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Old 27-Jul-06, 08:28 AM   #1
Merrida
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Knee "feels" like it's buckling backwards


Okay, I can come up with several scenarios re: muscle imbalances that would make NASM proud,.....buuuuut,.......I notice that, I have a few clients who have come to me because they're noticing this problem in their workouts and want to work with me to "fix" it.

First I always check form, postural distortions, biomechanics, etc.

But what's interesting is that once I've worked with them a while and have ascertained they're maintaining good form on their exercises, their responses to various strengthening and stabilization work VARIES tremendously. Some I've found "feel" this sensory subjective "buckling" (like their knee cap is rolling distally, almost as if their quads are pushing the patella inward) still,....and yet some show weak quads, some show weak hamstrings, some show biomechanic variances in gate,....

But I'm having a more challenging time than I thought pinpointing why they're getting this "buckling" sensation when I'm doing what I've done with others in the past (and has worked),....these few particulars are just not responding.

YES, I've referred them out.

But I'm still curious to get some forum feedback here.
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Old 27-Jul-06, 01:15 PM   #2
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Its the calves...

Look at the gastrocnemuis. And just because they use perfect form, doesn't mean muscles are firing when they are supposed to--they can be compensating.

It should make NASM proud and you proud.
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Old 27-Jul-06, 01:58 PM   #3
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Yeah, I'm on-board with understanding the difference between what may "appear" visually as "perfect form," while kinesthetically, on a sensory level for neural feedback, the appropriate muscles aren't firing (either via compensation, rerouting, etc.). That's why I do my best to watch my clients physiology while performing exercises,...to see and often feel the appropriate muscles contracting at the right time.

It's like watching someone do a squat when you know they're using all quads,...watch close enough, and you can tell when they are not engaging their glutes to fire up concentrically, even though "perception" may look like a fairly good squat because there are no grossly evident compensations.

I'm usually pretty good with those kinds of details (observing contractions). But hey, who knows, maybe I'm really missing this.

Can you explain more to me about your take on how the gastroc (and not soleus, eh? -- even with knee flexion?) are playing into this? I'm intrigued!
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Old 27-Jul-06, 02:08 PM   #4
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How do you watch your "client's physiology"? That happens on the inside??? I know you meant biomechanics...

Anyway, the gastroc is closest to the joint that is giving problems, right?
The gastroc has a minor role in knee flexion (along with the hamstring because they cross at the same joint). The issue isn't "why is it the gastroc and not the soleus?"--thats irrelevant.

Your client has weak calves and posible hamstrings which cannot deaccellerate flexion. That is why they are locking up. Work teh calves and in a couple of sessions the problem should diminish.

Thanks for being intrigued.
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Old 27-Jul-06, 02:21 PM   #5
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What I mean by watching their physiology, is,....watching for external signs of what is or might be going on internally. I am watching things from pupil dilation, skin, flushing, temperature changes, lip colour, dry mouth, tremors at "inappropriate" times or in unusual manners or locations, nail colour, changes in heart beat intensity as well as rate, breathing (visual & auditory cues), listening for audible arthro cues,.....etc., etc. Yes, I watch biomechanics as well, (of course), but I also am constantly watching for signs being manifested that something internally is being taxed incorrectly or excessively or inappropriately, ....and their body will give me cues. Whenever someone complains of pain, I can't help but look for how their body handles and compensates (internally and externally), unique to them, as they "try" or choose "not to try" to complete a ROM or choose a stopping point.

All that stuff aside, now to address your wonderful reply (which I thank you for!)

So you're saying it's calf AND hamstring weakness, and the buckling (in those cases I haven't been able to resolve) is from weak calves (not tight calves) and weak (not inflexible) hamstrings......Hmmm, this is really interesting to me!
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Old 27-Jul-06, 02:29 PM   #6
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If you are watching ALL those other things you mentioned...then its no surprise you missed the weak calves!!

All kidding aside...Have them stand on their toes (tippy) and try to quarter squat. If they cannot, blame the calves.
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Old 27-Jul-06, 02:33 PM   #7
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Watching "all that stuff" isn't active at this point,....I can't help but notice those things automatically, without trying. I'm detail oriented so observing those things feel very natural to me,...in addition to watching,.....yes, everything else!

Okay, so that will be my test. I see her on Saturday. I'll have her stand on her tippy toes and attempt a quarter squat. But what you're saying to me is,...if she cannot do this, (or what if that triggers that buckling sensation? Does that make a difference?)....then I'm to put more effort into strengthening her calves, AND her hamstrings, right,....? Or, for now, try to target calf strength as a primary and watch for changes?
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Old 27-Jul-06, 02:40 PM   #8
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You should make strengthening the posterior chain (calves and hamstrings) importnat in her overall training program. Her present exercise program may be teh reason why she is having this issue. Make modifications as needed.
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Old 27-Jul-06, 02:43 PM   #9
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I've referred her out because I've been working with her for quite a while and we've relieved many of her "aches and pains." Her program is balanced, and this "knee thing" is a relatively new development and hasn't responded to what I've traditionally done for others with the same subjective complaint. She's so hesitant to see an MD, I'm treading lightly to keep her from exacerbating anything while trying to help her strengthen the complex, until she gets her butt to her doctor.
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