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Many people suffer from temporary or chronic musculoskeletal issues that cause pain and discomfort when performing even the simplest forms of physical activity. The BioMechanics Method for Corrective Exercise With Online Video is designed to help fitness professionals, athletic trainers, strength and conditioning specialists, and physical therapists to identify and correct underlying imbalances so their clients and patients can resume pain-free movement.
Written by Justin Price, creator of The BioMechanics Method and a former IDEA Health & Fitness Association Personal Trainer of the Year, The BioMechanics Method for Corrective Exercise provides a systematic approach for applying effective corrective exercise strategies to assess and address muscle and joint pain:
• Identify and assess common musculoskeletal imbalances
• Understand how those imbalances affect different structures of the body
• Learn about the various types of corrective exercises
• Select appropriate exercise strategies for a client’s circumstances
• Design a corrective exercise program that addresses the underlying cause or causes
To fully equip professionals with various options to address their clients’ needs, part IV of the text, Complete Corrective Exercise Library, contains more than 65 self-myofascial release, stretching, and strengthening exercises along with suggestions for exercise progressions and regressions. Each technique is supplemented with full-color photos, and additional illustrations and tables aid with proper execution. Plus, the companion online video features 36 clips that provide the opportunity to directly observe and follow along with the application of many of these remarkable assessment and exercise techniques.
The BioMechanics Method for Corrective Exercise also offers practical advice and tools to further enhance the skills learned from the text. Strategies and examples for communicating with clients are integrated throughout to facilitate effective consultations and proper cuing for both the assessments and exercises. Skill acquisition activities and self-checks in every chapter allow readers to practice and perfect the real-life application of their techniques. A case study pulls it all together to demonstrate how the entire process can be implemented, from assessment to program design.
Finally, to capitalize on the specialized skills that are developed by reading this text, the final section of the book is devoted to creating and managing a corrective exercise business. It covers information on networking and referral systems, tips for maintaining scope of practice, and marketing and promotion methods for attracting and retaining clients.
The practices outlined in The BioMechanics Method for Corrective Exercise have been proven successful by thousands of The BioMechanics Method Corrective Exercise Specialists around the world. Mastering the strategies and techniques in this book will enable health and fitness professionals to recognize potential causes of musculoskeletal imbalances and apply appropriate corrective exercises to swiftly eliminate pain and improve physical function.
Part I. Fundamentals of Structural Assessment
Chapter 1. The Process of Structural Assessment
Initial Contact With Client
Structural Assessment Process
Review of Key Points
Self-Check
Chapter 2. Assessing the Feet and Ankles
Basic Anatomy
Common Deviations
Assessment Process
How the Feet and Ankles Relate to the Knees
Review of Key Points
Self-Check
Structural Assessment Skills Test
Chapter 3. Assessing the Knees
Basic Anatomy
Common Deviations
Assessment Process
Teaching Clients Neutral Position of the Knee
How the Knees Relate to the Feet and the Lumbo-Pelvic Hip Girdle
Review of Key Points
Self-Check
Structural Assessment Skills Test
Chapter 4. Assessing the Lumbo-Pelvic Hip Girdle
Basic Anatomy
Common Deviations
Assessment Process
Teaching Clients Neutral Position of the Lumbo-Pelvic Hip Girdle
How the Lumbo-Pelvic Hip Girdle Relates to the Feet, Ankles, Knees, and Thoracic Spine and Shoulder Girdle
Review of Key Points
Self-Check
Structural Assessment Skills Test
Chapter 5. Assessing the Thoracic Spine and Shoulder Girdle
Basic Anatomy
Common Deviations
Assessment Process
Teaching Clients Neutral Position of the Thoracic Spine and Shoulder Girdle
How the Thoracic Spine and Shoulder Girdle Relate to All Other Areas of the Body
Review of Key Points
Self-Check
Structural Assessment Skills Test
Chapter 6. Assessing the Neck and Head
Basic Anatomy
Common Deviations
Assessment Process
Teaching Clients Neutral Position of the Neck and Head
How the Head and Neck Relate to the Rest of the Body
Concluding the Structural Assessment Process
Review of Key Points
Self-Check
Structural Assessment Skills Test
Part II. Understanding Muscles and Movement
Chapter 7. Anatomy in Real Life
How Gravity Affects Movement
How Ground Reaction Forces Affect Movement
Overview of the Musculoskeletal System
Human Bungee Cord System
Review of Key Points
Self-Check
Chapter 8. Functional Anatomy of the Feet and Ankles
Bones and Joints
Soft Tissue Structures
Muscles
Effect of Foot and Ankle Muscles on the Most Common Musculoskeletal Deviations
Review of Key Points
Self-Check
Chapter 9. Functional Anatomy of the Knees
Bones and Joints
Soft Tissue Structures
Muscles
Effect of Knee Muscles on the Most Common Musculoskeletal Deviations
Review of Key Points
Self-Check
Chapter 10. Functional Anatomy of the Lumbo-Pelvic Hip Girdle
Bones and Joints
Soft Tissue Structures
Muscles
Effect of Lumbo-Pelvic Hip Girdle Muscles on the Most Common Musculoskeletal Deviations
Review of Key Points
Self-Check
Chapter 11. Functional Anatomy of the Thoracic Spine and Shoulder Girdle
Bones and Joints
Soft Tissue Structures
Muscles
Effect of the Thoracic Spine and Shoulder Girdle Muscles on the Most Common Musculoskeletal Deviations
Review of Key Points
Self-Check
Chapter 12. Functional Anatomy of the Neck and Head
Bones and Joints
Soft Tissue Structures
Muscles
Effect of the Neck and Head Muscles on the Most Common Musculoskeletal Deviations
Review of Key Points
Self-Check
Chapter 13. Fascia
Fascial Systems for Flexion and Extension
Fascial Systems for Lateral Movement
Fascial Systems for Rotational Movement
Fascial Systems and Complex Movement
Review of Key Points
Self-Check
Part III. Fundamentals of Corrective Exercise
Chapter 14. Elements of Corrective Exercise Programs
Building Client Confidence
Order of Exercises
Evaluating Exercises
Review of Key Points
Self-Check
Chapter 15. Self-Myofascial Release
What Is Self-Myofascial Release?
Origins of Self-Myofascial Release
Benefits of Self-Myofascial Release
Types of Self-Myofascial Release
Teaching Tips for Self-Myofascial Release Techniques
When Not to Use Self-Myofascial Release Techniques
Additional Considerations
Review of Key Points
Self-Check
Chapter 16. Stretching
What Is Stretching?
Origins of Stretching
Benefits of Stretching
Types of Stretches
Teaching Tips for Stretching Exercises
When Not to Use Stretching Exercises
Additional Considerations
Review of Key Points
Self-Check
Chapter 17. Strengthening
What Is Strengthening?
Origins of Strengthening Exercises
Benefits of Strengthening Exercises
Types of Strengthening Exercises
Teaching Tips for Strengthening Exercises
When Not to Use Strengthening Exercises
Additional Considerations
Review of Key Points
Self-Check
Chapter 18. Static Postural Considerations
Standing Postures
Seated Postures
Sleeping Postures
Review of Key Points
Self-Check 1
Self-Check 2
Part IV. Complete Corrective Exercise Library
Chapter 19. Self-Myofascial Release Exercises
Self-Myofascial Release Quick Tips
Self-Myofascial Release Exercise Library
Review of Key Points
Self-Check
Chapter 20. Stretching Exercises
Stretching Exercise Quick Tips
Stretching Exercise Library
Review of Key Points
Self-Check
Chapter 21. Strengthening Exercises
Strengthening Exercise Quick Tips
Strengthening Exercise Library
Review of Key Points
Self-Check
Part V. Corrective Exercise Program Design
Chapter 22. Building Successful Client Relationships
Understanding Basic Motivations and Behavior
How Roles Affect Behavior
Encouraging Client Participation
Functioning as a Facilitator
Review of Key Points
Self-Check
Chapter 23. Conducting Consultations
First Contact
Verbal Assessment Process
Visual and Hands-On Assessment Process
Closing the Deal
Review of Key Points
Self-Check 1
Self-Check 2
Chapter 24. Structuring Sessions and Programs
Beginning and Building Programs
Practical Considerations for Beginning and Building Programs
Review of Key Points
Self-Check
Chapter 25. Sample Sessions and Program
Client Background Information
Client Goals
Structural Assessment Results
Exercise Programming and Recommendations
Case Study Conclusion
Documenting Your Own Clients’ Homework
Self-Check
Part VI. Business of Corrective Exercise
Chapter 26. Enhancing Your Professional Image
Perfecting Your Protocols and Procedures
Improving Your Image to Attract New Clients
Integrating Corrective Exercise Protocols With Current Clients
Keys to Success
Review of Key Points
Self-Check
Chapter 27. Marketing Your Corrective Exercise Services
Understanding How Marketing Works
Creating Marketing Messages
Evaluating Delivery Methods
Implementing Your Marketing Strategy
Transitioning to a Full-Time Corrective Exercise Specialist
Review of Key Points
Self-Check
Chapter 28. Scope of Practice, Networks, and Referrals
Maintaining Your Scope of Practice
Developing Professional Networks and Referrals
Social Media and Networking Groups
Networking With Your Clients
Review of Key Points
Self-Check
Appendix. Blank Client Assessment Diagram
Justin Price is the creator of The BioMechanics Method, a systematic process used to assess and correct the underlying causes of musculoskeletal pain and dysfunction. Thousands of health and fitness professionals in more than 60 countries have earned The BioMechanics Method Corrective Exercise Specialist (TBMM-CES) credential—the highest-rated corrective exercise program in the industry.
