Knees Passing the Toes (Knee Pain)

I just wrapped up my Exercise Rehabilitation of the Knee course at Douglas College.

I learn so much from the fitness professionals that attend.  They all have great questions and I wanted to share one with you.

I got a great question from one of the registrants about knees passing the toes.

Commonly taught in fitness certification is the fact that you should not have the knees passing the toes.  My response to this is, it depends on the situation.

The Deal on the Knees Passing the Toes

==> CLICK HERE to watch the video on what the deal is with the knees passing the toes

3 Situations on the Knees Passing Toes

There are three different situations to consider when it comes to the knees passing the toes.

#1 – Client with a Knee Injury or Knee Pain

If your client has some sort of present knee injury or knee pain, you don’t want the knees to pass the toes, period.

You want to work the full range of motion of the knee, but this would be done in a non-weight-bearing situation.

#2 – Client with No Knee Injuries or No Knee Pain

If your client doesn’t have any knee problems or knee injuries, you want them to be able to squat all the way down and come back up.

In this situation, squatting down is going to have the knees pass the toes.

In an unloaded situation with no dumbbells, no barbells, no hack squat machine and no squat rack; you want your client to be able to go from standing, squat down and come back up, in the individual with the uninjured knee.

#3 – Adding Load to the Squat

If you start adding load (dumbbells and barbells and machines) you want them just to go to 90 degrees.

When the knees pass 90 degrees in a loaded situation, it ends up putting a lot of stress and strain on the knee joint.

I hope this clarifies things when it comes to the knees passing the toes.

So remember, in a client that has a knee injury, or previous knee injury, you don’t want the knees to pass the toes; you want to try to keep the weight shifted on the heels in order to activate hamstrings and glutes a lot more and decrease the strain on the knee joint.

In the second group of people, and the people that don’t have any kind of knee injury, you want them to be able to squat all the way down and come back up in an unloaded situation; that’s perfectly fine for them to do.

The third group, when you start loading things up and loading joints, you want to limit them to 90 degrees.

Thank for reading.  Make sure to leave me a comment and let me know what you thing about the blog post.

Rick Kaselj, MS

P.S. – One group of exerises that I make sure my knee injury clients doe are gluteus maximus exercises.  To learn The Most Effective Gluteus Maximus Exercises, CLICK HERE.

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7 Comments

  1. Rick,

    Doesn’t not practicing a squat with a load go against the “lift with your legs, not with your back” philosophy?

    Ideally, wouldn’t you want to progressively load a healthy individual so that their knees could handle more torque and stress through the joint?

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    Rick Kaselj Reply:

    John,

    Thanks for reading and commenting.

    John – Doesn’t not practicing a squat with a load go against the “lift with your legs, not with your back” philosophy?
    Rick – You do want to lift with your legs but in most squating situations with a load, you don’t pass 90 degrees. Watrch what you do during a day and see how often and when you go into a squat movment with a load. The exception are industrial athletes who requre it for work.

    John – Ideally, wouldn’t you want to progressively load a healthy individual so that their knees could handle more torque and stress through the joint?
    Rick – Yes, I would progressively overload someone for squats but with load the focus would be from 0 degrees to 90 degrees.

    Rick Kaselj
    http://www.ExercisesForInjuries.com

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    John Reply:

    Rick,

    Thanks for the timely response, but I have to disagree with some of your comments.

    While it is true that most (not all) squatting movements that we do in a day do not require the knee to go below 90 degrees, that doesn’t mean we should extend that philosophy into training. One of the main goals of fitness (if not the main goal in some cases) is to condition the body to better handle situations we encounter regularly in day-to-day life, as well as situations we don’t encounter as frequently. I would doubt that you do any loaded shoulder abduction (lateral dumbbell raises) in day-to-day life, but you and I will agree that they’re an integral exercise in maintaining a healthy shoulder joint.

    Not only is the back squat a great exercise for improving many things such as bone and tissue density, balance, posture, core strength, and integrating the pattern for proper lifting technique, but squatting below 90 degrees with a load is essential. Coaching your client to properly perform this exercise will create the proper stress and adaptation to ensure that your client has a healthy knee joint, and can handle situations which would not normally occur.

    For the same reasons I have stated above, loaded squats below 90 degrees can also go a long way in helping a client with a previous knee injury. This doesn’t mean that I would have a client with a very recent knee injury or surgery doing full range of motion, loaded, back squats a week removed from trauma, but the goal is to have your client eventually be able to perform a full back squat. And I wouldn’t necessarily ask a client to push through the heels in order to shift the work to the glutes and hamstrings, since some knee injuries will leave clients with a pathology in the quadriceps, and having more focus on the quads during exercise will help in its return to proper muscle function.

    Also, in a rehab setting, your goals is to help return your client to the level of function they had before the injury. If you say that a “healthy” client should be able to perform an unloaded squat to a full range of motion, but a client with a previous knee injury shouldn’t… Haven’t you failed as a rehab professional?

    John

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    Rick Kaselj Reply:

    John,

    Thank you for your reply and adding to the discussion.

    Rick Kaselj
    http://www.ExercisesForInjuries.com

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  2. Knee passing the toes, knee pain.

    Rick, While knees passing the toes can aggravate exsisiting pathology in the knee, I think it is essential to determine what the pathology is and then determine the appropriate exercise protocol.

    When the knee pathology exsists due to tracking problems at the knee itself then exercises that require the knee to pass the toe are not only essential but may also eliminate the knee pain quite quickly.

    Weakness in the vastus medialis is a big problem for the knee joint. The vastus medialis is most active in terminal extension and end range flexion while weight bearing. A few of my favorite exercises for weak vastus medialis and knee tracking problems are: Petersen step-up, Lunge, progressive step-ups(saggital, frontal) toe touch drill. All of these require the knee to go forward of the toe, and if prescribed and cued properly none of them will elicit more knee pain but will help to eliminate the knee pain quickly.

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    Rick Kaselj Reply:

    Lance,

    Excellent point and great exercise ideas.

    Thanks.

    Rick Kaselj
    http://www.ScapularStabilizationExercises.com

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  3. Thanks Rick!

    Good illustration over the video, appreciate your work & explanations, now I have clearer understanding of the situations on knee passing the toes!

    I always look forward to read your blog.

    Regards,
    Tannis

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  4. Hi Rick,

    Earlier this year, I had a chance to read your blog entry in which you advertised a knee injury rehabilitation webinar (http://exercisesforinjuries.com/acl-injury-exercises/).

    In that entry, you mention that you would discuss “the 3 reasons why you should have your clients have their knees pass their toes.”

    Could you please explain why you changed your stance in the subject?

    Thanks,

    John

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    Rick Kaselj Reply:

    John,

    I did go things in deal in the above post.

    I explain things more in the webinar.

    You are able to order and download the webinar at:

    http://exercisesforinjuries.com/acl-injury-exercises/

    Rick Kaselj
    http://www.ExercisesForInjuries.com

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    [Reply]

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