0:00 Most people don't realize that 90% of knee problems are caused by one thing which can affect walking upstairs, squatting in the gym, or even getting out of a chair. And if you fix it, it could take care of most knee problems. I'm going to show you what that thing is, and I'll give you an exercise plan that'll fix it for good. One that's been stress tested over my 15-year physical therapy career. Okay, let's start by looking at what this common issue is. A common misconception that people have is that the knee works like a door hinge, only bending and straightening, but it actually rotates. And that's where most knee issues reside. See, the knee joint works kind of like a jar. When I screw the lid on, I have to turn the lid one
0:45 direction, but I'm turning the jar in the opposite direction. And then if I want to take the lid off, I screw these two pieces in the opposite direction. Now, if you want a good jar, you got to be able to put the lid on and take it off. Well, what if the lid was stuck screwed on and I couldn't take it off? Well, you're screwed. The knee works the exact same way. The two bones that make up the knee, your shin, which is called the tibia, and the thigh, which is the femur, rotate in opposite direction. When the tibia rotates outward, the femur rotates inward. This motion happens as I straighten the knee. The opposite directions happen when I bend
1:31 the knee. The tibia rotates inward and the femur rotates outward. Now, here's the problem that happens with 90% of knee issues that I see in the clinic. Most people have a tibia that's stuck rotated outward. This is called external rotation. And a femur that's stuck rotated inward. They can't go the other way. This is called the screw home mechanism. And it's a normal motion that should happen, but it's not the only motion that should happen. When you're in this position, there's less joint space. Whereas, when you can go the other way, there's more joint space. It's also related to the mechanisms we see in a lot of injuries. knee valgus where the knee collapses in like so is a
2:17 common injury mechanism for things like ACL tear and this reduced space that I'm talking about. It's often what we see in things like knee arthritis. So we need to teach you to rotate your knee in the opposite direction. The tibia, the shin must rotate inward and the femur must rotate outward. Missy Elliot that thing. Flip it and reverse it. And you can actually start this by doing two soft tissue drills that target key areas that get tight in this situation. The first is your inner thigh close to the knee, your adductor. When these are relaxed, the femur will have an easier time rotating outward. Lie face down with a foam roller over that area. Starting
3:04 closer at the knee, work slowly up to about the middle part of the thigh and then just offload the pressure on the way down. So you'll go up, apply pressure on the thigh. You don't have to be too mean. Nice on the way down. Do this for 60 seconds. The other muscle you'll want to target is the lower part of the calf or the gastromia. You get this to relax, it's going to be easier to rotate the shin inward. You're going to be sitting for this one with your leg straight. Rotate your entire leg outward. This is external rotation. And you're going to work the calf slowly up and down along the entire outer aspect of it. Same thing, 60 seconds going up and down. Don't apply so much pressure that it hurts like hell. Now, just because these muscles are relaxed
3:50 doesn't mean your knee is going to automatically go where it needs to. You've opened the door, but you got to walk through it. Knee first. way to do that is by learning to move your knee in the opposite direction. You can start by assisting your knee into this opposite rotation. Get in a half kneeling position, making sure you're tall through the back kneecap. The foot should be in front of the shin. So, you should see the shin leaned backward. Take your hands and grab the front part of the shin. There's this rough patch where there's this bone that sticks out. It's called your tibial tuberosity. You want that to be the anchor point that you use to rotate the shin inward. Maintain this pressure and stay heel heavy. Slowly move your leg forward, driving it in line with the second toe
4:37 and then back out. Go forward and back, making sure that you stay heel heavy. The biggest mistakes that I see people make is driving the knee inward. This limits the ankle and knee rotation gains that we should have to help your knee feel better. And the other issue is losing heel contact. The heel is important in this because if you shift your weight too far forward, you're not going to get the rotation changes that we need at the shin in particular. Do two sets of 20 of this move. Now, even though you've learned how to move your knee differently, we need to address what's causing this rotational problem in the first place. You see, your knee doesn't just go on some rotational tantrum by itself. It needs an instigator. and it's got two of them,
5:24 your hip and your foot, telling your knee it can't have cookies. So sad. If we don't fix how these areas move, you're going to be back to square one. When getting the knee to unlock at the foot, it has to be able to flatten. This is called pronation. Watch what happens when I try to rotate my knee, but my foot can't flatten. I push the knee forward, but then it stops. So then you'll see my knee dive inward, which tips the foot on its side. This tipping of the foot is not pronation. It's just the entire leg collapsing inward. And a lot of times when that happens, you'll see the knee cave in along with it. What we want to make sure occurs is the entire foot flattens as the shin goes forward. Now, you also need the femur,
6:10 which is related to the hip, to rotate in the opposite direction. If you look at both ends of the femur, if I keep this bone flat and I turn it towards you, you could see that the portion that attaches into the hip is actually rotated upward a little bit. That's normal. There's a twist within this bone. The part close to the hip is going to be rotated more up and the part closest to the knee is naturally rotated more down. In the case of this knee rotation issue, what happens with the femur is the lower part is rotated more inward internal rotation and then the upper part in comparison is in relative external rotation or it's rotated outward. So to truly get the knee rotation to stick, we want to make sure that not only the bottom part of the femur can rotate outward into external
