Solving Knee Problems, Part 2

By Kelly Starrett

In ExPhysiology, Medical/Injuries, Videos

August 26, 2009

Video Article

Our series on solving knee problems continues with Kelly Starrett telling participants at a one day seminar at CrossFit Santa Cruz on March 14, 2009 that he first time an athlete engages the hamstring when squatting is an ‘aha!’ moment and “lights go off for them.” Starrett is the owner of San Francisco CrossFit and a Doctor of Physical Therapy.

If the tibia goes forward in a squat, joint forces across the meniscus will not be in perfect rotation. There will be compression and shear. Over time, this may result in a meniscus tear. “You set yourself up for that meniscus tear with your crappy squat,” Starrett says. To avoid injury, ensure the tibia is vertical, or least under control.

It’s also important to ensure athletes land properly with a definite “the buck stops here” end to the movement. The butt and hamstring should be engaged. Otherwise, athletes may put their knee forward and twist. Coaches should watch for a toe to heel to hamstring sequence.

Coaches should also harp on proper squat mechanics and repeating the “get the shin back” cue. Athletes need to have a good reason to put the knees forward. A good answer from an athlete might be that his knees were forward to keep his torso upright, but his hamstring was engaged.

6min 5sec

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24 Comments on “Solving Knee Problems, Part 2”

1

wrote …

Regarding knees forward for an upright torso (e.g. olympic style squat), does anyone know how prevalent knee injuries are amongst weightlifters? Maybe it is a case that they develop strong enough connective tissue through training that it is not an issue?

2

wrote …

Fall over a dog? This sounds like an ex-Denver Brocos quarterback joke?

These videos continue to be awesome. Kelly. Calgary. Do it.

3

Mike Kesthely wrote …

I second that motion. Calgary.

4

wrote …

Kelly, Yous the man.

5

Jeff Vale wrote …

K-Star,
Awesome vid. Love your expertise in dealing with people with physical "issues." A few questions if you get time.

So no oly shoes? Especially for people with knee issues?

Would you recommend a wider stance in most squatting to minimize shin angle and get more backside in it?

Thanks,
Jeff

6

wrote …

This has beeen already asked here but what about people who squat olympic style,should they start doing low back,vertical tibia squatting?
Maybe i'm wrong but cleans and snatches are received in a full squat,knee way over the toes.....

7

Rob Barrese wrote …

Great video as always.

Question about the OHS. This is definitely a problem with the OHS. Keeping the Tibia vertical is extremely difficult. Any thoughts on solutions for this, mechanical corrections, ect.?

8

wrote …

The tibias must be vertical or "at least under control."
Is there a way to describe an acceptable range for 'under control,' say, 10 or 15 degrees from vertical? The knee no further out than the toes?

I wish we could have seen what constituted a 'failed squat' at the very beginning of the piece, when that tall trainer in the hoodie sweatshirt was dropping to the box. After a bit of conversation, in the third squat he does, (when the student in the blue jacket drops out of the way of the camera, and Kelly talks about rocking back up with momentum) we get a pretty good view of his right leg in the bottom position. The tibia is inclined a bit; his knee is probably right over where his toes join his foot.

Later, when Kelly is more or less facing the camera, saying folks have to "get their hamstrings on," he jumps down into a squat. He appears to be in much the same position: the tibias are not totally vertical, but his knees are certainly not any further out than his toes.

Is that a decent enough understanding for now? I hope the next installment has a comparison between good and bad squats. In the meantime, I might have to go back and visit the video with Messers. Rippetoe and Thrifty.

9

wrote …

As far as injuries and exercise go, what would be recommended to a client that presents with "water" or fluid in the knee? The client/patient presents with stiffness and slight swelling in the same knee. Would you recommend RICE only, or RICE, then intermittent light movements/weights? Or even RICE with extended periods of rest from leg exercises in general while working through acute injuries doing only hip up exercises without loading the knees?

10

wrote …

As far as injuries and exercise go, what would be recommended to a client that presents with "water" or fluid in the knee? The client/patient presents with stiffness and slight swelling in the same knee. Would you recommend RICE only, or RICE, then intermittent light movements/weights? Or even RICE with extended periods of rest from leg exercises in general while working through acute injuries doing only hip up exercises without loading the knees?

11

Rob Barrese wrote …

#8 Thomas that is a good question. As a rule it had always been addressed knee out directly over your first and second toe but not past the toe and not outside the plane of the foot. I would like to see a clearer answer to your question as well.

