Questioning Valgus Collapse

In your experience do you find vagus collapse or buckling knee problems to be more related to VMO weakness or deep external hip rotators… Or both… Or something else?

One part is easy to answer.
The other is a little more interesting, at least to me.

1.  Absolutely nothing to do with VMO. That’s total trash.
No need to even continue with anything else.
Well, I will say this.  After unique threats to the knee joint, the arthorgenic inhibition of the VMO and other quads is the result.  It was never the cause in the first place.

........................., f- it.  I don't even know what to say.

……………………., F- it. I’m not even going to say anything.

2.  I’m inclined to say that same thing in regards to the 6 External Rotators, however, I’m probably less linear with this group of muscles.  I guess if you could contract them without other muscles, which you can’t, they could prevent valgus.  And if you train them eccentrically in an ipsilateral sidelying position, it could have positive effects on limiting knee valgus, but……

I’m just not sure you can ever feel firm about saying any one muscle or group of muscles are ever weak unless someone can’t feed him- or herself or get up out of a chair.  In my mind, there is no weak, just varying levels of strong.  Strong or strong enough has to be based on the task at hand.
I think you need context of whether you are pushing big wheels, controlling bodyweight, or in a highly supported or deloaded environment.

For instance, if a knee buckles on your 8th rep with 5 wheels, are you blaming a weak Glute Med?  I doubt it, and if you are, I’d highly doubt you’ve ever even unracked 5 wheels or know what 5 wheels means.  The weight was just too heavy, and you went somewhere to try to control the motion by crashing a joint together.
But if you have aberrant mechanics in running, you’ll blame Glute Med or Glute Min or whatever the last EMG study you read said was at fault.  I find it interesting as to how this makes such a difference when running has been shown to measure out anywhere from 1.5 to 7x body weight going through the lower extremity every time you hit the ground.

That's 5 wheels, and his rotator cuff is not weak when his shoulder hurts.  Trust me.

That’s 5 wheels, and his rotator cuff is not weak when his shoulder hurts. Trust me.

I find it even more interesting that for these folks with “bad mechanics,” if you put them onto a seated ABDuction machine from only the finest selectorized lines, many of them will be able to push a very low pin.  If you measured that first, no one would say ‘X’ muscle was weak because Captain Kinesiology says this or that muscle works in that motion.  Or if I can lateral walk against your little blue band, how can my Glute Med be weak?
If a muscle shows you force production of an appreciable level, the muscle can not be weak.  It’s the same myofibrils, same sarcoplasm, and same Z-lines in the muscle whether you’re in a seated ABD, monster band walk, a box squat, or a pistol.

So if I had to choose.........

So if I had to choose………

So I don’t think muscles are ever weak outside of extreme chronic situations of age-related disuse or disease.
I think the feedback of joint position, tension, compression, the list goes on, adds up to the brain making an acute change in motor strategy.  It is probably a protective choice more times than not, so this isn’t inherently negative.  A non-chronic motoric adaptation can be coached.  It can be outrun, and strength training can be part of that answer.  In fact, I think strength training is the best answer, but not because you are so much creating changes locally at muscle tissues to increase force production.  Rather, I believe you are adding the most potent aggregate of inputs to learn to repeat a series of similar strategies.  It’s acquisition of new motor skills.  It’s motor learning.

I think where the hot water comes into play is that when we look at literature measuring EMG in the presence of painful patterns, this low score gets translated into a weak muscle.  The EMG is not wrong unless of course they are using some surface EMG from KMart, but overall, you can’t argue with what a device reads.  But you can argue with what you are going to do about it and how any of it works.  EMG is real; it just doesn’t always matter or tell the whole story.  Much more on this on T=R2: Lateralizations & Regressions.

