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My Favorite Exercise Combinations: Installment 12 – The Hip Bone is Connected to The Knee Bone

Before I begin, I just want to comment and mention that many individuals want to begin talking about pathoanatomy and all of the complex items that happen in the body, but not many even master the basics and fundamentals before moving onto said items!

In fact, Tony Gentilcore had a funny quip to a tweet I had ranting about this very item.Tony G Tweet

With that under your belts, let’s dive into my newest and most favoritest exercise combination!

The Hip Bone is Connected to the Knee Bone

One common theme that happens quite a bit in many populations that I come across involves the knees exhibiting genu valgus. This is a fancy schmancy word meaning the knees cave in – this could be due to a few things:

1. Increased q-angle, in which a line is drawn from the anterior superior iliac spine (ASIS) to the center of the patella, and another line is drawn from the center of the patella to the middle of the femur.

qangle

2. Over-pronation of the medial arch of the foot, in which the arch of the foot is rolled inwards. If the foot collapses, the tibias could lose integrity and also fall in height as well, thus causing the patellas to fall towards one another.

Arch vs No Arch

3. Lack of hip internal rotation, which could be due to several factors, such as:

  • Lack of abdominal contribution in controlling the motion of the pelvis during gait
  • Lack of strength in glute medius
  • Lack of space in the posterior portion of your hip capsule due to congenital (or you were born with it) reasons
  • The individual does not know how to control the range of motion given to them

…among many others such as contact and non-contact injuries.

Look here for more information on hip internal rotation.

Observations vs Pragmatic Actions

So the mere observation of said information does not help us, rather we (you and I) can intervene in a few ways:

  1. Perform rehab like exercises in order to improve what we are looking at.
  2. Improve gait patterns (over-pronation, reduce postural swinging during gait, etc.)
  3. Improve the individual’s ability to control their body during athletic movements

Today I’ll be going over how to improve option three, in which I introduce the single leg hop where the landing is “stuck,” paired with a single leg squat, or bowler squat, with a subsequent medial band pull.

The single leg hop is a great regression or even beginning assessment tool to see how an individual interprets how to accelerate away from the ground, along with how they decelerate and negotiate gravity.

When an individual lands, a few incorrect items may occur:

  1. Lack of sticking landing (hopping instead of absorbing force)
  2. Overpronation
  3. Knee collapse
  4. Landing too “tall” or high, as opposed to a lowered position

Long story short, I am looking for alignment of the foot, knee, and hip.

Knee Alignment - Sagittal
Left: Good alignment when landing from a vertical hop. Right: Bad alignment when landing from a single leg vertical hop

Further, starting and ending with a lowered position allows an individual to react appropriately with respect to athletic endeavors – if the athlete lands in a higher position, there is less ability to decelerate using the posterior chain/glutes, and more likelihood the person will have to lower themselves in order to get faster, which takes time they could have saved if they just landed lower to begin with.

The bowler squat with a medial band pull requires the individual to maintain all of these alignment items, along with maintaining a lowered center of gravity.

Single Leg Medial Band Pull
The band is pulling the outside knee into valgus/collapse. The brain will recognize this and fight back, hopefully.

I’d also increase the demands by requiring the athlete to pause for 2 seconds at the bottom position, which will take any momentum out of the equation, and challenge their core integrity.

Note: When you have the band pulling on the leg, make sure your most outside leg has the band pulling them inwards toward the midline – otherwise you are assisting your knee in maintaining appropriate alignment. The purpose is to challenge the vestibular and nervous system by pushing the body out of alignment!

How Can I Program This?

I believe this can be a great precursor towards improving frontal plane development, or even single leg forward hops or bounds. For this reason using this as a “reminder” in the warm-ups may be the best bet.

A1. Single Leg Hop (Stick Landing) – 3×5/s

A2. Bowler Squat with Medial Band Pull with 2 Sec Pause – 3×4/s

Make sure to use a slightly less challenging band, because a very strong, or one inch or thicker band, may be too difficult and might hurt more than help!

As always,

Keep it funky.

MAsymbollogo

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My Favorite Programming Sequences: Installment 1

I’m starting off a new series of exercise programming favorites. This will aim to demonstrate very pragmatic programming choices for how I program for our athletes at Cressey Sports Performance.

In my recent post “So… What Do You Do? Part 2” I explained that I have been recently collecting assessment information in order to see where I am pragmatically with my exercise options.

“There’s an input… and an output.” –Charlie Weingroff

Through the large handful of assessments I’ve had in my disposal at this facility and past ones, there is a large discrepancy of unilateral instability that is often displayed through the midsection. Couple this with lack of range of motion, and we can begin to unravel a sequelae of neurological and systemic degradation.

APT
Lack of “anterior core” stability is coupled with a lack of pelvic control.

Some have called this gluteal amnesia. Following the Joint by Joint Approach will allow us to come to the conclusion that often the “core” will need stability, and the hip will need subsequent mobility.

Whether you are utilizing an active single leg assessment, or you are utilizing a passive test to determine the available range of motion at the hip, it is understood that the glute medius and glute minimus are hip internal rotators, or rather they are recruited when the femur is asked to internally rotate within the hip joint (acetabulum).

These specific muscle groups involve stabilizing the “core” by recruiting obliques, and reducing lumbar erector spinae recruitment patterns.

Prone Hip IR

A1. Single Leg Work

A2. Side Bridge or Side Plank

If our aim is to improve stability in a unilateral fashion, when the femur on the stable leg performs hip flexion, you are receiving an input aimed at improving lateral stability, as Tony Gentilcore put it, and this allows for literally ALL qualities (core stability, hip mobility, and strengthening via single leg training) to be improved upon.

This sequence also allows for the femur to shift into the acetabulum in a more posterior fashion as the lead leg goes into hip flexion (and the opposite is in hip extension) in a reverse lunge, for example.

Goblet Split Squat - Anterior Knee Block

If you don’t have stability of the core, nor do you not have adequate range of motion within the hip joint, what else is a better option than the combination of these two exercises to improve range of motion and quickly stabilizing what you have gained?

Who Is It For?

There aren’t many restrictions when it comes to this exercise sequence. If you have severe pain, probably a good idea to get it checked out, just to be safe. But other than that…

Using this as a “Phase 1” of programming to quite literally “reprogram” propioceptive input to the brain is not the worst thought process.

He doesn’t need to do side bridges in between these lunges.

Troubleshooting

  • Focusing on breathing and rib position, making sure you push *away* from the floor (which will reinforce abdominal control), along with hip positioning (posterior pelvic tilt while sideways) will help reinforce an appropriate position – and ultimately a great deal of awesomeness as displayed above.

This sequence is not meant to replace a lack of mobility found within the hip – however, it can be reinforced by including a posterior hip capsule stretch, which will allow a more relative input to the back of labrum, and by “activating” the glute medius/min, along with external/internal oblique recruitment from the side plank, you will be providing several opportunities for improving movement acquisition or learning.

Not bad for the first search term for “glute mobilization.”

Til next time.

Keep it funky.

MAsymbollogo