the context of arthritis, the benefits should theoretically extend to athletes as well. More research is needed to confirm this effect.

Cissus quadrangularis can alleviate the joint pain that results from specific injuries. If your post-exercise joint pain has persisted for years, you may want to consider consulting with a physiotherapist.

Do not supplement high amounts of anti-inflammatory supplements to dull injury pain. Continuing to work out after an injury can exacerbate tissue damage and increased recovery time, leading to overuse of pain-reducing supplements and permanent damage.

 

Alleviating Fatigue and Lethargy

There’s nothing like proper rest and nutrition to facilitate training, but sometimes you can’t avoid staying up late to finish a paper or getting up extra-early to beat the boss to the office.

 

The basics

Running a caloric deficit is great for weight loss, but not as great for energy levels. Though some people can go for long periods of time on reduced calories, a crash is inevitable. If your diet is interfering with your daily energy, consider a less drastic deficit.

The occasional all-nighter won’t have a long-term effect on gym performance, but consistently poor sleep will. Aim for six to 10 hours of sleep every night, and make sure your sleep environment doesn’t affect your recovery.

A healthy sleep environment is:

  • A slightly cool room tends to facilitate sleep, while a puddle of sweat is awful to wake up in.
  • Smart phones and tablets just before bed will disrupt melatonin secretion, leading to a more difficult time falling asleep.
  • Ears don’t close like eyes do. Even if you sleep through the night, loud noises can still impair sleep quality.
  • Caffeine-free. Any compounds that impair sleep will lower sleep quality, even for veteran coffee drinkers that can drink a pot of coffee at 8:00 p.m.
  • Where you sleep and how long you sleep for should be the same from night to night.

A good sleep environment actually makes it easier to get out of bed in the morning, since improved sleep quality leaves you feeling more rested.

 

Troubleshooting sleep quality

Some sleep issues can be alleviated through supplementation. People that have issues with sleep latency, meaning they have trouble falling asleep, can supplement melatonin or lemon balm.

Melatonin is a hormone that regulates sleep, but people with no difficulty falling asleep will not experience any further sleep benefits.

Lemon balm is a light sedative used to alleviate intrusive thoughts that can interfere with sleep.

Supplements that improve sleep quality, as opposed to sleep latency, include glycine and lavender.

About three grams of glycine taken thirty minutes before bed will improve sleep quality, but the supplement becomes less effective after prolonged use. To use glycine in the long term, avoid taking it daily.

Lavender, used in aromatherapy, is associated with improved sleep. Rubbing lavender oil on a pillow before bed can also improve sleep, but some people may experience skin irritation due to long-term exposure of skin to oil.

If stress is causing reduced sleep quality or poor sleep latency, supplements called adaptogens can help the body adapt to stress, resulting in fewer stress-related side effects, like fatigue and anxiety.

The most popular adaptogens are ashwagandha, Rhodiola rosea, and Panax ginseng. Ashwagandha is sometimes supplemented by athletes because it may improve cardiovascular performance and muscular strength. Siberian ginseng is another adaptogen option for people that get sick often, though it has very little effect on physical performance.

Breaking through plateaus

There’s a lot of factors to keep track of during long term training. Hitting a plateau can be frustrating because it takes time to isolate the factor responsible.

 

The basics

Daily caloric intake is the biggest influence on physical performance. Carbohydrates are more effective for strength training than fatty acids, but both are necessary for busting through plateaus.

Addressing general energy levels, fatigue, and joint pain is also a vital aspect of breaking through a plateau.

 

Troubleshooting plateaus

Supplements that improve physical performance can be useful for breaking through training plateaus. Creatine is the go-to recommendation, while caffeine (400mg) can be used once or twice a week as a pre-workout supplement.  Please note that although 400 mg is listed as a low dose in some studies, this would be a relatively high dose for someone who is caffeine naive.

There is preliminary evidence that suggests cholinergics like CDP-choline and Alpha-GPC may improve physical performance in a non-stimulatory way, but more research is needed to confirm this effect.

 

Identifying Lifestyle Weaknesses

To facilitate effective training, learn to isolate the weak points in your habits and work to improve them. Start with obvious factors, like staying up too late, and address others as they arise, whether in training, at work, or in life.

 

Examine comKamal Patel is a nutrition researcher with an MPH and MBA from Johns Hopkins University, and is on hiatus from a PhD in nutrition in which he researched the link between diet and chronic pain. He has published peer-reviewed articles on vitamin D and calcium as well as a variety of clinical research topics. Kamal has also been involved in research on fructose and liver health, mindfulness meditation, and nutrition in low income areas.

