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    • #71225
      AvatarPawan Lalwani

      Background, started with medial knee pain from cycling with a smaller q-factor on my road bike.  Q-factor is the distance between the pedals.  Not sure what was causing it, but it dissipated after a bike fit with custom spindles increasing q-factor to that of my mountain bike.  I think there are some issues that stem from the medial knee issue, the most obvious being dysfunction in my left vmo, it fires later than my right side, after the vastus lateralis.  It’s also noticeably smaller. 

      Fast forward a bit and I started to have bi-lateral IT Band tightness, solved it on the side without the original medial knee pain with glute/core strengthening, mobilizing the tissues, etc.  My left IT Band continues to be tight along with my lateral retinaculum, causing pain on the lateral side of my kneecap.  I can decrease tightness in the IT Band by really hitting my posterior chain hard, x-band walks, one legged rdls, hamstring curls, etc. Doing that along with some core strengthening, stir the pot, bird dogs, side planks, etc.  Have been going to PT on and off and we found I had a functional leg length discrepancy, affected leg was the shorter leg.  Since then the PT adjusted me back, left side of my pelvis was anteriorly rotated.  Since then everytime we check my leg length is about equal.  
      I can do most movements at the gym without flaring the lateral tightness, but squatting is one movement that seems to contribute.  I’ve been trying one legged body weight squats to strengthen the vmo and glute med.  I mainly cycle and backcountry ski. I think backcountry skiing utilizes a lot of tfl since your lifting a ski then stepping back, but not engaging your glutes like you would in a normal walking gait.  Your ski kind of slides against the snow instead of having a heel strike that causes the glutes to fire.  After ski touring when I bend over to unbuckle my boots my TFL and hipflexors are in spasm and want to tense up as I lean forward.  Since squatting contributes I’m wondering if there is a noticeable flaw I need to work on that would possibly help me correct the movement patterns that are causing this.
    • #75606
      AvatarNicholas Walker

      Why do your toes come of the ground? I think you weight it too much in the back, try squatting while stretching your arms and holding the kettlebell there, this counter balance is very effective.

      The buttwink, well I have seen worse ( I was a lot worse FYI ). What helped me was clearing up the glutes, specifically the TFL region and hams.
      Working the TFL allows you to create more torque, more ext. rotation and overall stability, definitely worth a shot 
      Your background in skiing could have made you forget about your glutes, as you stated. 
      My advice: Attack your glutes/TFL, try different techniques, mobilize them in every way. See the difference.
      Work the hams, they might play a role in rounding the back, however you do go pretty low, which is very awesome!
      Anyway keep up the great work, Share your progress!
    • #75611
      AvatarNathan Richer

      goblet squat! one of my favorites!

      some thoughts:
      1. at 0:05, as you descend you are hip hinging back and not dropping straight down. you should try to keep your body upright and descend down between your legs. something to try: using your hip flexors and hams, pull yourself all the way down to the deepest you can go. feel those muscles contract to pull you down. and keep your body upright – do not lean fwd.
      1a. you can also try holding the KB farther away from you fwd. this will be hard on your arms, but it will also give you some better counterbalancing potentially to let you get further upright. play with this. you may need a lighter KB. you can also try going down and at the deepest position you can safely get to, pushing the KB slowly away from your chest. this can potentially get you more upright if you see/feel yourself leaning fwd.
      2. at about 0:06, your pelvis starts to fault (ie. butt wink).  this is your deepest, safest position for now. i would not go lower until i fixed this. it could hurt your back over time.  there could be a lot of reasons for this. i would mobilize the ankles, lower leg, quads/hams, hips, psoas, QLs, t-spine – did i leave anything out haha? use the deep squat as a test – use video or a mirror. test the squat – mobilize one of the above – then retest the squat again. did you get lower without butt winking?
      3. small point – at 0:14 – as you come out of the “hole” push the ground away strongly with your legs.
      4. at 0:15 when you bend down to park the KB, your back is going into a big concave curve (ie. kyphotic). this is also dangerous. you should keep the back in good neutral position, and then deadlift the KB down to the ground. do not think your lift is over until you park the KB! 
      5. front view doesn’t look too bad, but hides the issues visible from the side.
      6. your feet are slightly turned out which is OK but as most people here would probably say, set yourself the goal of squatting with feet pointed straight forward and not to the outside. work up to this as you mobilize and work on the butt wink.
      great stuff and report back your progress!
    • #75612
      AvatarPawan Lalwani

      Thanks for breaking it down for me David.  Point 4 is something I need to pay close attention to.  Going to have an FMS screen to today so I’m hoping I get some good feedback on other movement patterns that could be contributing to my lateral knee tightness and pain as well.

