Ask The Doc: Why We Develop Bad Knees

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by MIKE CAISSE|DPT

Ask The Doc: Why We Develop Bad Knees
As athletes, as weekend warriors, as normal functioning humans we rely on motor control. What is motor control? The simple explanation:

It’s the brain’s ability to communicate with and manipulate the body throughout space. Think running, jumping, swimming, rowing, grappling, yoga, burpees, kipping, snatching, cleaning. Or even twerking if you’re into that sort of thing.

Why do we need motor control? Based on neuroscientist Daniel Wolpert’s research, the only reason we have brains is for producing adaptable and complex movements (Wolpert, 2013). Thankfully, as humans we’ve evolved from requiring such movements and motor control to capture prey/avoid large saber-toothed animals to requiring them to avoid injury and improve our body’s capabilities.

Statistics suggest that most of us have poor movement patterns. As humans get bigger, stronger, and faster, our joints are playing catch-up. Poor or inefficient movement patterns are thus compounded.
Obviously neither motor control nor its physiology are simple. As physiotherapists at Movement Rx, we have had the pleasure of studying motor control at the doctoral level and restoring appropriate motor control is exactly what we do for a living. One of our goals is to help people understand the WHY behind movement inefficiencies. I’ll get back to that, but for now let’s cover a great tool to illustrate motor control.

A reflex arc is the simplest and most primitive form of motor control. Please take a look at this simple model:

Knee graphic

Mechanical receptors in your joints, muscles and skin help you gather information to perform movement tasks (you have other senses; however, for simplicity I’ll use these three). As you perform movements that produce positive outcomes, those movements are stored in the brain as a motor pattern for later use. Those movements that produce negative outcomes are inhibited. Your brain has been building a database of movement since you were born to make your life easier. The reflex arc shown above demonstrates rudimentary motor control of the knee joint and thigh musculature. A stimulus produces a sudden stretch in the quadriceps and they contract as the hamstrings relax. This level of motor control does not even have to travel up to your brain; it’s a reflex — it’s so old that it is hard wired into your spinal cord to respond the same way every time.

Most of us have been moving like this for the majority of our lives because no one told us it was a problem.
Unfortunately, in life we encounter circumstances that cause us to move poorly. Commonly we see athletes who have decreased hip and ankle mobility caused by prolonged sitting and wearing shoes that have an excessive ‘drop’ – think any shoe where your heel is higher than your toes. (Yes, that means most of the shoes you own.) This causes the athlete to lose the ability to express optimal movement when walking, running, squatting, etc. Feet turning out, arches collapsing, knees pointing in, pelvis dropping on one side – these are all indicators of an athlete having learned a movement pattern that is incorrect.

Knees in

These aforementioned positions are not ideal and not congruent with the design of the body and its capacity to move. You can get away with moving like this for a while…until you can’t. Over time the tissues will fail when repetitively exposed to these load cycles while in poor positions. Dr. Kelly Starrett/K-Starr calls this “spending your genetics.” Most of us have been moving like this for the majority of our lives because no one told us it was a problem.

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