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Exercise Myths To Healthy Knees


We have done a few posts over here at DVRT about the VMO (Vastus Medialis Oblique is one of four quadriceps muscles), as for some reason people are back trying to isolate individual muscles again. Something I thought the health and fitness industry was moving away from but I was wrong. So here we are again, taking about the VMO or I should say quadriceps for more general terms.



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I keep seeing exercises pop up over and over again in the fitness industry that I use as a physical therapist but never would I think to see in a gym and general fitness setting. I could talk about a lot different exercises I see actually but lets talk about one in particular. The TKE (terminal knee extension) exercise. I keep seeing this over and over and it really throws me for a loop.



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Not that you asked but it throws me for a loop because its such an isolated exercise. Typically used for post surgical knee patient working on getting back their full range of motion and starting to do more weight bearing exercises. I never would have thought to see it in someones programming for general fitness. But its all over the gram as a new exercise you need to do for building strong knees.


Terminal knee extension is really just trying to isolate the quad and work on knee extension. Yes, that is something that a lot of people need to focus on when rehabbing after a surgery or injury but not something I would program for my general pop client or someone wishing to just build strong knees that didn't have surgery.


So if you have normal range of motion in your knee and have not had surgery your focus should be on more of an integrated approach to strengthening. Looking at the body as a whole and not such individuated compartments like just the quad. It should be focused on how the quad works with the rest of the muscles in the chain.



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Not only is it my opinion, but those of researchers in papers like this one (you can read HERE) that explicitly state that trying to isolate the quad muscles is not something we should really focus upon in a rehab setting. I want to emphasize, this was suggested to NOT focus on the VMO in rehab, which means in training it seems even more futile to try to do such a thing and doesn't solve our knee issues either.



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You can read HERE


If we are trying to specially work in knee pain, we have talked about this before, we need to make sure we have good foot/ankle mobility, good hip mobility, and good core strength. All these things and contribute to issues at the knee. Focusing on these things will not only help your knees but your overall strength and mobility so a bigger bang for you buck than trying to isolate individuals muscles and not get anywhere with your training.


So what does it look like when we take a more integrated approach?
Below I show exactly we discussed above, incorporating that ankle mobility, core strength and all that good stuff:



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I like to help people understand when exercises are being taken out of context. Sometimes, it isn't a question of if an exercise is good or bad, but what situations are we using the drills for in solving training goals.


A good example is all the fitness pros that I see using terminal knee extension to help with problematic knees. Terminal knee extension drills can be helpful, but typically only for those who are post surgery. That is because it is a very simple closed chain exercise, we can lose range of motion while people recover from surgery, and slowly starting to reintroduce integrated movements with limited range of motion are very helpful.


For those that aren't post surgical, the value isn't nearly as great or really helpful at all. Those that battle knee issues often run into the following issues…


-They lack ankle mobility (especially ankle dorsiflexion)

-Hip mobility
-Foot stability
-Hip/Posterior Chain Strength
-Timing of the muscles (this is where we teach the VMO to turn on at the right time through more integrated movements)
-Core strength (this controls our movement so we don't get into positions as much that overly stress our knees)


Using a Perform Better half foam roller while we do a press out is a tremendous way to help build ankle mobility. Our foot engages with the ground (giving some stability) we actively move through the range of motion that is available, and research shows that core stability can help us gain greater hip mobility at the same time.


A supine leg curl with our Ultimate Sandbag lift/chop helps us build not only foundational strength of the posterior chain, but also connects our core with our lower body in the natural diagonal patterns. We also start to introduce the need to have the ability to resist forces in other planes of motion that can cause compensations in the knee.


The MAX lateral step-up is an example of a more advanced strength training drill for the knee. We are linking everything from the foot to the core, there is a need to have stability in all 3 planes of motion, we are learning to produce force and use our posterior chain with our quads to control movement.

 

These 3 DVRT drills that I show below place heavy emphasis on not just treating the feet or hips individually either, but connecting them in a way they work together.

 



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The way I would have treated knee issues is VERY different than I look at knees now. As young physical therapist, I admit, I looked at the body in terms of parts. However, as I continued to look for better solutions for my patients, I started to learn how incomplete and misdirected a lot of my efforts actually were in getting results.


Knees are a great example of most of us think if a knee is giving us issues, we look at the knee. I'm not suggesting we don't look at the knee at all, but looking at the knee ONLY gives us a very incomplete story. That is because all our joints are impacted what is happening above and below the joint. For the knee, that means we have to put a lot of energy in looking at what is happening at the feet and hips.


These 3 DVRT drills that I show place heavy emphasis on not just treating the feet or hips individually either, but connecting them in a way they work together. For example, the split squat lift/chop I perform on a @perform_better balance pad to make my foot work harder to create stability while pulling apart the Ultimate Sandbag during the lift/chop ties in the core/hip complex to the movement. In other words, a much more effective way of building stability.


The half kneeling Around the World on this small balance beam places me in an inline position where again, my feet, hip, and core have to work synergistically to keep me stable. The Around the World is like a lift/chop with a plank, working more reactive stability of the core. Finally, a Front Loaded rear slide good morning with @valslide and XL mini Perform Better mini band gives me feedback to grab the ground” with my feet, use both feet, and by pulling the Ultimate Sandbag apart, I get a great tie in with the core/pelvis. Try these drills to help your or those you are trying to help knees be healthy and strong!

 

Again below showing how to incorporate everything we talked to about for healthier knees…



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Jessica Bento


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Jessica Bento, director of education at DVRT, has been a physical therapist for over 16 years practicing in orthopedics, neuro, and geriatric rehabilitation. Jessica is currently director of education for DVRTFitness.com where she has taught DVRT programs at national conferences and all over the world. You can get 30% off right now on Jessica’s DVRT Knee Rx course HERE with code “pb30”




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