Knee special tests vary in their sensitivity, specificity, and usefulness. In the acute situation, they may provide some useful information to guide decision-making for further diagnostic testing if symptoms, behavior, or progress warrant such.
With practice, the execution of some of the knee special tests can be simplified to a great degree to reduce the intrusiveness and time investment.
While they can be done quickly, take the time to be effective. Also, use a battery of tests rather than relying on a singular test for decision-making.
Demonstrated:
McMurray Test for meniscus
Varus and Valgus Stress for medial collateral and lateral collateral ligament
Anterior Drawer for ACL injury (modify the angle for Lachman’s Test)
Knee hyperextension
Traditionally, measuring hip flexion range of motion provides only information about how the femur moves in the hip joint.
If you think differently, hip flexion provides information about the existence of anterior pelvic tilt, sacral movement, lumbar spine movement, and breathing strategy.
This video guides you toward how you can think differently about how to measure hip flexion range of motion whether you work in physical therapy, athletic training, or fitness training.
I’ve also been busy on Instagram for The 16% and posted a few IGTV segments, so check those out.
Topics for this week’s Q & A:
In your model are the terms compressed and expanded used mutually exclusive or are they used in combination to describe strategies at different segments? Or does it depend if discussing “normal” vs compensatory strategies?
Could you discuss ideal / non compensatory foot position, and its relationship to inhalation and exhalation in different phases of gait and how, or if, we can potentially change compensatory foot mechanics with more proximal structures?
Is there a good resource for the lay person on what sinovial fluid is, and how the body utilizes it? Great video on knee flexion, I’m just wondering how my body could make such a mistake on where to store the fluid that would cause such discomfort.
Thoughts on psychedelics laying new road maps for altering neurotransmitters most commonly taken routes, similarly allowing us to alter our relationship with gravity and atmospheric pressure to reinstate a preferred posture?
Who or what are the 16%?
What are your thoughts on training barefoot and when, if, and how it could be practical?
What books or publications would you recommend that would aid in a deeper understanding of disordered breathing patterns/rib cage compensatory strategies and their effect on distal mechanics, and gait mechanics and how it relates to early to late propulsion?
Would you give your thoughts on strategies to improve the front rack position for FS/cleans as it relates to the ER/IR/ER arc? Do you think it would be more effective to train this position specifically, or utilize shoulder above and below it where you are more biased into ER to begin with and drive it from there?
What’s the best place to learn from you!?? Products, courses, just keep listening?
Bill can you discuss the position of the spine when you are trying to bias movements towards IR or ER. Should we be putting the spine into some extension as well? Are we just trying to keep the cylinder stacked? Does the IR/ER ideas refer to just the limbs?
Changing the way anyone thinks is a challenge. Emotions are attached to beliefs. Emotions determine how we make decisions. Many feel that there’s nothing wrong with the status quo and are satisfied with their current level of performance, knowledge, understanding, and outcomes.
Some will want to argue that the following perspective is merely an attempt to be contrarian. It is to a degree. That’s how we change and improve. We have taken many things at face value and accepted them without question. I am choosing to ask questions and think differently. This has served me well so far. I don’t fear being wrong.
Many different models are successful. We are often successful but for different reasons than what is reality because we can never really tell why a patient improves or a client moves better.
You don’t need to make any changes to what you do. If you’re one of the satisfied, then please click away to your next favorite website and enjoy.
If you want another perspective to consider, please read on. Even in doing so, you don’t have to agree. I encourage your consideration. Perhaps a useful conversation will arise that makes us all better at what we do.
My personal goal is to think differently about movement in the hopes that it provides an ever improving model of a complex human.
Consider an alternative perspective.
It may be a small jump for some, and a large leap for others. Still, others may not even consider this a change, and I am merely restating something with different words. So be it.
Thinking differently about movement.
In the hopes of learning about themselves, men began dissecting the deceased somewhere around 3rd century BC (Anat Cell Biol. 2015 Sep; 48(3): 153–169.). I’m sure they did so in a less formal manner prior to that. We are a curious species.
Lacking depth of understanding, I can imagine they looked at the cadaver as they would any other mechanics apparatus of their time. We learn many things via analogy so it stands to reason that the physics of the time predominated when they saw a hardened skeleton with its apparent endless array of levers and pulleys. Surely, we move just like the pulley system we use to get water from the well.
This view is still taught today from the most elementary to the highest level of anatomical study. But, I think, it is a limited view that prevents an even more fascinating solution to how we move on earth.
A Simple Rule Repeated
Go back through what we think is our evolution to the first single supercell.
It was basically a bag of water with some stuff in it.
We are no different.
We are mostly water and some stuff (mostly collagen).
In my mind, we are just battery-powered, water-filled, anti-gravity, helically-oriented, morphing meat suits.
If this is true, then we must behave based on the physical rules of how water and stuff interact in response to all the forces we are exposed to such as gravity, forces inside our body, and forces imposed upon us.
The Wacky Waving Inflatable Tube Man and The First Strategy
I think we have more in common with the Wacky Waving Inflatable Tube Man than levers and pulleys. Actually, levers in the human system would be quite destructive, but that’s a discussion for another time.
The tube man moves against gravity via an expansive strategy provided by its inflation.
You do the same every time you breathe in. This is strategy number one. It is an efficient and low energy solution to dealing with gravity and all the other forces imposed on us.
As the fluid volume of air expands the thorax, the entire body experiences fluid shifts and pressure changes that alter our physical shape against gravity. Just watch yourself in the mirror as you take the deepest breath possible, and you’ll see what I mean. You’re now a cousin of the Wacky Waving Tube Man.
Now shut off the fan that fills the Wacky Waving Tube Man. He no longer has an expansive capability to hold himself against gravity and he collapses. He still has some air inside, but it’s just not enough for him to expand and lift himself up. If only, he had muscles that could squeeze the remaining air, he’d stay upright.
Your Morphing Meat Suit and the Second Strategy
I’m assuming you’re still standing in front of a mirror watching your body change shape as you breathe. You can see the collapse of your thorax as you exhale. You actually lose height as you breathe out just like the tube man, but you don’t collapse as he does.
Why not?
Unlike the tube man, we have a second strategy.
We have muscles. Muscles change shape. Just flex your elbow and contract your biceps and revel in your awesomeness but pay attention to the shape of the muscle. It changes. It squeezes.
The other muscles of your body do the same every time you breathe out so you don’t collapse under the load of gravity.
You compress the fluids (water and the remaining air) inside your body to hold your position against gravity or to move through space. This is your second strategy. It takes more energy in comparison to your expansive strategy, but it does work quite well.
Just recall the last time you pulled a heavy deadlift or put a barbell on your shoulders for a heavy squat. You squeeze the body to maintain position under the forces of the load. This is obviously an amplification of the strategy, but it is the same.
Expand or Compress
To simplify.
You have two strategies of movement against the forces imposed upon you.
You can expand by increasing the fluid content of your body (air in) to maintain shape, to acquire position, and to move.
You can compress the fluid content of your body to maintain shape, to acquire a position and to move.
Coordinate the compressive strategy with the expansive strategy to promote fluid shift effectively and you can move through space in a number of different ways. Our ability to manipulate shape allows us to walk, run, lift heavy things, throw, jump, bend and twist.
Restricting or overemphasizing one strategy over another can raise performance in a very specific way to do ever-amazing things or it can be a source of limitation that imposes load on the system that can be quite unpleasant and perpetuate unrecoverable changes.
If you ask me, this is more interesting than talking about levers and pulleys.
