One of the most prevalent movement flaws we see on a daily basis is an inward collapsing of the knee during cutting, squatting, and jump landing patterns. This is especially true in females, who tend to have a more difficult time preventing this motion due to their skeletal structure (wider pelvis). This pattern can lead to a variety of knee injuries, the most threatening of which is the well-known ACL tear.
Retraining Proper Movement Patterns
The approach we take in retraining this pattern includes educating our athletes on what the pattern should look like, strengthening the muscles on the outside of the hip, which is influential in pulling the upper leg and knee out, and practicing proper technique in a variety of athletic movements (including speed training, plyometric training, resistance training, and conditioning). This approach has proven extremely effective for just about every athlete we’ve had.
The exception is athletes that have a flat foot (or two). When the foot flattens out (or pronates), it drives the lower leg into internal rotation. My colleague John Pallof calls the talocrural joint (what many refer to as the “ankle joint”) a torque converter, since inversion and eversion (inward or outward tilting) at this segment leads to internal and external rotation of the lower leg. He also pointed out that a few degrees of excessive inversion (as is the case in individuals with flat feet or “over pronation”) translates into even more degrees of internal rotation of the lower leg, which translates into even MORE degrees of internal rotation at the hip.
Try This!
One way to illustrate this concept is just to move your arm in large circles. If you look at the diameter of the circle made at your arm by your shoulder, it will be considerably smaller than the diameter of the circle made by your hand. In the above example, your lower leg would be your upper arm (small circle) and your hip would be your hand (large circle).
In athletes that have difficulty keeping their knee out, despite a few weeks of training and coaching under their belt, I take a closer look at their feet and am starting to notice a common theme.
If you look closely, you’ll see that the achilles tendon appears to head straight down, and then take a somewhat sharp turn toward the outside of the foot. This is indicative of an over-pronated foot. This athlete appears to have the problem on both feet. Can you imagine what his knees will look like?
See how his knees appear to point inward? In a correctly positioned foot, the achilles would appear more vertical and the back of the knee would be facing straight back instead of rotating toward the inside.
There is some debate about whether we can restore an arch in our feet through training. I’ve run this question by my friend Ryan Chang, who was a fellow grad student when I was at UMass Amherst, but current works as a Pedorthis at Kintec Footlabs and has done biomechanics work for Adidas, and he seemed to think getting an orthotic was the better route. John Pallof agreed. It’s better to get a corrective orthotic in there early to prevented undesirable motion at the knee and hip. As I mentioned in last weeks newsletter, unwanted motion accumulates into serious injuries. Knee meniscus tears and hip labral tears are amongst the many injuries that could result from this.
If your feet look like the gentleman’s in the picture above, it may be worth scheduling an appointment with a specialist to see if you’re right for orthotics. John Pallof was kind enough to pass along his “go-to” resource in this regard: Sole Supports. If you go to the site, you can find a provider that’s near you.
Take Home Message
My hope is that you take this information seriously and don’t push this stuff to the back burner. I recently heard my friend Joe Heiler (a PT from Traverse City, MI) mention that Jan Eckstrand presented research at the 2009 Soccer Industry Medical Symposium 2009 stating that an analysis of 70 teams from 18 countries over 8 seasons (over 9000 injuries!) revealed that previous injury was BY FAR the best predictor of future injury. This isn’t to say that previous ankle sprains are predictive of future ankle sprains (although they are); this means that ANY injury is the greatest predictor of ANY future injury. This point CANNOT be overlooked. Injury prevention should be the primary goal of every athlete, and is the primary reason I think athletes need to be training year-round.
To your success,
Kevin Neeld
P.S. Don’t forget to check out the re-release of my Hockey Development Coaching Program! The bonuses alone are worth the investment.