Known as one of the top musculoskeletal assessment and corrective exercise experts in the world, Price was named the Personal Trainer of the Year by the IDEA Health & Fitness Association in 2006. He is a subject matter expert on corrective exercise for the American Council on Exercise, BOSU, TRX (Fitness Anywhere), Personal Training on the Net, and PTA Global.
Price has also authored The Complete Idiot’s Guide to Functional Training Illustrated and The Amazing Tennis Ball Back Pain Cure. He has been an expert consultant for Arthritis Today, BBC, Chicago Tribune, Discovery Health, Fox News, Los Angeles Times, Men’s Health, MSNBC, New York Times, Newsweek, Time, Wall Street Journal, WebMD, and Women’s Health & Fitness.
“[T]he information in The BioMechanics Method for Corrective Exercise is provided in a very methodological, step-by-step manner that will serve the reader well in determining which corrective exercise pathway is best for them to explore.”
—Taylor-Kevin Isaacs, MS, CPT-MES, CSCS, NASM-CES, MELT, Award-Winning Kinesiologist and Exercise Physiologist
Foam rolling the hip flexor group of muscles
Exercise benefits: Rejuvenating and regenerating the hip flexor muscles will help the lumbar spine flex, enabling the pelvis to posteriorly rotate more effectively.
Area(s) of body: Lumbo-pelvic hip girdle
Imbalance(s): Anterior pelvic tilt, excessive lumbar lordosis, valgus knee position, lack of dorsiflexion, overpronation
Structures addressed: Hip flexor group of muscles
Exercise benefits: Rejuvenating and regenerating the hip flexor muscles will help the lumbar spine flex, enabling the pelvis to posteriorly rotate more effectively. The hip flexors also work eccentrically to slow down internal rotation and extension of the leg. Therefore, flexibility in these tissues will also help promote better movement of the hip, leg, knee, and ankle.
How to perform
- Place the roller perpendicular to the front of the body, and lie over it at hip level.
- Find a sore spot on the front of the hips, and hold body weight on it for a few seconds to help the tissues release.
- Move the upper body to roll to different sore spots on the upper leg; keep the abdominals engaged to ensure that the lower back does not arch too much.
Duration and repetitions: Roll for 30 seconds to 1 minute on each side at least once per day.
Tip: Angle the roller so that it is in line with the crease of the groin (i.e., at 45 degrees to the hip and leg) to increase the pressure of the massage.
Progress: Perform the Hip Flexor Stretch (Sagittal).
Regress: Use a tennis ball to massage the hip flexors (see detailed information in next exercise).
How the knees relate to the feet and ankles and the lumbo-pelvic hip girdle
The knee is the structure that bridges the feet and ankles and the lumbo-pelvic hip girdle. Therefore, any imbalances or malalignments in the structures above or below it will directly affect how the knee feels and functions.
The knee is the structure that bridges the feet and ankles and the lumbo-pelvic hip girdle. Therefore, any imbalances or malalignments in the structures above or below it will directly affect how the knee feels and functions. For example, during the single-leg squat assessment, you should have noticed that a valgus knee is usually accompanied by overpronation of the foot and ankle complex. This is because as the foot and ankle collapse toward the midline during overpronation, the lower leg also rotates inward excessively, pulling the knee into a valgus position. This movement of the knee also causes the thighbone to rotate inward, affecting the position of the hip socket (where the upper leg articulates with the pelvis). Because of this change in position of the upper leg and hip socket, the pelvis shifts out of alignment by rotating down and forward. This change in position of the pelvis causes the lower back to arch excessively (see figure 3.9) (Kendall, McCreary, and Provance 2005; Price and Bratcher 2010).
Figure 3.9 Compensations of pelvis caused by excessive inward rotation of upper and lower leg.
Figure 3.10 Sample of completed knee assessment on Client Assessment Diagram.
Review of Key Points
The knee joint is primarily a hinge joint that connects the lower leg and the upper leg. Malalignments or imbalances in the more mobile joints of the feet and ankles or the lumbo-pelvic hip girdle will affect their connection point, the knees.
- The two most common deviations found in the knees are
- problems with side-to-side alignment (e.g., valgus knee position) and
- tracking problems during flexion and extension.
- Apart from instances of acute trauma, knee pain is usually caused by imbalances in the structures above and below the knee joint. Therefore, the overall health and function of the feet and ankles and the lumbo-pelvic hip girdle directly affect the condition of the knees.
- Placing the feet and ankles into a neutral position when standing will most likely bring the knees into proper alignment. Overpronation of the feet and ankles causes the lower and upper leg to rotate too far inward, moving the knee toward the midline.
- When you learn about the types and intensity of physical activity people engage in, you can better understand the amount of stress they place on their knees. Identifying the activities that cause or reduce pain can help you determine what soft tissue structures may be irritated or dysfunctional.
- Popping or grinding noises that occur when a person sits down, stands up, or otherwise flexes and extends the knee suggest tracking problems.
- Record any pertinent information on the Client Assessment Diagram.
Self-Check
The condition of your knees can act as an early warning system for potential musculoskeletal imbalances in the feet and ankles or in the lumbo-pelvic hip girdle. Assess your own knees, and mark the grade you would give yourself on the following knee health report card.
Learn more about the hamstring group
Muscle specifics: A hamstring muscle on the back of the leg. It originates on the ischial tuberosity of the pelvis (i.e., the “sit bone”), travels down the back of the upper leg, crosses the knee joint, and inserts on the medial side of the tibia a little lower down than the semimembranosus (Agur and Dalley 2013).
Semitendinosus (Hamstring Group)
Muscle specifics: A hamstring muscle on the back of the leg. It originates on the ischial tuberosity of the pelvis (i.e., the “sit bone”), travels down the back of the upper leg, crosses the knee joint, and inserts on the medial side of the tibia a little lower down than the semimembranosus (Agur and Dalley 2013).
Muscle action(s): Bends (flexes) the knee and pushes (extends) the hips forward. It also helps with inward rotation of the leg when the knee is bent (Gray 1995).
Real-life movements: The bungee cord action of the semitendinosus muscle helps decelerate flexion of the hips when the knee is relatively straight. This motion helps load the muscle with potential energy that is then used to help extend the hips when a person stands erect.
Real-life movement example: Acts like a bungee cord to decelerate flexion of the hips during movements such as bending forward at the waist to pat a dog or tie your shoe laces. Since the semitendinosus inserts at the tibia, it also helps control the rotation of the lower leg during weight-bearing activities like walking and running.
Helpful tips: The semitendinosus muscle works in concert with the semimembranosus muscle to help minimize stress to the knees, hips, and lower back.
Biceps Femoris (Hamstring Group)
Muscle specifics: A hamstring muscle on the back of the leg. It has two origin points: The long head originates on the ischial tuberosity of the pelvis (i.e., “the sit bone”), and the short head originates lower down on the femur. The muscle travels down the back of the upper leg, crosses the knee joint, and inserts on the outside of the fibula and tibia (Agur and Dalley 2013).
Muscle action(s): Both the long head and the short head of the biceps femoris are responsible for bending the knee (knee extension), and the long head also helps extend the hips. Both heads help with outward rotation of the leg when the knee is bent (Gray 1995).
Real-life movements: The bungee cord action of the biceps femoris helps decelerate flexion of the hips and extension of the knee. It also helps decelerate internal rotation of the lower leg.
Real-life movement example: Acts like a bungee cord to decelerate hip flexion during movements such as bending over at the waist to touch your toes or pick a flower. It also helps control internal rotation of the lower leg during weight-bearing activities like walking and running.
Helpful tips: All of the hamstring muscles work in concert like guide ropes coming up from the lower leg to help control movement of the hips, pelvis, and lower back during weight-bearing activities.
Foam rolling the hip flexor group of muscles
Exercise benefits: Rejuvenating and regenerating the hip flexor muscles will help the lumbar spine flex, enabling the pelvis to posteriorly rotate more effectively.
