Exploring your transverse plane stability
If you have any pain, please consult with your physician or physical therapist prior to attempting any of the movements suggested. This content is intended for clients who have been screened in the Foundations/ Practical Strength curriculum.
As many of you know, I have been working in the field of physical therapy and movement instruction since 1995. This does not necessarily give me any gravitas or chops- but it does mean that I have born witness to a lot of fads- both in fitness and in medicine.
As a natural skeptic, I am always suspicious of any fad- eat this one food, do this one movement- as most fads come to be disproven over time. All good science is constantly changing, and we really need to remain open and critical, so we can respond to the new information as it comes in.
When I first started in the field of physical therapy, anterior (front of the) knee pain was treated as if it stemmed from weakness in the medial quadricep muscles. This made good sense given what we could observe at the time.
When we looked at someone with anterior (front) knee pain, they often stood with their patella slid to the outside and rotated- as if it had lost a medial (inside) anchor).
When we asked someone to squat, we often noticed a worsening of this postural alignment.
I spent many of my early years as a physical therapy aide teaching patients how to use their vastus medialis (medial quadricep), how to tape their kneecaps (which is still a good tool)- but generally, completely getting it wrong. Case after case- wrong. (Sorry folks, we were doing the best we could with the information we had at that time).
In the late 90s research was conducted in biomechanics out of the University of Southern California using a fairly new technology at the time- an open MRI machine.
What was observed when clients with anterior knee pain entered the MRI and performed a squat, was that their knee caps stayed in the same spot, but their entire femurs rotated internally (!!!) What we were seeing was correct, but our perspective was all wrong. We had assumed the kneecap was moving due to lack of support while the femur stayed stationary- and so we treated a muscle that controlled the kneecap.
But in actuality, the kneecap was stable, but the whole of the femur rotated in a dysfunctional pattern – into internal rotation.
So in order to treat excessive internal rotation, we had to rework our hypothesis of training the medial quadricep, and instead train the lateral rotators.
The lateral (external) rotators of the hip are a strangely named mouthful of 6 muscles fanning between the sacrum/ pelvis and femur. The muscles are: the piriformis, gemellus superior, obturator internus, gemellus inferior, obturator externus, quadratus femoris: the PGOGOQs.
When we are weight bearing, they work to help us keep our knees from falling inward together. This internal rotation can be confusing to see, as it can accompany the aforementioned Trendelenburg sign (explored last week).
Because of the proximity to the sciatic nerve and the piriformis (some people have sciatic nerves that actually pierce the piriformis muscle) keeping mobility and stability of the PGOGOQs is essential for healthful sciatic nerve function.
Self-Assessing Your PGOGOQs: DO try this at home:
Stand in front of a mirror. Squat as if you were sitting into a chair. Notice if there is any amount of your knees falling together (this is called genu valgum) or if there is any apparent shifting of your kneecap to the outside (lateral) aspect of your leg (recall from above, this is an illusion, but it goves you cues about what is happening with the femur below)
Increasing the challenge- single leg:
If everything looks A-OK proceed to examining the same squat but single leg. Look for any amount of your knee diving in, or any amount of your kneecap sliding laterally.
Don’t be afraid to use something like a stable dresser to hold onto while you are performing the movement. You’re not testing your balance- you are looking for any movement anomalies. Jot down any findings.
In our practical strength training we focus on performance of muscles so support good mechanics in all planes of motion. To build awareness of your PGOGOQs, try out non- weight bearing external rotation (aka clams).
Happy Moving (and stabilizing)!
For more info on gluteals , join us for our Fire Up Your Glutes Workshop this month, as we will explore more about gluteal anatomy, how to best mobilize as well as strengthen the gluteals and how to use your gluteals in everyday life.