    • #75613
      AvatarNathan Richer

      another way to think about it – the deadlift (or hip hinge) involves moving your pelvis forward and back. the squat involves moving your pelvis up or down.  keep this in mind as you work on the goblet squat. mixing the two is definitely neither!

      also i assume you also do other KB work? if you swing a lot, you may be unintentionally bringing the hip hinge into this squat.
      please do share your FMS numbers. yes that can help.
    • #75618
      AvatarPawan Lalwani
      Scored 17 out of 21 on the FMS Screen

      Deep Squat I had some trouble with my feet shoulder width going deep, with my heels up on something I was able to go deeper without any problems. They did notice my right knee tracked in a little, but nothing too bad. I usually squat with a bit of a wider stance, toes pointed out just a bit as seen in the video above.

      Hurdle Step Scored a 2 they mentioned I swing my leg out and over the line instead of just stepping over.

      Inline Lunge scored a 2, was a little shaky coming down, but not much else to be noted.

      Shoulder Mobility scored a 3, surprising since I separated my shoulder a couple years back and didn’t rehab all the much, just ROM drills, no real soft tissue mobs

      Active Straight Leg Raise scored a 3, good hamstring mobility, not much to note, however I do feel a pulling on my left kneecap when mobilizing the biceps femoris with a lacrosse ball, also felt it when a PT hit a trigger point dry needling, continuing to work on that.

      Trunk Stability Pushup scored a 3, didn’t say much about this, other than I scored a 3

      Rotary Stability scored a 2, could do the movement when lifting my left hand and leg(affected side) but couldn’t remove my right knee and hand from the ground without falling over. Could do the bird dog movement opposite sides just fine, heard everyone has issues with this one. Curious why I could complete the original movement with my left side, but not on my right. Any insight here is appreciated, forgot to ask.

      Passed the shoulder impingment test and posterior rocking test. No real asymmetry noted except for the rotary stability. He did check my psoas and I didn’t have any tenderness/tightness. Noticed my rectus femoris on my affected leg is pretty tight vs unaffected side. Gives me a couple things to look into and work on, but I feel like I’ve been working on most of this stuff already with all the mobs and strength exercises I’ve done.

    • #75621
      AvatarNathan Richer

      some of the FMS tests have left and right components: hurdle step, inline lunge, shoulder mobility. ASLR, rotary stability.  what were your scores on each side? were there any discrepancies? sounds like rotary stability would be a 3 on the left side, but right was a 2.

      rotary stability is probably THE hardest out of any of the tests to score a 3 by far. i was at a talk by Gray Cook where he acknowledges that the tests are not equal or perfect. i assume you’re right handed? you therefore would have more control stabilizing on your dominant side/hand than on your weaker side. 
      the FMS is directional, not necessarily able to tell you exactly what is wrong.  if you get 2s on everything, it actually means you’re probably ready to go. differences between sides indicate things to work on for sure, as do 1s and 0s.
      did the person give you any correctives as dictated by the results of the FMS?
    • #75624
      AvatarPawan Lalwani

      He gave me the same score for l-r on all of the tests.  The main guy administering the test mentioned he didn’t see any asymmetries, guy certified in smfa that was looking on agreed.  He was going to email me with some additional things to work on and I have another private session at the gym with him that was included in the price of the assessment.  The only things he mentioned I added above in my last paragraph.

    • #75625
      AvatarNathan Richer

      cool – let us know how the additional things to do works for you. lots of ways to skin the cat – FMS and its correctives can do well for you.

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