KNEE STABILITY & PLACEBOS

[Guest guest]

The 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

Denver, USA