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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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

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

Excellent point and great exercise ideas.

Thanks.

Rick Kaselj
http://www.ScapularStabilizationExercises.com

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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.

Thank you for your reply and adding to the discussion.

Rick Kaselj
http://www.ExercisesForInjuries.com

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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

Very informative post and I can particularly use this for all my clients.

Regards,
Jenny

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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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?