Area(s) of body: Lumbo-pelvic hip girdle
Imbalance(s): Anterior pelvic tilt, excessive lumbar lordosis, valgus knee position, lack of dorsiflexion, overpronation
Structures addressed: Hip flexor group of muscles
Exercise benefits: Rejuvenating and regenerating the hip flexor muscles will help the lumbar spine flex, enabling the pelvis to posteriorly rotate more effectively. The hip flexors also work eccentrically to slow down internal rotation and extension of the leg. Therefore, flexibility in these tissues will also help promote better movement of the hip, leg, knee, and ankle.
How to perform
- Place the roller perpendicular to the front of the body, and lie over it at hip level.
- Find a sore spot on the front of the hips, and hold body weight on it for a few seconds to help the tissues release.
- Move the upper body to roll to different sore spots on the upper leg; keep the abdominals engaged to ensure that the lower back does not arch too much.
Duration and repetitions: Roll for 30 seconds to 1 minute on each side at least once per day.
Tip: Angle the roller so that it is in line with the crease of the groin (i.e., at 45 degrees to the hip and leg) to increase the pressure of the massage.
Progress: Perform the Hip Flexor Stretch (Sagittal).
Regress: Use a tennis ball to massage the hip flexors (see detailed information in next exercise).
How the knees relate to the feet and ankles and the lumbo-pelvic hip girdle
The knee is the structure that bridges the feet and ankles and the lumbo-pelvic hip girdle. Therefore, any imbalances or malalignments in the structures above or below it will directly affect how the knee feels and functions.
The knee is the structure that bridges the feet and ankles and the lumbo-pelvic hip girdle. Therefore, any imbalances or malalignments in the structures above or below it will directly affect how the knee feels and functions. For example, during the single-leg squat assessment, you should have noticed that a valgus knee is usually accompanied by overpronation of the foot and ankle complex. This is because as the foot and ankle collapse toward the midline during overpronation, the lower leg also rotates inward excessively, pulling the knee into a valgus position. This movement of the knee also causes the thighbone to rotate inward, affecting the position of the hip socket (where the upper leg articulates with the pelvis). Because of this change in position of the upper leg and hip socket, the pelvis shifts out of alignment by rotating down and forward. This change in position of the pelvis causes the lower back to arch excessively (see figure 3.9) (Kendall, McCreary, and Provance 2005; Price and Bratcher 2010).
Figure 3.9 Compensations of pelvis caused by excessive inward rotation of upper and lower leg.
Figure 3.10 Sample of completed knee assessment on Client Assessment Diagram.
Review of Key Points
The knee joint is primarily a hinge joint that connects the lower leg and the upper leg. Malalignments or imbalances in the more mobile joints of the feet and ankles or the lumbo-pelvic hip girdle will affect their connection point, the knees.
- The two most common deviations found in the knees are
- problems with side-to-side alignment (e.g., valgus knee position) and
- tracking problems during flexion and extension.
- Apart from instances of acute trauma, knee pain is usually caused by imbalances in the structures above and below the knee joint. Therefore, the overall health and function of the feet and ankles and the lumbo-pelvic hip girdle directly affect the condition of the knees.
- Placing the feet and ankles into a neutral position when standing will most likely bring the knees into proper alignment. Overpronation of the feet and ankles causes the lower and upper leg to rotate too far inward, moving the knee toward the midline.
- When you learn about the types and intensity of physical activity people engage in, you can better understand the amount of stress they place on their knees. Identifying the activities that cause or reduce pain can help you determine what soft tissue structures may be irritated or dysfunctional.
- Popping or grinding noises that occur when a person sits down, stands up, or otherwise flexes and extends the knee suggest tracking problems.
- Record any pertinent information on the Client Assessment Diagram.
Self-Check
The condition of your knees can act as an early warning system for potential musculoskeletal imbalances in the feet and ankles or in the lumbo-pelvic hip girdle. Assess your own knees, and mark the grade you would give yourself on the following knee health report card.
Learn more about the hamstring group
Muscle specifics: A hamstring muscle on the back of the leg. It originates on the ischial tuberosity of the pelvis (i.e., the “sit bone”), travels down the back of the upper leg, crosses the knee joint, and inserts on the medial side of the tibia a little lower down than the semimembranosus (Agur and Dalley 2013).
Semitendinosus (Hamstring Group)
Muscle specifics: A hamstring muscle on the back of the leg. It originates on the ischial tuberosity of the pelvis (i.e., the “sit bone”), travels down the back of the upper leg, crosses the knee joint, and inserts on the medial side of the tibia a little lower down than the semimembranosus (Agur and Dalley 2013).
Muscle action(s): Bends (flexes) the knee and pushes (extends) the hips forward. It also helps with inward rotation of the leg when the knee is bent (Gray 1995).
Real-life movements: The bungee cord action of the semitendinosus muscle helps decelerate flexion of the hips when the knee is relatively straight. This motion helps load the muscle with potential energy that is then used to help extend the hips when a person stands erect.
Real-life movement example: Acts like a bungee cord to decelerate flexion of the hips during movements such as bending forward at the waist to pat a dog or tie your shoe laces. Since the semitendinosus inserts at the tibia, it also helps control the rotation of the lower leg during weight-bearing activities like walking and running.
Helpful tips: The semitendinosus muscle works in concert with the semimembranosus muscle to help minimize stress to the knees, hips, and lower back.
Biceps Femoris (Hamstring Group)
Muscle specifics: A hamstring muscle on the back of the leg. It has two origin points: The long head originates on the ischial tuberosity of the pelvis (i.e., “the sit bone”), and the short head originates lower down on the femur. The muscle travels down the back of the upper leg, crosses the knee joint, and inserts on the outside of the fibula and tibia (Agur and Dalley 2013).
Muscle action(s): Both the long head and the short head of the biceps femoris are responsible for bending the knee (knee extension), and the long head also helps extend the hips. Both heads help with outward rotation of the leg when the knee is bent (Gray 1995).
Real-life movements: The bungee cord action of the biceps femoris helps decelerate flexion of the hips and extension of the knee. It also helps decelerate internal rotation of the lower leg.
Real-life movement example: Acts like a bungee cord to decelerate hip flexion during movements such as bending over at the waist to touch your toes or pick a flower. It also helps control internal rotation of the lower leg during weight-bearing activities like walking and running.
Helpful tips: All of the hamstring muscles work in concert like guide ropes coming up from the lower leg to help control movement of the hips, pelvis, and lower back during weight-bearing activities.
Foam rolling the hip flexor group of muscles
Exercise benefits: Rejuvenating and regenerating the hip flexor muscles will help the lumbar spine flex, enabling the pelvis to posteriorly rotate more effectively.
Area(s) of body: Lumbo-pelvic hip girdle
Imbalance(s): Anterior pelvic tilt, excessive lumbar lordosis, valgus knee position, lack of dorsiflexion, overpronation
Structures addressed: Hip flexor group of muscles
Exercise benefits: Rejuvenating and regenerating the hip flexor muscles will help the lumbar spine flex, enabling the pelvis to posteriorly rotate more effectively. The hip flexors also work eccentrically to slow down internal rotation and extension of the leg. Therefore, flexibility in these tissues will also help promote better movement of the hip, leg, knee, and ankle.
How to perform
- Place the roller perpendicular to the front of the body, and lie over it at hip level.
- Find a sore spot on the front of the hips, and hold body weight on it for a few seconds to help the tissues release.
- Move the upper body to roll to different sore spots on the upper leg; keep the abdominals engaged to ensure that the lower back does not arch too much.
Duration and repetitions: Roll for 30 seconds to 1 minute on each side at least once per day.
Tip: Angle the roller so that it is in line with the crease of the groin (i.e., at 45 degrees to the hip and leg) to increase the pressure of the massage.
Progress: Perform the Hip Flexor Stretch (Sagittal).
Regress: Use a tennis ball to massage the hip flexors (see detailed information in next exercise).
How the knees relate to the feet and ankles and the lumbo-pelvic hip girdle
The knee is the structure that bridges the feet and ankles and the lumbo-pelvic hip girdle. Therefore, any imbalances or malalignments in the structures above or below it will directly affect how the knee feels and functions.
The knee is the structure that bridges the feet and ankles and the lumbo-pelvic hip girdle. Therefore, any imbalances or malalignments in the structures above or below it will directly affect how the knee feels and functions. For example, during the single-leg squat assessment, you should have noticed that a valgus knee is usually accompanied by overpronation of the foot and ankle complex. This is because as the foot and ankle collapse toward the midline during overpronation, the lower leg also rotates inward excessively, pulling the knee into a valgus position. This movement of the knee also causes the thighbone to rotate inward, affecting the position of the hip socket (where the upper leg articulates with the pelvis). Because of this change in position of the upper leg and hip socket, the pelvis shifts out of alignment by rotating down and forward. This change in position of the pelvis causes the lower back to arch excessively (see figure 3.9) (Kendall, McCreary, and Provance 2005; Price and Bratcher 2010).