Special Offer for Inner Circle Members

Examine.com was kind enough to extend two special discounts for my Inner Circle members:

  • Examine Supplement Goals Refernce GuideExamine.com Supplement Goals Reference Guide – This is the ultimate resource on supplements, and what they call “the cheat sheet” to better health, a better body, and a better life.  They’ve done all the work and analyzed over 33,000 research studies to discuss over 300 supplements and 180 health goals.  Within seconds you’ll be browsing around, identifying health goals you want to improve, and finding supplements that will help you get there.  Best of all, this is a lifetime eBook.  Every morning the guide is updated based on the latest scientific evidence!  It’s really unbelievable.  This is normal $49 but they have a special offer for Inner Circle members of $39.99.
  • Examine.com Monthly Research Digest – For this looking for even more, Examine.com has a monthly research digest that reviews all the latest nutrition and supplement articles for you to stay on top of the evidence.  Inner Circle members get $5 off the monthly price or $50 off the yearly price.

How to access the special offers:

 

 

How to Perform Self-Myofascial Release

The latest Inner Circle webinar recording on my How to Perform Self-Myofascial Release is now available.

 

How to Perform Self-Myofascial Release

Self Myofascial Release SystemThis month’s Inner Circle webinar reviews my system of performing self-myofascial release.  As with anything else, there is a right way, wrong way, and a better way to perform self-myofascial release.  In this webinar I will:

  • Discuss why we use self-myofascial release
  • Review the different types of tools you can use and my recommendations on what I think is best
  • Overview how I perform self-myofascial release with my clients, patients, and athletes
  • Discuss when to perform self-myofascial release

To access this webinar:

Should We Stop Blaming the Glutes for Everything?

Today’s guest post comes from John Snyder, PT, DPT, CSCS.  John, who is a physical therapist in Pittsburgh, has a blog that has been honored as the “Best Student Blog” by Therapydia the past two years.  He’s a good writer and has many great thoughts on his website.  John discusses some of our common beliefs in regard to the role of the proximal hip on knee pain.  I’ll add some comments at the end as well, so be sure to read the whole article and my notes at the end.  Thanks John!

 

Should We Stop Blaming the Glutes for Everything?

should we stop blaming the glutes

Anterior cruciate ligament (ACL) rupture1,2 and patellofemoral pain syndrome (PFPS)3,4,5 are two of the most common lower extremity complaints that physicians or physical therapists will encounter. In addition to the high incidence of these pathologies, with regards to ACL injury, very high ipsilateral re-injury and contralateral injury have also been reported6,7,8.

With the importance of treating and/or preventing these injuries, several researchers have taken it upon themselves to determine what movement patterns predispose athletes to developing these conditions. This research indicates that greater knee abduction moments9,10, peak hip internal rotation11, and hip adduction motion12 are risk factors for PFPS development. Whereas, for ACL injury, Hewett and colleagues13 conducted a prospective cohort study identifying increased knee abduction angle at landing as predictive of injury status with 73% specificity and 78% sensitivity. Furthermore, as the risk factors for developing both disorders are eerily similar, Myer et al performed a similar prospective cohort study finding that athletes demonstrating >25 Nm of knee abduction load during landing are at increased risk for both PFPS and ACL injury14.

 

Does Weak Hip Strength Correlate to Knee Pain?

With a fairly robust amount of research supporting a hip etiology in the development of these injuries, it would make sense that weakness of the hip musculature would also be a risk factor, right?

A recent systematic review found very conflicting findings on the topic. With regards to cross-sectional research, the findings were very favorable with moderate level evidence indicating lower isometric hip abduction strength with a small and lower hip extension strength with a small effect size (ES)15. Additionally, there was a trend toward lower isometric hip external rotation and moderate evidence indicates lower eccentric hip external rotation strength with a medium ES in individuals with PFPS15. Unfortunately, the often more influential prospective evidence told a different story. Moderate-to-strong evidence from three high quality studies found no association between lower isometric strength of the hip abductors, extensors, external rotators, or internal rotators and the risk of developing PFPS15. The findings of this systematic review indicated hip weakness might be a potential consequence of PFPS, rather than the cause. This may be due to disuse or fear avoidance behaviors secondary to the presence of anterior knee pain.

