Redefining the fitness of performance With Joel Jamieson

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Joint Mechanics: The Knee

In this week’s episode of 8WeeksOut TV, Dr. Gerry Ramogida continues his series on the biomechanics of performance with a discussion on the how to evaluate and train the knee. Given how frequently knees get injured, across a wide variety of sports, this is an especially important topic and one every athlete and coach should pay particular attention to.

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Joel: Hey there. I'm Joel Jamieson.

Howie: I'm Howie Clark.

Joel: In this week's episode of 8 Weeks Out TV, we're going to give you a whole new way to look at the knee.
Welcome back. Today again, we have Dr. Gerry Ramogida back with us. After last week, you really just explored the foot and ankle; and I know, took a look at your dorsiflexion.

Howie: Yeah. I was blown away when he talked about you could have up to a 20% loss of power.

Joel: Absolutely.

Howie: In any athletics, 20% is ridiculous.

Joel: Game over?

Howie: That's game over. Even little increments that we try to improve, whether it be strength and conditioning, any aspect of improving your performance, a couple of percent is what's going to make a difference. I was shocked to see where I was at.

Joel: This week, we're going to take a look a little further up the chain; we're going to look at the knee. What I really like about his approach is just the idea that changes, little micro-movements, make a big difference in your macro movements. Today, we're going to, like I said, moving up and looking at the knee. He's going to tell us a little bit more about how he evaluates a knee and something that most people don't think about. It's going to be great.

Gerry: Last week, I introduced that concept of micro movement dictates macro movement. Again, tribute that thought process to Dr. [inaudible: 01:31].

Joel: Process or process?

Gerry: Whatever side of the border you're on, that's your choice. With the knee, we know that by its construction, the medial condyle of the femur is larger and longer than the lateral. That has impact on the knee mechanics when you go from flexion to extension; it creates a rotary movement. Everyone knows that a knee acts like a hinge, and flexion/extension is the primary movement, but it's really the internal and external rotation in that joint that allows for that full range of flexion/extension to occur; it's something that often is forgotten.

Go ahead and lie on your back for me. As a basic assessment, what we do is we just bring the hip to 90 and the knee to 90, and we get a grip around each malleolus. I got my finger coming to the medial malleolus, my thumb on the lateral malleolus, and I'm just getting a sense. I turn, and what you want to make sure is you're not getting movement at the ankle joint, and you turn internally. The other way to look and insure that you're getting the tibia is that the tibial tuberosity is moving. It says in the books if you look, it can be anywhere from 20 to 30 degrees of internal and 40 degrees of external. You're doing pretty good, so nothing major to find there.

There is an exercise we will show, that can help with that. The reason it becomes important as well, is that if you don't have that internal and external rotation as you go through flexion/extension, it increases the compressor forces on the meniscus. Ultimately what will happen overtime if you lack those ranges is the meniscus will start to wear. Many athletes suffer from meniscal tears; they can be acute, but a lot of times, it's just the gradual wear-and-tear. Again, 90; just checking for the quality of internal, quality of external. In this position, you can even use that as immobilization. You can easily just gently take them in and work it a little bit.

Joel: Going back to last week, maybe just give us a little bit of insight of how those micro movements of the foot can maybe effect the movement in the knee.

Gerry: Right; or vice-versa. When we're talking about the major movement of the foot being pronation and supination, and being a combination of all the joints of the foot: The forefoot, mid- foot, subtalar joint contributing to that. Likewise, if the tibia isn't internally rotating properly, it's very hard to get controlled pronation of the foot because that tibial internal rotation has an influence on the rear foot. If the tibia is moving properly, that will influence how the ankle joint moves. If you're lacking in terms of your tibial rotation, often what you'll see with some people is a very quick pronatory moment, where they go from supination really rapidly into pronation. It can be attributed to poor tibial movement.

The other thing about the knee which is often forgotten is the patella; the knee cap. It sits there and everyone knows it's there but it never gets much attention. There are a number of ligaments which attach to the patella and keep it in its anatomical position. It's good just to have with the leg relaxed, and then just get a general feel for the quality and smoothness of that movement medially and laterally, and up and down. Often what you'll find is that in one direction that patella doesn't want to move. As a result, that alters the propriosetptive information, in regards to movement in the knee, which again, will have influence on muscle firing patterns, often the VMO. We talk about VMO inactivity with knee issues.