Figure 3.9 Compensations of pelvis caused by excessive inward rotation of upper and lower leg.
Figure 3.10 Sample of completed knee assessment on Client Assessment Diagram.
Review of Key Points
The knee joint is primarily a hinge joint that connects the lower leg and the upper leg. Malalignments or imbalances in the more mobile joints of the feet and ankles or the lumbo-pelvic hip girdle will affect their connection point, the knees.
- The two most common deviations found in the knees are
- problems with side-to-side alignment (e.g., valgus knee position) and
- tracking problems during flexion and extension.
- Apart from instances of acute trauma, knee pain is usually caused by imbalances in the structures above and below the knee joint. Therefore, the overall health and function of the feet and ankles and the lumbo-pelvic hip girdle directly affect the condition of the knees.
- Placing the feet and ankles into a neutral position when standing will most likely bring the knees into proper alignment. Overpronation of the feet and ankles causes the lower and upper leg to rotate too far inward, moving the knee toward the midline.
- When you learn about the types and intensity of physical activity people engage in, you can better understand the amount of stress they place on their knees. Identifying the activities that cause or reduce pain can help you determine what soft tissue structures may be irritated or dysfunctional.
- Popping or grinding noises that occur when a person sits down, stands up, or otherwise flexes and extends the knee suggest tracking problems.
- Record any pertinent information on the Client Assessment Diagram.
Self-Check
The condition of your knees can act as an early warning system for potential musculoskeletal imbalances in the feet and ankles or in the lumbo-pelvic hip girdle. Assess your own knees, and mark the grade you would give yourself on the following knee health report card.
Learn more about the hamstring group
Muscle specifics: A hamstring muscle on the back of the leg. It originates on the ischial tuberosity of the pelvis (i.e., the “sit bone”), travels down the back of the upper leg, crosses the knee joint, and inserts on the medial side of the tibia a little lower down than the semimembranosus (Agur and Dalley 2013).
Semitendinosus (Hamstring Group)
Muscle specifics: A hamstring muscle on the back of the leg. It originates on the ischial tuberosity of the pelvis (i.e., the “sit bone”), travels down the back of the upper leg, crosses the knee joint, and inserts on the medial side of the tibia a little lower down than the semimembranosus (Agur and Dalley 2013).
Muscle action(s): Bends (flexes) the knee and pushes (extends) the hips forward. It also helps with inward rotation of the leg when the knee is bent (Gray 1995).
Real-life movements: The bungee cord action of the semitendinosus muscle helps decelerate flexion of the hips when the knee is relatively straight. This motion helps load the muscle with potential energy that is then used to help extend the hips when a person stands erect.
Real-life movement example: Acts like a bungee cord to decelerate flexion of the hips during movements such as bending forward at the waist to pat a dog or tie your shoe laces. Since the semitendinosus inserts at the tibia, it also helps control the rotation of the lower leg during weight-bearing activities like walking and running.
Helpful tips: The semitendinosus muscle works in concert with the semimembranosus muscle to help minimize stress to the knees, hips, and lower back.
Biceps Femoris (Hamstring Group)
Muscle specifics: A hamstring muscle on the back of the leg. It has two origin points: The long head originates on the ischial tuberosity of the pelvis (i.e., “the sit bone”), and the short head originates lower down on the femur. The muscle travels down the back of the upper leg, crosses the knee joint, and inserts on the outside of the fibula and tibia (Agur and Dalley 2013).
Muscle action(s): Both the long head and the short head of the biceps femoris are responsible for bending the knee (knee extension), and the long head also helps extend the hips. Both heads help with outward rotation of the leg when the knee is bent (Gray 1995).
Real-life movements: The bungee cord action of the biceps femoris helps decelerate flexion of the hips and extension of the knee. It also helps decelerate internal rotation of the lower leg.
Real-life movement example: Acts like a bungee cord to decelerate hip flexion during movements such as bending over at the waist to touch your toes or pick a flower. It also helps control internal rotation of the lower leg during weight-bearing activities like walking and running.
Helpful tips: All of the hamstring muscles work in concert like guide ropes coming up from the lower leg to help control movement of the hips, pelvis, and lower back during weight-bearing activities.
Foam rolling the hip flexor group of muscles
Exercise benefits: Rejuvenating and regenerating the hip flexor muscles will help the lumbar spine flex, enabling the pelvis to posteriorly rotate more effectively.
Area(s) of body: Lumbo-pelvic hip girdle
Imbalance(s): Anterior pelvic tilt, excessive lumbar lordosis, valgus knee position, lack of dorsiflexion, overpronation
Structures addressed: Hip flexor group of muscles
Exercise benefits: Rejuvenating and regenerating the hip flexor muscles will help the lumbar spine flex, enabling the pelvis to posteriorly rotate more effectively. The hip flexors also work eccentrically to slow down internal rotation and extension of the leg. Therefore, flexibility in these tissues will also help promote better movement of the hip, leg, knee, and ankle.
How to perform
- Place the roller perpendicular to the front of the body, and lie over it at hip level.
- Find a sore spot on the front of the hips, and hold body weight on it for a few seconds to help the tissues release.
- Move the upper body to roll to different sore spots on the upper leg; keep the abdominals engaged to ensure that the lower back does not arch too much.
Duration and repetitions: Roll for 30 seconds to 1 minute on each side at least once per day.
Tip: Angle the roller so that it is in line with the crease of the groin (i.e., at 45 degrees to the hip and leg) to increase the pressure of the massage.
Progress: Perform the Hip Flexor Stretch (Sagittal).
Regress: Use a tennis ball to massage the hip flexors (see detailed information in next exercise).
How the knees relate to the feet and ankles and the lumbo-pelvic hip girdle
The knee is the structure that bridges the feet and ankles and the lumbo-pelvic hip girdle. Therefore, any imbalances or malalignments in the structures above or below it will directly affect how the knee feels and functions.
The knee is the structure that bridges the feet and ankles and the lumbo-pelvic hip girdle. Therefore, any imbalances or malalignments in the structures above or below it will directly affect how the knee feels and functions. For example, during the single-leg squat assessment, you should have noticed that a valgus knee is usually accompanied by overpronation of the foot and ankle complex. This is because as the foot and ankle collapse toward the midline during overpronation, the lower leg also rotates inward excessively, pulling the knee into a valgus position. This movement of the knee also causes the thighbone to rotate inward, affecting the position of the hip socket (where the upper leg articulates with the pelvis). Because of this change in position of the upper leg and hip socket, the pelvis shifts out of alignment by rotating down and forward. This change in position of the pelvis causes the lower back to arch excessively (see figure 3.9) (Kendall, McCreary, and Provance 2005; Price and Bratcher 2010).
Figure 3.9 Compensations of pelvis caused by excessive inward rotation of upper and lower leg.
Figure 3.10 Sample of completed knee assessment on Client Assessment Diagram.
Review of Key Points
The knee joint is primarily a hinge joint that connects the lower leg and the upper leg. Malalignments or imbalances in the more mobile joints of the feet and ankles or the lumbo-pelvic hip girdle will affect their connection point, the knees.
- The two most common deviations found in the knees are
- problems with side-to-side alignment (e.g., valgus knee position) and
- tracking problems during flexion and extension.
- Apart from instances of acute trauma, knee pain is usually caused by imbalances in the structures above and below the knee joint. Therefore, the overall health and function of the feet and ankles and the lumbo-pelvic hip girdle directly affect the condition of the knees.
- Placing the feet and ankles into a neutral position when standing will most likely bring the knees into proper alignment. Overpronation of the feet and ankles causes the lower and upper leg to rotate too far inward, moving the knee toward the midline.
- When you learn about the types and intensity of physical activity people engage in, you can better understand the amount of stress they place on their knees. Identifying the activities that cause or reduce pain can help you determine what soft tissue structures may be irritated or dysfunctional.
- Popping or grinding noises that occur when a person sits down, stands up, or otherwise flexes and extends the knee suggest tracking problems.
- Record any pertinent information on the Client Assessment Diagram.
Self-Check
The condition of your knees can act as an early warning system for potential musculoskeletal imbalances in the feet and ankles or in the lumbo-pelvic hip girdle. Assess your own knees, and mark the grade you would give yourself on the following knee health report card.
Learn more about the hamstring group
Muscle specifics: A hamstring muscle on the back of the leg. It originates on the ischial tuberosity of the pelvis (i.e., the “sit bone”), travels down the back of the upper leg, crosses the knee joint, and inserts on the medial side of the tibia a little lower down than the semimembranosus (Agur and Dalley 2013).
Semitendinosus (Hamstring Group)
Muscle specifics: A hamstring muscle on the back of the leg. It originates on the ischial tuberosity of the pelvis (i.e., the “sit bone”), travels down the back of the upper leg, crosses the knee joint, and inserts on the medial side of the tibia a little lower down than the semimembranosus (Agur and Dalley 2013).
