FMS to valgus collapse

I am a former D1 soccer player and current private strength coach who has always had pronation, tibial external rotation, knee valgus, and hip medial rotation problems, especially on my right side. One chiro said it starts at my foot because my peroneals are so tight and this limits dorsiflexion which then causes me to pronate and the knee and hip follow. At my internship at Athletes Peformance it was all about the hip external rotators and I know for sure that is not everything. When I run my foot splays out to the side and I look ridiculous like those weak women joggers with huge q angles. I am just tired of these power leaks and I have searched everywhere (Shirley Sarhman included) and I cannot find an answer. Mini bands have only gotten me so far. From what I understand I am tight in – peroneals, adductors, TFL-ITB, and biceps femoris and weak in – glute med, posterior tibialis and semi hamstrings. I am also in anterior tilt I think on my right side more so and this puts my into pronation.

The truth of the matter is that this issue can have any combination of contributions to the valgus collapse.

It can be coming from the foot itself. Perhaps a lack of ankle mobility into dorsiflexion is being compensated for with dropping the arch into pronation. This is a classic example of robbing stability to make up for a lack of mobility.

The knee is typically not to blame, as the mechanics at the joint are guided by the ankle below and hip above.

By your description, the contribution to your right pelvis position can be stiff anterior hips, stiff lower back, and/or inhibited anterior abdominals and glutes. All 4 of those players can lead to valgus collapse.

The lower-crossed syndrome that you are describing holds true for all the areas where you think you are tight or weak.
So you know your problem, and you have described it well.
So what do we do about it?

I would ask you to try to work through your FMS weak links with a committed diligence, and see what happens. The asymmetry and anterior shift on the right should show in multiple screens of the FMS.  Something I want to emphasize is that you don’t need to be playing around with ASLR, Leg Lock Bridges, and Partner Stretches for 6 weeks.  Get the mobility and lock it in and progress to the higher level movements as quickly as you can.  Deadlifts, Swings, and Presses are higher level movements, but they are corrective as well.  I don’t want the message of training through the FMS to highlight only the lower level mobility and stability.  There are plenty of heavy and aggressive lifts that merit the mobility and stability you already have and the new levels you can earn.

You can address the tone and weakness/motor control of each segment individually or regionally as Sahrmann might, but I don’t know if you will get the gas mileage you are looking for. Piecing together all the right parts doesn’t always work out as we hope when we try to put them all together. If you look at whole-body, long-chain movements and rank them by their “disgust,” the weakest link will reveal itself. Going after each spot individually won’t hurt, but I would urge you to look at movements before you look at the impairments.

If you are not familiar with the FMS, this would be a great keyhole into the system.

  • October 30, 2010

Leave a Reply 11 comments

Jeff Cubos Reply

“I would urge you to look at movements before you look at the impairments.”

This is the boat that many of us, including myself, miss too often.

CL mentioned this to me last month as he wondered how people can be so focused on both Sahrmann’s work and the movement concept at the same time. Was an ah-ha moment for me.

Charlie Reply

I have cultured my thoughts that Sahrmann’s work does not involve a revention of movement. Her systems uses movement to alleviate pain. This is useful and even brilliant to incorporate into the movement-based approach, but it is not enough.

Her lack of manual therapy approaches works because of the missing “reinvention” of movement.

That being said, she is an ally as she fights the evil forces of kinesiology- and impairment-based training with strong fervor. There is much to be learned from her work. I wish she felt the same towards others.

Rob Butler Reply

Great post … We actually just started looking at these mechanics with our post-op ACL patients and its amazing how quickly these patients are asked to jump around on one leg however we have yet to see any of them have a 3 on the FMS DS. For patients with LE problems or surgery our current thought is a 14 with no AS is a good start but they actually need to be better than average and they sure need to be better than they were before surgery. So we are thinking >14, no AS, 2 DS for return to sport but > 14 , no AS, 3 DS for release from therapy. It is amazing how the patients can relate to their landing with a simple deep squat or their running mechanics through a simple half kneeling exercise.

Charlie Reply

Rob – The discharge criteria you suggest is a powerful sociological commentary. The notion that “training” stops when you go back to sport is a major problem. It probably doesn’t get a lot of burn in discussions, but I agree with you highly.
Whether it’s PT or not, I can live with simply continued training towards the 3 and 21 overall. We know it’s not a race for a 21, but we are always trying to get there with good terminal level training. I think that can happen with a PT or trainer as long as it happens right.

Rob Butler Reply

We’ve been thinking about the fundamental “selling” rationale for the orthos and it goes something like this…

You have a patient who has wiped the fundamental motor program out that was the foundation for jumping … I think we should probably get that back before we say they are “good to go.”

It just hit me this week how much of a medical emergency it is when a 3 year old is missing a fundamental motor developmental milestones, however, we simply assume people to have lost motor developmental milestones as adolescents and adults.

Thanks again for the reply. We are going to try to develop a grant to track patients for a year following their ACL rehab discharge and see if we can predict injury using the FMS and YBT. It is bound to give us more than isokinetic testing and a subjective therapist assessment of movement patterns.

Mat Herold Reply

Charlie,

Cool to see my question used as a blog. Thanks for the info…however I am still really struggling with this issue in myself and my athletes. I have spent time on my tfl, peroneals, internal rotators of the femur rolling them out with a soft ball, and strengthening glute med and the foot arch in a tripod. Doesnt seem to work. Even when my femur is not in internal rotation my foot everts and I think it has to do with lateral tibial torsion. Perhaps I need to spend more time on the anterior tilt positon of my ride side. I really appreciate your help and I hope others can benefit from your expertise on this matter.

Charlie Reply

Mat – That is very reasonable to blame tibial rotation, but analyzing and treating at that level can get complicated.
You can not go wrong attacking the hip. Hammer it and see what you get.

Mat Herold Reply

Thanks Charlie. I have noticed recently that my femur rotates medially because my glute max/med does not activate during ground contact!!! During a squat with knee and hip flexion it is easy for me, but extended in an upright position it does not. Same when I lift my knee up to my chest (hip flexion)- the glute med does not activate. Does this make sense? In other words- when I walk my left foot stays in contact with the ground longer but on my right its a touch and go- the glute never kicks in for hip extension- then again maybe that happens because of tight plantar flexors!!!? GEEZ

Charlie Reply

Tight plantar flexors is a possible, but if what you are saying is true, I’d want to get that checked out with a neuro workup to make sure there is no nerve adhesion that is limiting the glute contraction.

Mat Reply

Thanks again. I will look into it and update you with the outcome.

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