#9 Jared good question. I would think your first suggestion is the answer but I'd like to also see a definitive call on that as well.

12

Hollis Molloy wrote …


Every squat is a compromise. In this video series Kelly is talking about helping athletes with knee pain. Getting the "hamstring on" is vital to keeping the knee in good position and the tibia nearly vertical. The "vertical tibia" is a cue to get the athlete to turn on the hamstring.

The cues are used to get an athlete to engage their hamstring and maintain peak tension at the bottom of the squat. When the the knee shoots forward because the hamstring is not engaged is when we see problems.

13

wrote …

#9 I was that client,stiffness and slight swelling in my right knee.Air squats are the way to go,with weight in heels and vertical shins.Ice after a workout.
Always aware of technique in walking lunges.My knee only improved with exercise.
I have the beginning of arthritis so substitute rowing for running.

14

Jared,
Definitely air squats with the vertical shin. You may also want to widen the stance a bit and have them reach their hips way back so they feel the stretch in the adductors and hams. Also, lots of quad stretching (at least once the knee will allow for that much of a bend). This has really taken a lot of heat off of my knees. Many of us CFers become very quad dominant squatters and you just have to stretch those babies out so they don't get so tight and start causing knee problems. You will also have to work hard with this athlete in any kind of front squat (thruster, sq. cleans etc.) It also helps me to widen out just a bit and wear flat shoes. Oly shoes with a high heal are not great imo for people with acute knee issues. Once they are cleared up maybe give the oly shoes a try again and really work on keeping the hams in the lift as K-star talks about. The fluid could also be form a structural issue ie. meniscus or bone spur. Can't hurt to get and mri or x-ray. Even if those came up positive though you might be able to solve a lot of it with some really focused squatting mechanics. Those are my two cents from a guy who has dealt with some knee stuff personally. Hope it helps.
Jeff

15

wrote …

Kelly's the best thing to hit CrossFit since Mike Burgener!

16

wrote …

This has already been covered in the hamstring activation comments by me!!! Don't ever mess with the best!

17

wrote …

Great vid Kelly!
One comment which made me say "Oh no he didn't"....was this one about "ride it hard and put it away wet" This is something my Dad use to say and I haven't heard it for a long time. Awesome!
In addition to Calgary, hit up Vancouver too.
Come on...do it soon!

18

Saul Jimenez wrote …

I was just riding my athletes like a pony yesterday about this issue in the context of the dead lift. This is where coordination and accuracy have a direct effect on increasing power and speed. If you can't control a muscle, it can't be stronger and sure as heck can't get more powerful. This is going on the website. Thanks K-Star!

19

wrote …

Thanks for the great instruction Kelly!

Six years ago I had major surgery in my left knee (acl tear, mulitple meniscus tears, along with a plethora of cartilage free bodies). Went through the standard PT rehab, six weeks no weight bearing with ROM stretching, then to three months PT assisted standard strength training, then to another four months of self strength training. Given this effort, eight months later I was left with little to no confidence in the knee and gave up my playtime activities for fear injuring the knee again.

I came across CF on a cimbing forum and decided to give it a try due to my frustration with the prior mediocre results. Six months later I have a newfound outlook my knee's performance. With a bit of time, effort, and solid instruction from trainers like Kelly, there's hope for my knee yet.....

Thanks again.

20

wrote …

Excellent video. Everything Kelly was saying was echoed by Dave Tate in his video on box squats. Thanks again for the great info.

21

replied to comment from Bret Brovick

Bret Brovick is a self indulgent tool box who needs to work out a Gold's

22

wrote …

Another great video, Kelly! I am a 66 yr old guy who until this past April was lucky enough not to have had any knee problems. Two weeks ago I had arthroscopic surgery on my right knee to clean up a badly torn, lateral meniscus which had folded over, plus some other stuff (crystallization & beginning arthritis). Recovery is going well, but I am still uncertain about getting back into my modified versions of CF WODs. Is there any place I can find more info on starting back after surgery?

23

wrote …

James.... I work for athletic republic.... Not gold's gym....

24

Clint Thompson wrote …

Great advice on doing proper squats. Do you recommend doing squats properly as a way to help reduce knee pain as well or this more for preventing it? Would you advise using knee supports like http://www.bodyhelix.com.au/Patella-Helix-p/pt01.htm during squatting for people that have knee problems?

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