Muscle action(s): Bends (flexes) the knee and pushes (extends) the hips forward. It also helps with inward rotation of the leg when the knee is bent (Gray 1995).
Real-life movements: The bungee cord action of the semitendinosus muscle helps decelerate flexion of the hips when the knee is relatively straight. This motion helps load the muscle with potential energy that is then used to help extend the hips when a person stands erect.
Real-life movement example: Acts like a bungee cord to decelerate flexion of the hips during movements such as bending forward at the waist to pat a dog or tie your shoe laces. Since the semitendinosus inserts at the tibia, it also helps control the rotation of the lower leg during weight-bearing activities like walking and running.
Helpful tips: The semitendinosus muscle works in concert with the semimembranosus muscle to help minimize stress to the knees, hips, and lower back.
Biceps Femoris (Hamstring Group)
Muscle specifics: A hamstring muscle on the back of the leg. It has two origin points: The long head originates on the ischial tuberosity of the pelvis (i.e., “the sit bone”), and the short head originates lower down on the femur. The muscle travels down the back of the upper leg, crosses the knee joint, and inserts on the outside of the fibula and tibia (Agur and Dalley 2013).
Muscle action(s): Both the long head and the short head of the biceps femoris are responsible for bending the knee (knee extension), and the long head also helps extend the hips. Both heads help with outward rotation of the leg when the knee is bent (Gray 1995).
Real-life movements: The bungee cord action of the biceps femoris helps decelerate flexion of the hips and extension of the knee. It also helps decelerate internal rotation of the lower leg.
Real-life movement example: Acts like a bungee cord to decelerate hip flexion during movements such as bending over at the waist to touch your toes or pick a flower. It also helps control internal rotation of the lower leg during weight-bearing activities like walking and running.
Helpful tips: All of the hamstring muscles work in concert like guide ropes coming up from the lower leg to help control movement of the hips, pelvis, and lower back during weight-bearing activities.
Foam rolling the hip flexor group of muscles
Exercise benefits: Rejuvenating and regenerating the hip flexor muscles will help the lumbar spine flex, enabling the pelvis to posteriorly rotate more effectively.
Area(s) of body: Lumbo-pelvic hip girdle
Imbalance(s): Anterior pelvic tilt, excessive lumbar lordosis, valgus knee position, lack of dorsiflexion, overpronation
Structures addressed: Hip flexor group of muscles
Exercise benefits: Rejuvenating and regenerating the hip flexor muscles will help the lumbar spine flex, enabling the pelvis to posteriorly rotate more effectively. The hip flexors also work eccentrically to slow down internal rotation and extension of the leg. Therefore, flexibility in these tissues will also help promote better movement of the hip, leg, knee, and ankle.
How to perform
- Place the roller perpendicular to the front of the body, and lie over it at hip level.
- Find a sore spot on the front of the hips, and hold body weight on it for a few seconds to help the tissues release.
- Move the upper body to roll to different sore spots on the upper leg; keep the abdominals engaged to ensure that the lower back does not arch too much.
Duration and repetitions: Roll for 30 seconds to 1 minute on each side at least once per day.
Tip: Angle the roller so that it is in line with the crease of the groin (i.e., at 45 degrees to the hip and leg) to increase the pressure of the massage.
Progress: Perform the Hip Flexor Stretch (Sagittal).
Regress: Use a tennis ball to massage the hip flexors (see detailed information in next exercise).
How the knees relate to the feet and ankles and the lumbo-pelvic hip girdle
The knee is the structure that bridges the feet and ankles and the lumbo-pelvic hip girdle. Therefore, any imbalances or malalignments in the structures above or below it will directly affect how the knee feels and functions.
The knee is the structure that bridges the feet and ankles and the lumbo-pelvic hip girdle. Therefore, any imbalances or malalignments in the structures above or below it will directly affect how the knee feels and functions. For example, during the single-leg squat assessment, you should have noticed that a valgus knee is usually accompanied by overpronation of the foot and ankle complex. This is because as the foot and ankle collapse toward the midline during overpronation, the lower leg also rotates inward excessively, pulling the knee into a valgus position. This movement of the knee also causes the thighbone to rotate inward, affecting the position of the hip socket (where the upper leg articulates with the pelvis). Because of this change in position of the upper leg and hip socket, the pelvis shifts out of alignment by rotating down and forward. This change in position of the pelvis causes the lower back to arch excessively (see figure 3.9) (Kendall, McCreary, and Provance 2005; Price and Bratcher 2010).
Figure 3.9 Compensations of pelvis caused by excessive inward rotation of upper and lower leg.
Figure 3.10 Sample of completed knee assessment on Client Assessment Diagram.
Review of Key Points
The knee joint is primarily a hinge joint that connects the lower leg and the upper leg. Malalignments or imbalances in the more mobile joints of the feet and ankles or the lumbo-pelvic hip girdle will affect their connection point, the knees.
- The two most common deviations found in the knees are
- problems with side-to-side alignment (e.g., valgus knee position) and
- tracking problems during flexion and extension.
- Apart from instances of acute trauma, knee pain is usually caused by imbalances in the structures above and below the knee joint. Therefore, the overall health and function of the feet and ankles and the lumbo-pelvic hip girdle directly affect the condition of the knees.
- Placing the feet and ankles into a neutral position when standing will most likely bring the knees into proper alignment. Overpronation of the feet and ankles causes the lower and upper leg to rotate too far inward, moving the knee toward the midline.
- When you learn about the types and intensity of physical activity people engage in, you can better understand the amount of stress they place on their knees. Identifying the activities that cause or reduce pain can help you determine what soft tissue structures may be irritated or dysfunctional.
- Popping or grinding noises that occur when a person sits down, stands up, or otherwise flexes and extends the knee suggest tracking problems.
- Record any pertinent information on the Client Assessment Diagram.
Self-Check
The condition of your knees can act as an early warning system for potential musculoskeletal imbalances in the feet and ankles or in the lumbo-pelvic hip girdle. Assess your own knees, and mark the grade you would give yourself on the following knee health report card.
Learn more about the hamstring group
Muscle specifics: A hamstring muscle on the back of the leg. It originates on the ischial tuberosity of the pelvis (i.e., the “sit bone”), travels down the back of the upper leg, crosses the knee joint, and inserts on the medial side of the tibia a little lower down than the semimembranosus (Agur and Dalley 2013).
Semitendinosus (Hamstring Group)
Muscle specifics: A hamstring muscle on the back of the leg. It originates on the ischial tuberosity of the pelvis (i.e., the “sit bone”), travels down the back of the upper leg, crosses the knee joint, and inserts on the medial side of the tibia a little lower down than the semimembranosus (Agur and Dalley 2013).
Muscle action(s): Bends (flexes) the knee and pushes (extends) the hips forward. It also helps with inward rotation of the leg when the knee is bent (Gray 1995).
Real-life movements: The bungee cord action of the semitendinosus muscle helps decelerate flexion of the hips when the knee is relatively straight. This motion helps load the muscle with potential energy that is then used to help extend the hips when a person stands erect.
Real-life movement example: Acts like a bungee cord to decelerate flexion of the hips during movements such as bending forward at the waist to pat a dog or tie your shoe laces. Since the semitendinosus inserts at the tibia, it also helps control the rotation of the lower leg during weight-bearing activities like walking and running.
Helpful tips: The semitendinosus muscle works in concert with the semimembranosus muscle to help minimize stress to the knees, hips, and lower back.
Biceps Femoris (Hamstring Group)
Muscle specifics: A hamstring muscle on the back of the leg. It has two origin points: The long head originates on the ischial tuberosity of the pelvis (i.e., “the sit bone”), and the short head originates lower down on the femur. The muscle travels down the back of the upper leg, crosses the knee joint, and inserts on the outside of the fibula and tibia (Agur and Dalley 2013).
Muscle action(s): Both the long head and the short head of the biceps femoris are responsible for bending the knee (knee extension), and the long head also helps extend the hips. Both heads help with outward rotation of the leg when the knee is bent (Gray 1995).
Real-life movements: The bungee cord action of the biceps femoris helps decelerate flexion of the hips and extension of the knee. It also helps decelerate internal rotation of the lower leg.
Real-life movement example: Acts like a bungee cord to decelerate hip flexion during movements such as bending over at the waist to touch your toes or pick a flower. It also helps control internal rotation of the lower leg during weight-bearing activities like walking and running.
Helpful tips: All of the hamstring muscles work in concert like guide ropes coming up from the lower leg to help control movement of the hips, pelvis, and lower back during weight-bearing activities.
Foam rolling the hip flexor group of muscles
Exercise benefits: Rejuvenating and regenerating the hip flexor muscles will help the lumbar spine flex, enabling the pelvis to posteriorly rotate more effectively.
