T Nation

Client with Weird Knees


#1

One of my clients has the weirdest knees. She has no knee stability whatsoever, and her party piece is that she can point her feet forward and let her knees collapse in. It's hard to picture, but I can assure you it is weird.

So it means her knees collapse in on squats, but putting a band around her knees takes care of that for the most part.

It also makes her leg (only seems to happen with the right in this circumstance) collapse in during deadlifts which isn't something I'd ever seen before, but switching to sumo stance has cured that.

Anyone ever encountered anything like this before? How'd you deal with it?


#2

[quote]Yogi wrote:
her party piece[/quote]
Um, I don’t know how they run things in your neighborhood, but a trainer getting to know his client’s party piece is usually grounds for dismissal around here.

Sounds like some very lax MCLs or some hyper-mobility (in the wrong direction) at the knees. Weird, and probably dangerous for her.

So glute/abductor activation solves the problem? I’d focus on that.

Again, see above.

Sounds like she’s got some joint funkiness (that’s a technical term, for any non-trainers reading along), but it also sounds like you know the band-aid fixes, which should give insight to the longer-term items to address. I’d attack the issues that you’ve found solutions for and make them regular parts of the training.

(Also, wait, since when are you a trainer? I don’t remember hearing that before.)


#3

[quote]Chris Colucci wrote:

[quote]Yogi wrote:
her party piece[/quote]
Um, I don’t know how they run things in your neighborhood, but a trainer getting to know his client’s party piece is usually grounds for dismissal around here.[/quote]

lol, I think party piece means something different where you and I are from!

[quote]Chris Colucci wrote:

Sounds like some very lax MCLs or some hyper-mobility (in the wrong direction) at the knees. Weird, and probably dangerous for her.[/quote]

Yeah, weirdly her other joints don’t do it. All the hyper-mobile people I’ve seen have it everywhere.

[quote]Chris Colucci wrote:
Sounds like she’s got some joint funkiness (that’s a technical term, for any non-trainers reading along), but it also sounds like you know the band-aid fixes, which should give insight to the longer-term items to address. I’d attack the issues that you’ve found solutions for and make them regular parts of the training.[/quote]

Aye, I have her do tons of glute acivation stuff in her warm up so hopefully it’ll get better, in the meantime I’ll just keep doing the banded squats and sumo deads. I just worry that they are, like you say, band aids and not addressing some serious dysfunction somewhere. She says it’s never given her any pain or anything so it might just be one of those things.

[quote]Chris Colucci wrote:
(Also, wait, since when are you a trainer? I don’t remember hearing that before.)[/quote]

I’m a man of many talents, Chris. I’m actually the gym manager but I PT a few clients on the side for extra pocket money


#4

You need to look both upstream at the glute med but also downstream at the foot.

Do this: put your weight on your right leg and attempt to collapse your arch of that foot. Look what happens to your knee, it collapses inwards.

It may be that her knee has normal mobility, but is being forced to compensate for a collapsing arch. Sumo places the pressure on the outside of the foot allowing the arch to maintain it’s shape. Additionally, the glute activation torques the knee into a more stable position.

I’m not saying this is what it is, just that you should look at the hip and the foot when addressing knee valgus.


#5

[quote]Dr. Pangloss wrote:
You need to look both upstream at the glute med but also downstream at the foot.

Do this: put your weight on your right leg and attempt to collapse your arch of that foot. Look what happens to your knee, it collapses inwards.

It may be that her knee has normal mobility, but is being forced to compensate for a collapsing arch. Sumo places the pressure on the outside of the foot allowing the arch to maintain it’s shape. Additionally, the glute activation torques the knee into a more stable position.

I’m not saying this is what it is, just that you should look at the hip and the foot when addressing knee valgus.[/quote]

Nice catch Dr. P, I hadn’t even considered problems with her feet.

Did a little google research just there and it looks like you might be on to something! Thanks very much.


#6

I actually saw this multiple times when I was training regular people. The NASM opt model actually has a system in place which should help at. You were actually right on track based on the info given. Now there could be other wrong with her.

I can write the big words, but they hurt my brain. So I’m just gonna post the videos instead


This stuff is just basic but should get you started

Now I’m not a huge fan of NASM model, but the assessments did help a lot with my clients. As far as exercises goes. NASM tells you lateral tube walking, bridges with the band and squats with the band so your actually probably right on track.

Even if its not the glutes, judging from my previous clients, I couldn’t give them enough glute and hammy work. They never worked that shit out


#7

[quote]jtamez17 wrote:
I actually saw this multiple times when I was training regular people. The NASM opt model actually has a system in place which should help at. You were actually right on track based on the info given. Now there could be other wrong with her.

