Further to my earlier mail on treating knee stability problems, here is some
more discussion that I have been sharing with the person who is the
unfortunate victim of those problem. He added this information:
<< Causes of my knee problems:
1. I have a hyperlordosis problem that might be related to having tight psoas
2. I seem to have a tendency to round my back at the bottom of the squat
3. There was something to do with my vastus lateralis coming into play
before my vastus medialis while I squat which contributed to my knee
instability ( note that I did not hurt my knee squatting)
4. I think there were some slight rotation problems with my shoulders
5. I think I had a slight tilt that brought my right shoulder up and my left
hip >>
***None of those tests would be considered to be scientifically definitive.
For example, while psoas ‘tightness’ may have something to do with excessive
‘hollowing’ of the lumbar spine, that is one of several possible explanations
for significant lordosis.
Anyway, tightness of psoas would tend to counteract your tendency to round
the back during the squat. Rounding of the lower spine generally has more to
do with limited flexibility in the ankle and knee joints than the psoas. In
addition, it can simply be due to ‘bad’ neuromotor habits accumulated over
prolonged periods of uncorrected training. Very often, the use of a few
hands-on kinaesthetic ‘tricks’ that I mentioned in my last letter, improve
the situation markedly in a few minutes.
If your back tends to round too much near the deepest part of your squat,
then simply squat as far as you can go with good form and gradually increase
the depth of squatting over a period of a few weeks and the rounding problem
quite happily will resolve itself.
How did they ascertain if one of the vastus muscles was ‘firing’ before the
other without using an EMG? How did they conclude that the way in which your
muscles came into play are not appropriate for your individual structure and
characteristics? It is well known that all muscles contribute to different
degrees with different timing, so what a muscle test reveals under static or
short range conditions may be totally irrelevant to what happens under full
range movement in a given sporting action. There is no set universal pattern
which applies to all of us.
Probably what had more effect on your squatting than anything else is the
fact that knee injuries are notorious for producing reflex inhibition of the
quadriceps. The body innately knows that the ability to produce very
forceful contraction, so it somehow activates inhibitory nervous processes
which counteract your ability to contract muscles that operate the injured
joint. Very often, if you have an injured knee, you will tend to become more
of a “back squatter” with a marked forward lean and you will often tilt your
injured knee in such a way as to minimise the stress on it. This will lead
to tilting of the hip, rotation of the trunk and other such problems. No
need to look for mystical causes in vasti , psoas or pyriformis muscles, or
in “muscle imbalance” – the problem may simply lie in reflexive protective
processes.
<<I thought I had been balanced by another therapist, so I’m thinking that
the tilt might have been related to the pain in my knee. >>
***Your diagnosis is probably as accurate as any therapist is going to make -
your intuitive diagnosis agrees with my above analysis based upon a knowledge
of motor control. Far too often, impressive sounding jargon is used to
justify a model of the injury and healing process, when the truth is that the
diagnosticians don’t really know. However, a diagnosis couched in
pseudoscientific language sounds a lot more convincing to the client and the
therapist – remember that both people involved in the healing situation need
to satisfy psychological needs.
The only way in which one can avoid this situation is to list several
possible causes and, by harmless trial and error (guided by movement patterns
and perception of pain), narrow them down to a short list of the most likely
causes. Of course, genuine medical examination such as radiological scans of
the area should be used to rule out the possibility of really serious
pathology, if this may be of any concern.
Dr Mel C Siff