Area(s) of body: Lumbo-pelvic hip girdle
Imbalance(s): Anterior pelvic tilt, excessive lumbar lordosis, valgus knee position, lack of dorsiflexion, overpronation
Structures addressed: Hip flexor group of muscles
Exercise benefits: Rejuvenating and regenerating the hip flexor muscles will help the lumbar spine flex, enabling the pelvis to posteriorly rotate more effectively. The hip flexors also work eccentrically to slow down internal rotation and extension of the leg. Therefore, flexibility in these tissues will also help promote better movement of the hip, leg, knee, and ankle.
How to perform
- Place the roller perpendicular to the front of the body, and lie over it at hip level.
- Find a sore spot on the front of the hips, and hold body weight on it for a few seconds to help the tissues release.
- Move the upper body to roll to different sore spots on the upper leg; keep the abdominals engaged to ensure that the lower back does not arch too much.
Duration and repetitions: Roll for 30 seconds to 1 minute on each side at least once per day.
Tip: Angle the roller so that it is in line with the crease of the groin (i.e., at 45 degrees to the hip and leg) to increase the pressure of the massage.
Progress: Perform the Hip Flexor Stretch (Sagittal).
Regress: Use a tennis ball to massage the hip flexors (see detailed information in next exercise).
How the knees relate to the feet and ankles and the lumbo-pelvic hip girdle
The knee is the structure that bridges the feet and ankles and the lumbo-pelvic hip girdle. Therefore, any imbalances or malalignments in the structures above or below it will directly affect how the knee feels and functions.
The knee is the structure that bridges the feet and ankles and the lumbo-pelvic hip girdle. Therefore, any imbalances or malalignments in the structures above or below it will directly affect how the knee feels and functions. For example, during the single-leg squat assessment, you should have noticed that a valgus knee is usually accompanied by overpronation of the foot and ankle complex. This is because as the foot and ankle collapse toward the midline during overpronation, the lower leg also rotates inward excessively, pulling the knee into a valgus position. This movement of the knee also causes the thighbone to rotate inward, affecting the position of the hip socket (where the upper leg articulates with the pelvis). Because of this change in position of the upper leg and hip socket, the pelvis shifts out of alignment by rotating down and forward. This change in position of the pelvis causes the lower back to arch excessively (see figure 3.9) (Kendall, McCreary, and Provance 2005; Price and Bratcher 2010).
Figure 3.9 Compensations of pelvis caused by excessive inward rotation of upper and lower leg.
Figure 3.10 Sample of completed knee assessment on Client Assessment Diagram.
Review of Key Points
The knee joint is primarily a hinge joint that connects the lower leg and the upper leg. Malalignments or imbalances in the more mobile joints of the feet and ankles or the lumbo-pelvic hip girdle will affect their connection point, the knees.
- The two most common deviations found in the knees are
- problems with side-to-side alignment (e.g., valgus knee position) and
- tracking problems during flexion and extension.
- Apart from instances of acute trauma, knee pain is usually caused by imbalances in the structures above and below the knee joint. Therefore, the overall health and function of the feet and ankles and the lumbo-pelvic hip girdle directly affect the condition of the knees.
- Placing the feet and ankles into a neutral position when standing will most likely bring the knees into proper alignment. Overpronation of the feet and ankles causes the lower and upper leg to rotate too far inward, moving the knee toward the midline.
- When you learn about the types and intensity of physical activity people engage in, you can better understand the amount of stress they place on their knees. Identifying the activities that cause or reduce pain can help you determine what soft tissue structures may be irritated or dysfunctional.
- Popping or grinding noises that occur when a person sits down, stands up, or otherwise flexes and extends the knee suggest tracking problems.
- Record any pertinent information on the Client Assessment Diagram.
Self-Check
The condition of your knees can act as an early warning system for potential musculoskeletal imbalances in the feet and ankles or in the lumbo-pelvic hip girdle. Assess your own knees, and mark the grade you would give yourself on the following knee health report card.
Learn more about the hamstring group
Muscle specifics: A hamstring muscle on the back of the leg. It originates on the ischial tuberosity of the pelvis (i.e., the “sit bone”), travels down the back of the upper leg, crosses the knee joint, and inserts on the medial side of the tibia a little lower down than the semimembranosus (Agur and Dalley 2013).
Semitendinosus (Hamstring Group)
Muscle specifics: A hamstring muscle on the back of the leg. It originates on the ischial tuberosity of the pelvis (i.e., the “sit bone”), travels down the back of the upper leg, crosses the knee joint, and inserts on the medial side of the tibia a little lower down than the semimembranosus (Agur and Dalley 2013).
Muscle action(s): Bends (flexes) the knee and pushes (extends) the hips forward. It also helps with inward rotation of the leg when the knee is bent (Gray 1995).
Real-life movements: The bungee cord action of the semitendinosus muscle helps decelerate flexion of the hips when the knee is relatively straight. This motion helps load the muscle with potential energy that is then used to help extend the hips when a person stands erect.
Real-life movement example: Acts like a bungee cord to decelerate flexion of the hips during movements such as bending forward at the waist to pat a dog or tie your shoe laces. Since the semitendinosus inserts at the tibia, it also helps control the rotation of the lower leg during weight-bearing activities like walking and running.
Helpful tips: The semitendinosus muscle works in concert with the semimembranosus muscle to help minimize stress to the knees, hips, and lower back.
Biceps Femoris (Hamstring Group)
Muscle specifics: A hamstring muscle on the back of the leg. It has two origin points: The long head originates on the ischial tuberosity of the pelvis (i.e., “the sit bone”), and the short head originates lower down on the femur. The muscle travels down the back of the upper leg, crosses the knee joint, and inserts on the outside of the fibula and tibia (Agur and Dalley 2013).
Muscle action(s): Both the long head and the short head of the biceps femoris are responsible for bending the knee (knee extension), and the long head also helps extend the hips. Both heads help with outward rotation of the leg when the knee is bent (Gray 1995).
Real-life movements: The bungee cord action of the biceps femoris helps decelerate flexion of the hips and extension of the knee. It also helps decelerate internal rotation of the lower leg.
Real-life movement example: Acts like a bungee cord to decelerate hip flexion during movements such as bending over at the waist to touch your toes or pick a flower. It also helps control internal rotation of the lower leg during weight-bearing activities like walking and running.
Helpful tips: All of the hamstring muscles work in concert like guide ropes coming up from the lower leg to help control movement of the hips, pelvis, and lower back during weight-bearing activities.
Foam rolling the hip flexor group of muscles
Exercise benefits: Rejuvenating and regenerating the hip flexor muscles will help the lumbar spine flex, enabling the pelvis to posteriorly rotate more effectively.
Area(s) of body: Lumbo-pelvic hip girdle
Imbalance(s): Anterior pelvic tilt, excessive lumbar lordosis, valgus knee position, lack of dorsiflexion, overpronation
Structures addressed: Hip flexor group of muscles
Exercise benefits: Rejuvenating and regenerating the hip flexor muscles will help the lumbar spine flex, enabling the pelvis to posteriorly rotate more effectively. The hip flexors also work eccentrically to slow down internal rotation and extension of the leg. Therefore, flexibility in these tissues will also help promote better movement of the hip, leg, knee, and ankle.
How to perform
- Place the roller perpendicular to the front of the body, and lie over it at hip level.
- Find a sore spot on the front of the hips, and hold body weight on it for a few seconds to help the tissues release.
- Move the upper body to roll to different sore spots on the upper leg; keep the abdominals engaged to ensure that the lower back does not arch too much.
Duration and repetitions: Roll for 30 seconds to 1 minute on each side at least once per day.
Tip: Angle the roller so that it is in line with the crease of the groin (i.e., at 45 degrees to the hip and leg) to increase the pressure of the massage.
Progress: Perform the Hip Flexor Stretch (Sagittal).
Regress: Use a tennis ball to massage the hip flexors (see detailed information in next exercise).
How the knees relate to the feet and ankles and the lumbo-pelvic hip girdle
The knee is the structure that bridges the feet and ankles and the lumbo-pelvic hip girdle. Therefore, any imbalances or malalignments in the structures above or below it will directly affect how the knee feels and functions.
The knee is the structure that bridges the feet and ankles and the lumbo-pelvic hip girdle. Therefore, any imbalances or malalignments in the structures above or below it will directly affect how the knee feels and functions. For example, during the single-leg squat assessment, you should have noticed that a valgus knee is usually accompanied by overpronation of the foot and ankle complex. This is because as the foot and ankle collapse toward the midline during overpronation, the lower leg also rotates inward excessively, pulling the knee into a valgus position. This movement of the knee also causes the thighbone to rotate inward, affecting the position of the hip socket (where the upper leg articulates with the pelvis). Because of this change in position of the upper leg and hip socket, the pelvis shifts out of alignment by rotating down and forward. This change in position of the pelvis causes the lower back to arch excessively (see figure 3.9) (Kendall, McCreary, and Provance 2005; Price and Bratcher 2010).