I can write the big words, but they hurt my brain. So I’m just gonna post the videos instead


This stuff is just basic but should get you started

Now I’m not a huge fan of NASM model, but the assessments did help a lot with my clients. As far as exercises goes. NASM tells you lateral tube walking, bridges with the band and squats with the band so your actually probably right on track.

Even if its not the glutes, judging from my previous clients, I couldn’t give them enough glute and hammy work. They never worked that shit out
[/quote]

nice! Thanks very much!

And yeah, I do a TON of glute and hamstring work with all my clients. I’ll keep on with the banded squats and sumo deads so I can still get her training heavy, and I’ll give her some rehab stuff to do at home which she obviously won’t do because nobody ever does, but at least I tried.


#8

Jonnie Candito did an excellent video which outlines a number of issues around knees collapsing. Don’t have youtube ATM but a search for: Candito squats knees caving in should bring it up. Should help out.


#9

[quote]tsantos wrote:
Jonnie Candito did an excellent video which outlines a number of issues around knees collapsing. Don’t have youtube ATM but a search for: Candito squats knees caving in should bring it up. Should help out.[/quote]

Thanks man, if it was just the usual knees collapsing in from having a weak glute med then it’d be easy enough to fix, but this chick’s got something seriously freaky going on with her knees.

I’ll ask her if it’s cool to upload a picture or video.


#10

Knock-knees?


#11

[quote]roybot wrote:
Knock-knees?

http://en.wikipedia.org/wiki/Genu_valgum[/quote]

you might just have cracked it! I didn’t realise knock-knees could be as severe as that.

Interestingly, from that wiki it says to work on the adductors, whereas I would’ve thought more abduction would be necessary. Something to think about.

Did a bit of reading and it looks like what I’ve been doing with her should help fix it


#12

[quote]Yogi wrote:

[quote]roybot wrote:
Knock-knees?

http://en.wikipedia.org/wiki/Genu_valgum[/quote]

you might just have cracked it! I didn’t realise knock-knees could be as severe as that.

Interestingly, from that wiki it says to work on the adductors, whereas I would’ve thought more abduction would be necessary. Something to think about.

Did a bit of reading and it looks like what I’ve been doing with her should help fix it[/quote]

If her sumo squat is good then get her doing horse stance bodyweights squats.


#13

How’s her hip mobility?


#14

[quote]jskrabac wrote:
How’s her hip mobility?[/quote]

It’s ok, no problems with squat depth or anything like that.

Her mobility in general is pretty good. She has the usual deficits in her upper back that you’d expect in a beginner, but the only issue is really that her crazy knees can be all over the place at times.


#15

[quote]Yogi wrote:
I’m a man of many talents, Chris. I’m actually the gym manager but I PT a few clients on the side for extra pocket money
[/quote]

Where are you working now mate?


#16

[quote]ChongLordUno wrote:

[quote]Yogi wrote:
I’m a man of many talents, Chris. I’m actually the gym manager but I PT a few clients on the side for extra pocket money
[/quote]

Where are you working now mate?
[/quote]

Yo dude, how’ve you been? Wasn’t sure if you still came around these parts.

Left the big smoke to take a job in the sticks. Not sure I’d recommend it!

You still in Glasgow? How’s the website going? What’re you up to these days?


#17

[quote]Yogi wrote:
Yo dude, how’ve you been? Wasn’t sure if you still came around these parts.

Left the big smoke to take a job in the sticks. Not sure I’d recommend it!

You still in Glasgow? How’s the website going? What’re you up to these days?[/quote]

Aye I’m good mate. Still in Glasgow grafting away. I seen that the supp shop you worked in has been turned into some hipster foodie joint?

Website is going well as is the PT business. If you’re up for doing a blog post for me then fire in big chap!


#18

[quote]ChongLordUno wrote:

[quote]Yogi wrote:
Yo dude, how’ve you been? Wasn’t sure if you still came around these parts.

Left the big smoke to take a job in the sticks. Not sure I’d recommend it!

You still in Glasgow? How’s the website going? What’re you up to these days?[/quote]

Aye I’m good mate. Still in Glasgow grafting away. I seen that the supp shop you worked in has been turned into some hipster foodie joint?

Website is going well as is the PT business. If you’re up for doing a blog post for me then fire in big chap!
[/quote]

glad to hear it mate! Yeah that shop went the way of the dodo so we opened a gym instead.

I’ll get in touch through your website, good to hear things are going well for you!