 

Does Hip Strengthening Improve Hip Biomechanics?

Regardless of its place as a cause or consequence, hip strengthening has proved beneficial in patients with both PFPS16,17,18 and following ACL Reconstruction19, but does it actually help to change the faulty movement patterns?

Gluteal strengthening can cause several favorable outcomes, from improved quality of life to decreased pain, unfortunately however marked changes in biomechanics is not one of the benefits. Ferber and colleagues20 performed a cohort study analyzing the impact of proximal muscle strengthening on lower extremity biomechanics and found no significant effect on two dimensional peak knee abduction angle. In slight contrast however, Earl and Hoch21 found a reduction in peak internal knee abduction moment following a rehabilitation program including proximal strengthening, but no significant change in knee abduction range of motion was found. It should be noted that this study included strengthening of all proximal musculature and balance training, so it is hard to conclude that the results were due to the strengthening program and not the other components.

 

Does Glute Endurance Influence Hip Biomechanics?

All this being said, it is possible that gluteal endurance may be more influential than strength itself, so it would make sense that following isolated fatigue of this musculature, lower extremity movement patterns would deteriorate.

Once again, this belief is in contrast to the available evidence. While fatigue itself most definitely has an impact on lower extremity quality of movement, isolated fatigue of the gluteal musculature tells a different story. Following a hip abductor fatigue protocol, patients only demonstrated less than a one degree increase in hip-abduction angle at initial contact and knee-abduction angle at 60 milliseconds after contact during single-leg landings22. In agreement with these findings, Geiser and colleagues performed a similar hip abductor fatigue protocol and found very small alterations in frontal plane knee mechanics, which would likely have very little impact on injury risk23.

 

Can We Really Blame the Glutes?

The biomechanical explanation for why weakness or motor control deficits in the gluteal musculature SHOULD cause diminished movement quality makes complete sense, but unfortunately, the evidence at this time does not agree.

While the evidence itself does not allow the gluteal musculature to shoulder all of the blame, this does not mean we should abandon addressing these deficits in our patients. As previously stated, posterolateral hip strengthening has multiple benefits, but it is not the end-all-be-all for rehabilitation or injury prevention of lower extremity conditions. Proximal strength deficits should be assessed through validated functional testing in order to see its actual impact on lower extremity biomechanics on a patient-by-patient basis. Following this assessment, interventions should be focused on improving proximal stability, movement re-education, proprioception, fear avoidance beliefs, graded exposure, and the patient’s own values, beliefs, and expectations.

 

John SnyderJohn Snyder, PT, DPT, CSCS received his Doctor of Physical Therapy degree from the University of Pittsburgh in 2014. He created and frequently contributes to SnyderPhysicalTherapy.com (Formerly OrthopedicManualPT.com), which is a blog devoted to evidence-based management of orthopedic conditions.  

 

Mike’s Thoughts

John provides an excellent review of many common beliefs in regard to the influence of the hip on knee pain.  While it is easy to draw immediate conclusions from the result of one study or meta-analysis, one must be careful with how they interpret date.

I think “anterior knee pain,” or even PFPS, is just too broad of a term to design accurate research studies.  It’s going to be hard to find prospective correlations with such vague terminology.  Think of it as watering down the results.  Including a large sample of people, including men, women, and adolescents and attempting to correlate findings to “anterior knee pain” is a daunting task.

Imagine if we followed a group of adolescents from one school system for several years.  Variations in gender, sport participation, recreational activity, sedentary level, and many more factors would all have to be considered.  Imagine comparing the development of knee pain in a 13 year old sedentary female that decided she wanted to run cross country for the first time with an 18 year old male basketball player that is playing in 3 leagues simultaneously.  Two different types of subjects with different activities and injury mechanisms.  But, these two would be grouped together with “anterior knee pain.”

What do we currently know?  We know hip weakness is present in people with PFPS and strengthening the hips reduces symptoms.  As rehabilitation specialists, that is great, we have a plan.  I’m not sure we can definitely say that hip weakness will cause knee pain, but I’m also not sure we can say it won’t.  Designing a prospective study to determine may never happen, there are just too many variables to control.

John does a great job presenting studies that require us to keep an open mind.  I’m not sure we can make definitive statements from these results, but realize that there are likely many more variables involved with the development of knee pain.  Hip strength and biomechanics may just be some of them.  Thanks for sharing John and helping us to remember that it’s not always the glutes to blame!