Figure 3.9 Compensations of pelvis caused by excessive inward rotation of upper and lower leg.
Figure 3.10 Sample of completed knee assessment on Client Assessment Diagram.
Review of Key Points
The knee joint is primarily a hinge joint that connects the lower leg and the upper leg. Malalignments or imbalances in the more mobile joints of the feet and ankles or the lumbo-pelvic hip girdle will affect their connection point, the knees.
- The two most common deviations found in the knees are
- problems with side-to-side alignment (e.g., valgus knee position) and
- tracking problems during flexion and extension.
- Apart from instances of acute trauma, knee pain is usually caused by imbalances in the structures above and below the knee joint. Therefore, the overall health and function of the feet and ankles and the lumbo-pelvic hip girdle directly affect the condition of the knees.
- Placing the feet and ankles into a neutral position when standing will most likely bring the knees into proper alignment. Overpronation of the feet and ankles causes the lower and upper leg to rotate too far inward, moving the knee toward the midline.
- When you learn about the types and intensity of physical activity people engage in, you can better understand the amount of stress they place on their knees. Identifying the activities that cause or reduce pain can help you determine what soft tissue structures may be irritated or dysfunctional.
- Popping or grinding noises that occur when a person sits down, stands up, or otherwise flexes and extends the knee suggest tracking problems.
- Record any pertinent information on the Client Assessment Diagram.
Self-Check
The condition of your knees can act as an early warning system for potential musculoskeletal imbalances in the feet and ankles or in the lumbo-pelvic hip girdle. Assess your own knees, and mark the grade you would give yourself on the following knee health report card.
Learn more about the hamstring group
Muscle specifics: A hamstring muscle on the back of the leg. It originates on the ischial tuberosity of the pelvis (i.e., the “sit bone”), travels down the back of the upper leg, crosses the knee joint, and inserts on the medial side of the tibia a little lower down than the semimembranosus (Agur and Dalley 2013).
Semitendinosus (Hamstring Group)
Muscle specifics: A hamstring muscle on the back of the leg. It originates on the ischial tuberosity of the pelvis (i.e., the “sit bone”), travels down the back of the upper leg, crosses the knee joint, and inserts on the medial side of the tibia a little lower down than the semimembranosus (Agur and Dalley 2013).
Muscle action(s): Bends (flexes) the knee and pushes (extends) the hips forward. It also helps with inward rotation of the leg when the knee is bent (Gray 1995).
Real-life movements: The bungee cord action of the semitendinosus muscle helps decelerate flexion of the hips when the knee is relatively straight. This motion helps load the muscle with potential energy that is then used to help extend the hips when a person stands erect.
Real-life movement example: Acts like a bungee cord to decelerate flexion of the hips during movements such as bending forward at the waist to pat a dog or tie your shoe laces. Since the semitendinosus inserts at the tibia, it also helps control the rotation of the lower leg during weight-bearing activities like walking and running.
Helpful tips: The semitendinosus muscle works in concert with the semimembranosus muscle to help minimize stress to the knees, hips, and lower back.
Biceps Femoris (Hamstring Group)
Muscle specifics: A hamstring muscle on the back of the leg. It has two origin points: The long head originates on the ischial tuberosity of the pelvis (i.e., “the sit bone”), and the short head originates lower down on the femur. The muscle travels down the back of the upper leg, crosses the knee joint, and inserts on the outside of the fibula and tibia (Agur and Dalley 2013).
Muscle action(s): Both the long head and the short head of the biceps femoris are responsible for bending the knee (knee extension), and the long head also helps extend the hips. Both heads help with outward rotation of the leg when the knee is bent (Gray 1995).
Real-life movements: The bungee cord action of the biceps femoris helps decelerate flexion of the hips and extension of the knee. It also helps decelerate internal rotation of the lower leg.
Real-life movement example: Acts like a bungee cord to decelerate hip flexion during movements such as bending over at the waist to touch your toes or pick a flower. It also helps control internal rotation of the lower leg during weight-bearing activities like walking and running.
Helpful tips: All of the hamstring muscles work in concert like guide ropes coming up from the lower leg to help control movement of the hips, pelvis, and lower back during weight-bearing activities.
Foam rolling the hip flexor group of muscles
Exercise benefits: Rejuvenating and regenerating the hip flexor muscles will help the lumbar spine flex, enabling the pelvis to posteriorly rotate more effectively.
Area(s) of body: Lumbo-pelvic hip girdle
Imbalance(s): Anterior pelvic tilt, excessive lumbar lordosis, valgus knee position, lack of dorsiflexion, overpronation
Structures addressed: Hip flexor group of muscles
Exercise benefits: Rejuvenating and regenerating the hip flexor muscles will help the lumbar spine flex, enabling the pelvis to posteriorly rotate more effectively. The hip flexors also work eccentrically to slow down internal rotation and extension of the leg. Therefore, flexibility in these tissues will also help promote better movement of the hip, leg, knee, and ankle.
How to perform
- Place the roller perpendicular to the front of the body, and lie over it at hip level.
- Find a sore spot on the front of the hips, and hold body weight on it for a few seconds to help the tissues release.
- Move the upper body to roll to different sore spots on the upper leg; keep the abdominals engaged to ensure that the lower back does not arch too much.
Duration and repetitions: Roll for 30 seconds to 1 minute on each side at least once per day.
Tip: Angle the roller so that it is in line with the crease of the groin (i.e., at 45 degrees to the hip and leg) to increase the pressure of the massage.
Progress: Perform the Hip Flexor Stretch (Sagittal).
Regress: Use a tennis ball to massage the hip flexors (see detailed information in next exercise).
How the knees relate to the feet and ankles and the lumbo-pelvic hip girdle
The knee is the structure that bridges the feet and ankles and the lumbo-pelvic hip girdle. Therefore, any imbalances or malalignments in the structures above or below it will directly affect how the knee feels and functions.
The knee is the structure that bridges the feet and ankles and the lumbo-pelvic hip girdle. Therefore, any imbalances or malalignments in the structures above or below it will directly affect how the knee feels and functions. For example, during the single-leg squat assessment, you should have noticed that a valgus knee is usually accompanied by overpronation of the foot and ankle complex. This is because as the foot and ankle collapse toward the midline during overpronation, the lower leg also rotates inward excessively, pulling the knee into a valgus position. This movement of the knee also causes the thighbone to rotate inward, affecting the position of the hip socket (where the upper leg articulates with the pelvis). Because of this change in position of the upper leg and hip socket, the pelvis shifts out of alignment by rotating down and forward. This change in position of the pelvis causes the lower back to arch excessively (see figure 3.9) (Kendall, McCreary, and Provance 2005; Price and Bratcher 2010).
Figure 3.9 Compensations of pelvis caused by excessive inward rotation of upper and lower leg.
Figure 3.10 Sample of completed knee assessment on Client Assessment Diagram.
Review of Key Points
The knee joint is primarily a hinge joint that connects the lower leg and the upper leg. Malalignments or imbalances in the more mobile joints of the feet and ankles or the lumbo-pelvic hip girdle will affect their connection point, the knees.
- The two most common deviations found in the knees are
- problems with side-to-side alignment (e.g., valgus knee position) and
- tracking problems during flexion and extension.
- Apart from instances of acute trauma, knee pain is usually caused by imbalances in the structures above and below the knee joint. Therefore, the overall health and function of the feet and ankles and the lumbo-pelvic hip girdle directly affect the condition of the knees.
- Placing the feet and ankles into a neutral position when standing will most likely bring the knees into proper alignment. Overpronation of the feet and ankles causes the lower and upper leg to rotate too far inward, moving the knee toward the midline.
- When you learn about the types and intensity of physical activity people engage in, you can better understand the amount of stress they place on their knees. Identifying the activities that cause or reduce pain can help you determine what soft tissue structures may be irritated or dysfunctional.
- Popping or grinding noises that occur when a person sits down, stands up, or otherwise flexes and extends the knee suggest tracking problems.
- Record any pertinent information on the Client Assessment Diagram.
Self-Check
The condition of your knees can act as an early warning system for potential musculoskeletal imbalances in the feet and ankles or in the lumbo-pelvic hip girdle. Assess your own knees, and mark the grade you would give yourself on the following knee health report card.
Learn more about the hamstring group
Muscle specifics: A hamstring muscle on the back of the leg. It originates on the ischial tuberosity of the pelvis (i.e., the “sit bone”), travels down the back of the upper leg, crosses the knee joint, and inserts on the medial side of the tibia a little lower down than the semimembranosus (Agur and Dalley 2013).