6:56 rotation, but the top part can rotate inward into internal rotation. Now, this is a lot of stuff, but I have one move that I got from Bill Hartman that addresses all of this. Easy. Lie on your side with the affected knee on the ground. You'll want about a 20 to 30° bend at both the knee and the hip. Your thigh should be relaxed on the ground without forcing it, and your foot should be flat on the wall. If you notice that your knee hovers in the air, then what you can do is slide your foot up on the wall and then spin the foot down until that outer part of the thigh is relaxed. Roll forward over the top to ensure that the thigh is on the ground. Press your heel and ball the foot into the wall
7:43 without lifting the knee up. Keep this pressure. Get two to three out of 10 amount. You're going to lift your top leg backward and place the foot on the ground behind you. It'll look sort of like it's in a clamshell position. Roll back to the start. Swing the top leg backwards. Foot on the ground. Swing the top leg forward. So, the shin goes to the ground as you're doing this backward and forward roll. The knee should stay relaxed on the ground and it shouldn't lift up. This is a really big coordination exercise. Okay. So, if you have a hard time with that and you can't go that far, just do the clamshell version where you start with the shin flat on the ground. Lift the knee up a little bit and back down. Whichever variation you end up doing, you'll feel
8:28 that top glute work. Do two to three sets of 15 reps with this move. So, you've loosened up the knee, you've learned how to move it differently, but these changes won't stick long term if you don't strengthen this new pattern. Think of it like this. You just taught your knee a new language, but if you don't practice it, you're going to forget it. These next three exercises are some indepth conversation in your new language, which will help lock in these new mechanics. The first place to start is with a stagger squat on a foam roller. Place the foam roller along your lower back and go up against the wall. Walk both of your feet out in front of you so your shins are leaned backward. The knee that's causing problems should stay in front. Slide the opposite leg
9:13 back just a little bit. You want to start like this. As you progress, you'll eventually switch feet because that will work that leg more. It's normal for the leg that's slid back to be working harder. Grab a weight. Hold it at about chest height. Look straight ahead. Stay heavy on your heel and let out a nice long inhale through your nose at the top. When you've inhaled about 3/4 of the way, begin squatting down, keeping it above parallel and keeping heavy on your heel. You'll feel your quads work and it's normal for the back leg to work the most. Exhale, come back up without locking the knees out. So, it's inhale, squat down, exhale, come up. The biggest mistakes that I see people make is losing heel contact or taking too wide of a stance. Do three sets of eight to 10 reps. And eventually, you'll want to
10:00 progress so the problem leg is the one that's slid back. You'll next want to learn how to push with that leg that's causing you problems without letting the knee cave in. The diagonal lunge is a great choice for that. Place one foot back and the other one's going to be a bit in front and pointing out to the side. You'll want to hold a weight on the same side as the back leg. Make sure your foot stays flat. You're going to use this back leg as your push foot. Take a breath of air in through the nose. On the exhale, you want to use that foot to push you so that way you get more weight on the opposite heel. The knee should stay centered over the toe. Inhale, go back to the start. Keep that inhale. Think about pushing. Exhale and load on the heel. Inhale, come back to the start. The biggest mistakes that
10:46 I see people make are with the push foot. Letting the knee cave in or the foot tip are a problem because you're not going to get that foot pronation or flattening that we need to allow you to push out. And that's what causes the knee to cave in. Other issues I see are swinging the trunk away or turning the hips outward. If you do that, more of the load's going to be on the back leg. We're trying to transfer load to the lead leg and work on pushing on that back leg or having the lead leg knee cave in. If you notice that happens, elevate the lead leg on a box. It'll make it a little bit easier. Do three sets of eight to 10 reps on both sides. This next move is the most difficult, but it's also the most important for getting changes to stick long term. If you can nail this, your knee is going to
11:31 be damn near bulletproof. Grab a weight, hold it at your chest. You want to step back so your shin is leaned backward. On the back leg, you want to be up on the tippy toe. Both knees will be soft. Take a long inhale in the top position. Once you've inhaled about halfway, begin to drop down. Your back kneecap should go straight down to the ground. Your front shin should move forward over the second toe while staying heel heavy. Exhale, come back up without locking out. So, it's inhale, drop down, exhale, come back up. Some of the biggest mistakes that I see with this is either losing foot pressure on the front foot, sweeping the legs to the side, or hiking the hip. If you find yourself doing any of those, just elevate the front foot
12:17 until those issues no longer happen. is we want the working leg to be predominantly the lead leg. The other issue that I see is people locking their knees out at the top position. You want to stay soft and bouncy so that way the front leg gets cooked. Do three sets of six to 10 reps with this move. So now you might know how to unlock your knee. But if that knee issue is coming from somewhere else in your lower body, these moves might not be enough. Watch this video here so you can get a customized routine for your entire lower