What we've seen with working with athletes is that when the patella cannot move freely, as particularly from medial to lateral, involving the medial ligaments that provide support to the patella, that lack of movement often correlates to lack of activity within VMO. Just something to think about.

Joel: I know you said there's a simple exercise or drill that we can have athletes on their own, do to improve.

Gerry: Just to improve the tibial mobility or at least to see how they feel when they do that and it'll help to improve mobility.

Joel: Great. Let's check that out.

Gerry: We've been talking about mobility of the knee. Previously, we spoke about mobility of the ankle, and we're going to speak about mobility of the hip in the future. This is an exercise that encourages an increase in mobility that will work for all 3 joints. What we're going to do . . . Howie's supporting himself with the hurdle here. We're going to have him have a slight degree of dorsiflexion, some knee flexion here, and then slight flexion at the hip; he's in a nice upright posture. What we're going to have him do is he's going to swing that front leg, and he's just going to go into internal and external rotation. You can see what's happening; he's getting nice internal rotation at the ankle and external. He's keeping the foot controlled, so he's not rolling the medial border up; he's not rolling off the lateral border. He's keeping the foot on the floor, which will then allow a nice movement about the ankle, and you can see that.

You can see the knee is going through internal and external, which we were assessing earlier. It's just a nice, controlled way to allow for that motion to occur. Then likewise, with the slight degree of flexion in the hip and the way he's opening up, you're getting a nice movement in both internal and external rotation of the hip. You can have an athlete do that 30 seconds to 1 minute, and it's just a nice way of hitting both foot, ankle, knee, hip, even spine.

Joel: I know you said that there's some athletes that you would not recommend do this exercise, right?

Gerry: Yeah. If you have someone that you know that has a significant ankle injury or they have some issues in the knee that has not been looked at and assessed, and this being checked off with a provider, the only risk there is because we're encouraging internal and external rotation, if there is any type of mechanical issue restricting that, we don't want to risk causing more injury to the knee or potential issues with the meniscus. You just got to be careful with that.

Joel: Other than that, you're good to go?

Gerry: Other than that, should be good to go.

Joel: That's something you do every day, every other day? How often would you do that?

Gerry: In that controlled manner, in a nice, easy motion and within the limits of comfort; you don't want to push it, go fast, or go crazy with the range, you could do that daily.

Joel: Nice. Thanks again for coming in. Like you said, next week, we're going to be covering the hip, talk about how this all ties together and work its way up the chain. Thanks again for watching this episode of 8 Weeks Out TV. We'll have more again for you with Dr. Gerry (?) next week.

Jim: I'm Jim Laret; I'm the owner of J&M Strength and Conditioning, in Lexington, Kentucky. I was in wrestling, I was in football, and that's what got me into strength training. I did my first power lifting meet in 2002; [inaudible: 09:34] the number of times. My best competition total was just under 2,200 pounds, at 242.

Before I started using HRV, I basically just went as hard as I could all the time, and I just pushed, and pushed, and pushed. I almost died of ulcerative colitis because I pushed myself so hard for so long. The HRV actually keeps me from doing that, because I wake up every day and if my line keeps going down, I know I'm on a path for destruction, and then I'm now able to say, "Man. I need to take more time to recover. I need to do more meditation."

I'm able to pull 90% of what I did in competition quite easily on a regular basis with very little work. If you're a gym owner, the logistics of dealing with the city and permits, and all that kind of stuff. My training has taken a backseat, but I'm still putting up really nice numbers with a lot less work because I'm taking a lot better care of myself due to the accountability of the HRV app.

It also allows me to make adjustments that other coaches can't make, and it allows me to educate my clients using that tool on how stress affects them. We can see if they're actually adapting to training; we can see if we're pushing them hard enough. It's really the way of the future of training. This is not only great for power lifters; this is great for anyone to see how their body handles stress.

A lot of people that come to us, their diet's so horrible, their sleep is terrible; training is just going to bury them. Basically, I've been doing some form of strength training since I was 12. I've seen every trend you can imagine come and go. There's several things that are consistent: You have to lift weights to get stronger. You have to stick to fundamentals. This is one thing I see that's a game-changer.

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