Semitendinosus (Hamstring Group)
Muscle specifics: A hamstring muscle on the back of the leg. It originates on the ischial tuberosity of the pelvis (i.e., the “sit bone”), travels down the back of the upper leg, crosses the knee joint, and inserts on the medial side of the tibia a little lower down than the semimembranosus (Agur and Dalley 2013).
Muscle action(s): Bends (flexes) the knee and pushes (extends) the hips forward. It also helps with inward rotation of the leg when the knee is bent (Gray 1995).
Real-life movements: The bungee cord action of the semitendinosus muscle helps decelerate flexion of the hips when the knee is relatively straight. This motion helps load the muscle with potential energy that is then used to help extend the hips when a person stands erect.
Real-life movement example: Acts like a bungee cord to decelerate flexion of the hips during movements such as bending forward at the waist to pat a dog or tie your shoe laces. Since the semitendinosus inserts at the tibia, it also helps control the rotation of the lower leg during weight-bearing activities like walking and running.
Helpful tips: The semitendinosus muscle works in concert with the semimembranosus muscle to help minimize stress to the knees, hips, and lower back.
Biceps Femoris (Hamstring Group)
Muscle specifics: A hamstring muscle on the back of the leg. It has two origin points: The long head originates on the ischial tuberosity of the pelvis (i.e., “the sit bone”), and the short head originates lower down on the femur. The muscle travels down the back of the upper leg, crosses the knee joint, and inserts on the outside of the fibula and tibia (Agur and Dalley 2013).
Muscle action(s): Both the long head and the short head of the biceps femoris are responsible for bending the knee (knee extension), and the long head also helps extend the hips. Both heads help with outward rotation of the leg when the knee is bent (Gray 1995).
Real-life movements: The bungee cord action of the biceps femoris helps decelerate flexion of the hips and extension of the knee. It also helps decelerate internal rotation of the lower leg.
Real-life movement example: Acts like a bungee cord to decelerate hip flexion during movements such as bending over at the waist to touch your toes or pick a flower. It also helps control internal rotation of the lower leg during weight-bearing activities like walking and running.
Helpful tips: All of the hamstring muscles work in concert like guide ropes coming up from the lower leg to help control movement of the hips, pelvis, and lower back during weight-bearing activities.
Foam rolling the hip flexor group of muscles
Exercise benefits: Rejuvenating and regenerating the hip flexor muscles will help the lumbar spine flex, enabling the pelvis to posteriorly rotate more effectively.
Area(s) of body: Lumbo-pelvic hip girdle
Imbalance(s): Anterior pelvic tilt, excessive lumbar lordosis, valgus knee position, lack of dorsiflexion, overpronation
Structures addressed: Hip flexor group of muscles
Exercise benefits: Rejuvenating and regenerating the hip flexor muscles will help the lumbar spine flex, enabling the pelvis to posteriorly rotate more effectively. The hip flexors also work eccentrically to slow down internal rotation and extension of the leg. Therefore, flexibility in these tissues will also help promote better movement of the hip, leg, knee, and ankle.
How to perform
- Place the roller perpendicular to the front of the body, and lie over it at hip level.
- Find a sore spot on the front of the hips, and hold body weight on it for a few seconds to help the tissues release.
- Move the upper body to roll to different sore spots on the upper leg; keep the abdominals engaged to ensure that the lower back does not arch too much.
Duration and repetitions: Roll for 30 seconds to 1 minute on each side at least once per day.
Tip: Angle the roller so that it is in line with the crease of the groin (i.e., at 45 degrees to the hip and leg) to increase the pressure of the massage.
Progress: Perform the Hip Flexor Stretch (Sagittal).
Regress: Use a tennis ball to massage the hip flexors (see detailed information in next exercise).
How the knees relate to the feet and ankles and the lumbo-pelvic hip girdle
The knee is the structure that bridges the feet and ankles and the lumbo-pelvic hip girdle. Therefore, any imbalances or malalignments in the structures above or below it will directly affect how the knee feels and functions.
The knee is the structure that bridges the feet and ankles and the lumbo-pelvic hip girdle. Therefore, any imbalances or malalignments in the structures above or below it will directly affect how the knee feels and functions. For example, during the single-leg squat assessment, you should have noticed that a valgus knee is usually accompanied by overpronation of the foot and ankle complex. This is because as the foot and ankle collapse toward the midline during overpronation, the lower leg also rotates inward excessively, pulling the knee into a valgus position. This movement of the knee also causes the thighbone to rotate inward, affecting the position of the hip socket (where the upper leg articulates with the pelvis). Because of this change in position of the upper leg and hip socket, the pelvis shifts out of alignment by rotating down and forward. This change in position of the pelvis causes the lower back to arch excessively (see figure 3.9) (Kendall, McCreary, and Provance 2005; Price and Bratcher 2010).
Figure 3.9 Compensations of pelvis caused by excessive inward rotation of upper and lower leg.
Figure 3.10 Sample of completed knee assessment on Client Assessment Diagram.
Review of Key Points
The knee joint is primarily a hinge joint that connects the lower leg and the upper leg. Malalignments or imbalances in the more mobile joints of the feet and ankles or the lumbo-pelvic hip girdle will affect their connection point, the knees.
- The two most common deviations found in the knees are
- problems with side-to-side alignment (e.g., valgus knee position) and
- tracking problems during flexion and extension.
- Apart from instances of acute trauma, knee pain is usually caused by imbalances in the structures above and below the knee joint. Therefore, the overall health and function of the feet and ankles and the lumbo-pelvic hip girdle directly affect the condition of the knees.
- Placing the feet and ankles into a neutral position when standing will most likely bring the knees into proper alignment. Overpronation of the feet and ankles causes the lower and upper leg to rotate too far inward, moving the knee toward the midline.
- When you learn about the types and intensity of physical activity people engage in, you can better understand the amount of stress they place on their knees. Identifying the activities that cause or reduce pain can help you determine what soft tissue structures may be irritated or dysfunctional.
- Popping or grinding noises that occur when a person sits down, stands up, or otherwise flexes and extends the knee suggest tracking problems.
- Record any pertinent information on the Client Assessment Diagram.
Self-Check
The condition of your knees can act as an early warning system for potential musculoskeletal imbalances in the feet and ankles or in the lumbo-pelvic hip girdle. Assess your own knees, and mark the grade you would give yourself on the following knee health report card.
Learn more about the hamstring group
Muscle specifics: A hamstring muscle on the back of the leg. It originates on the ischial tuberosity of the pelvis (i.e., the “sit bone”), travels down the back of the upper leg, crosses the knee joint, and inserts on the medial side of the tibia a little lower down than the semimembranosus (Agur and Dalley 2013).
Semitendinosus (Hamstring Group)
Muscle specifics: A hamstring muscle on the back of the leg. It originates on the ischial tuberosity of the pelvis (i.e., the “sit bone”), travels down the back of the upper leg, crosses the knee joint, and inserts on the medial side of the tibia a little lower down than the semimembranosus (Agur and Dalley 2013).
Muscle action(s): Bends (flexes) the knee and pushes (extends) the hips forward. It also helps with inward rotation of the leg when the knee is bent (Gray 1995).
Real-life movements: The bungee cord action of the semitendinosus muscle helps decelerate flexion of the hips when the knee is relatively straight. This motion helps load the muscle with potential energy that is then used to help extend the hips when a person stands erect.
Real-life movement example: Acts like a bungee cord to decelerate flexion of the hips during movements such as bending forward at the waist to pat a dog or tie your shoe laces. Since the semitendinosus inserts at the tibia, it also helps control the rotation of the lower leg during weight-bearing activities like walking and running.
Helpful tips: The semitendinosus muscle works in concert with the semimembranosus muscle to help minimize stress to the knees, hips, and lower back.
Biceps Femoris (Hamstring Group)
Muscle specifics: A hamstring muscle on the back of the leg. It has two origin points: The long head originates on the ischial tuberosity of the pelvis (i.e., “the sit bone”), and the short head originates lower down on the femur. The muscle travels down the back of the upper leg, crosses the knee joint, and inserts on the outside of the fibula and tibia (Agur and Dalley 2013).
Muscle action(s): Both the long head and the short head of the biceps femoris are responsible for bending the knee (knee extension), and the long head also helps extend the hips. Both heads help with outward rotation of the leg when the knee is bent (Gray 1995).
Real-life movements: The bungee cord action of the biceps femoris helps decelerate flexion of the hips and extension of the knee. It also helps decelerate internal rotation of the lower leg.
Real-life movement example: Acts like a bungee cord to decelerate hip flexion during movements such as bending over at the waist to touch your toes or pick a flower. It also helps control internal rotation of the lower leg during weight-bearing activities like walking and running.
Helpful tips: All of the hamstring muscles work in concert like guide ropes coming up from the lower leg to help control movement of the hips, pelvis, and lower back during weight-bearing activities.
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