Dr Mel Siff Talks Knee Stability and Placebos
Author: Dr Mel Siff Blog // Category: Dr Siff on Injuries/Disease, Dr Siff on Resistance TrainingThe topic of “knee stability” has been discussed on other user groups. This
sort of comment is fairly typical of feedback from readers.
<<I have had problems with knee stabilization. My trainer and therapist
stated that I’d been squatting too deep without doing any quad work and that
my vastus medialis wasn’t firing properly. To solve my problem, I had to
stop squatting and deadlifting for a month and do some extra exercises to
correct for my poor vastus functioning.>>
Mel Siff:
***This is a common sort of plausible-sounding pseudoscientific jargon that
many therapists and quasi-therapists throw into their ‘diagnostic’ analyses
of athletes. It would be fascinating to hear from them what constitutes
“proper” firing of vastus medialis and how they determined without invasive
EMG tests how “improper” the firing actually was.
Firing of nerves depends on numerous factors, including stage of lift,
relative angles between the different joints, velocity of movement, magnitude
of load, rate of load change, pattern of movement, so it is highly misleading
to talk about improper firing as a general problem.
This sort of junk science means almost nothing, though it often serves to
provide some sort of placebo explanation that can assist in the recovery
process. It is well known that drugs tend to work better when the patient
has read about the effectiveness of that drug or had its powers explained by
the doctor.
In fact, some researchers have found evidence that certain regimes of
exercise appear to work more because of their placebo effects than their
direct physical conditioning effects. So, the therapist or trainer gives an
athlete a carefully worked out card of exercises and procedures to
follow like a medical prescription and this formalisation alone can
facilitate a definite part of the healing.
This is wonderful to know, because it means that virtually any plausible
sounding therapist, personal trainer or coach can draw up an impressive
looking training program (which also does contain exercises which DO contain
well-known productive exercises) and help a client make definite progress!
The ideal situation is where one can devise a program which contains
exercises which offer maximal physical and placebo stimulation.
So, when you are devising any program, try to ensure to involve a strong “Faith
Factor” (placebo or what you will effect), so that everything that
you do will allow your mind to augment what your body is doing. In other
words, try to use exercises or ways of using those exercises which you
strongly believe in and avoid ones which you do not believe in – or work at
modifying those exercises which you do not believe in, so that you do learn to
have some faith in them.
<<No squatting and deadlifting for about a month >>
***This was totally unnecessary. If exercises like this are associated with
some movement problem, it usually has far more to do with the technique and
method of using them than the exercises themselves. You could have continued
to use these exercises in a manner that would have enhanced your knee
stability and increased your strength. By the way, knee stability has little
to do directly with the knee or any of its musculature – stability has to do
with voluntary and involuntary (reflex) processes, not simply the strength or
size of the muscles.
<<Do the following exercises:
1. Step ups with the foot rotated outwards slightly and your lower foot’s
toes raised, using dumbbells of 10lbs in each hand.
2. Lunges with rear leg raised with sets of 20 repetitions.
3. Stretches for the psoas muscles >>
*** The reasoning here was that outward rotation of the foot should recruit
vastus medialis more strongly, but research has been very equivocal on this
issue. Moreover, each person in a relaxed stance exhibits different degrees
of hip rotation (not knee rotation), so that a general formula for a specific
type of “knee” rotation is meaningless.
More important than this is that the knee cannot rotate unless it is flexed,
so that there is no such thing as knee rotation or disposition in isolation
of what happens at other joints. If your knees tend to “knock” inwards
during parts of the squat, this is a perfectly normal attempt by the body to
stabilise the lower extremities. It is only when the flexed knee shows
excessive tilt or internal rotation under heavy or ballistic loading that
injury becomes far more likely.
If this happens, there are several strategies to correct this – you can have
someone press gently on the inside of the knees to keep them from going into
valgus (“knock-kneed” position) or have someone keep their hands on the outsides
of your knees for you to push against (sometimes coaches place a band or thin
belt placed around the knees to achieve the same effect). Others may place a
smaller physio ball between the knees to offer the same sort of guidance.
These technique are part of what are called “kinaesthetic manipulation”, a
system that can help impart or correct many exercises techniques in lifting
and other sports (Ch 8 of “Supertraining”, 1999).
Using methods like this, you need not have given up squats or deadlifts,
though there was no harm at all in adding some lunge variations and stretches
of the hip flexors.. However, I would also have added some rotatory slow and
isometric ’stretches’ of the rotators of the hip, because internal and
external mobility of the lower extremity (“leg”) depends largely on these
muscles and the other soft tissues around the hip joint.
Dr Mel C Siff