3.  Of the muscles in question related to knee valgus, glute med and glute min are the fan favorites to cause improvements with what these researchers call isolated strengthening exercises.  A study came out just this week from Iran with a killer N=14.  Quite frankly, when we look at the literature, there is more than enough to suggest that so many weeks of doing your little clamshells and bridges positively affects knee pain.  Again though, just like EMG, you can’t argue with the study unless you think they fudged it, or the statistics were suspect.  I don’t know or care enough about these studies to say that.  But we know really anything can change pain, so the ANOVA that was missing in the Experimental Group was their FABQ, autonomic neural or subjective stress measures, what they did on days not with the researchers, and follow-up after they returned or if they returned to their previously provocative activity.
I used to believe whole heartedly in this type literature, but I was wrong.  It’s just not something that motivates my thought any more.  It is really embarrassing to sit and listen to these researchers say bend forward 8 degrees to get more Glute Min, ankle mobility or rib position doesn’t matter,  or “Don’t worry, I used to be a powerlifter,” but it’s also good to stay updated with messages you think you disagree with to be sure you are on the right side of the ticket, or further dismiss something.
All in all, why would one ever do soft isolated drills if they have the joint position to progressively get after squats, deadlifts, steps, and lunges…..progressively, not get after big wheels right away?  How can you do a clamshell and only use the deep stabilizing muscles?  And if you are using the big glute max, how can you load it enough to make local adaptations?  This is just stuff I think about with the research from your EMG heroes.

All in all.  All for one.  Oh, the irony.

All in all. All for one. Oh, the irony.

Muscles aren’t weak.  No one’s Glute Med or Glute Min or whatever muscle is devoid of force production.  Try some other test in a highly supported and/or non-threatening environment and see if it’s still weak.  Muscles can’t be weak only some of the time.  It’s the same muscle regardless of the position you put the body in.  What the brain creates or allows for is what may be different.
Motor function is pattern-specific, and it’s variable-specific.  It’s load-specific.  It’s fitness-specific.  It’s joint competency-specific. Yes, it’s whatever you want to to be-specific.
You want to say the pattern is weak?  That makes more sense even though it’s not the words I would use.  At least I think I understand what that person is trying to explain.

So if it’s not weak, then what is it?
It’s motor control.

And there in lies another fairly hollow statement.  It’s the correct statement, but it still can mean dozens of different things.
It doesn’t mean any one technique is the answer, but in truth, any one technique might work.
The realities of why someone’s knee collapses when you think it’s not supposed to (because actually, it is supposed to, it’s just not desirable if chronically adapted to), lie in the heavily indebted works of Pr Janda.  When Janda used the words “inhibited” and “facilitated,” remember 1) they were translations into English, and 2) he did not describe them with the ridiculous absolutism of more recent commercial models where individual muscles, some that you can not even palpate or selectively contract for a billion dollars, are inhibited and devoid of contractile function or facilitated in a state of constant tetany amounting to screwing up everything from motor function, pancreatic regulation, or osteopenia of the zyomatic arch.

So I will choose to suggest that EMGs read what they read when knees go valgus or knees hurt because the unique series of inputs yields the brain to down-regulate neural drive to certain muscles, up-regulate it to others, and the acute motor pattern is delivered.  Do it enough that way, it will become autonomous or “normal” under that and under similar variables not enough to cause enough proprioception to change.  Then you need treatment, and whatever works, works, and it doesn’t matter why it works.  And it doesn’t matter why it works because no one can prove why it works, but they can prove that someone feels better or moves differently.  That’s all the matters even if their clinical intentions are absurd.

I don’t think muscles are weak.
I don’t think muscles are off unless you’re dead.  Or unless you’re a chicken running with your head cut off.
I don’t think glutes have amnesia.  They don’t have a brain.  Brains have amnesia.
I don’t think you have weak glutes because you can’t root into the floor.  But you will be weak when you swing or snatch.
I don’t think lateral band walks “work Glute Medius.”  They work lateral shuffling at the intensity that you choose to perform them.

I hear these big cats go for the neck.

I hear these big cats go for the neck.

Knees buckle because of…….
1) threat being mediated by causing you to recognize something is wrong, and knee buckling may make you stop via severe loss of force production,
2) ankle mechanics are compromised, knee and hip are not, and the proprioceptive input yields a level change that feels safe,
3) loss of loaded tibial internal rotation because of JMD, TED, or SMCD yielding proprioceptive input where the level change feels safe,
4) hip mechanics such as anteversion yield proprioceptive input where the level change feels safe,
5) spinal mechanics or function yield form closure of the pelvis and joints south,
6) biological power was not consistent with the demand in terms of the weight being too heavy, acute interval rest was not sufficient, or Readiness was not respected; motor strategy or form closure of hip IR may result,
7) the unique movement variables were not resilient to such as new shoes, surfaces, acute split-attention, or using an olympic bar instead of the Texas Power Bar, feels weird on your neck in a high bar squat,
8) no one ever coached the individual to not do it.

And then again, you want the knee to buckle sometimes to ensure you are maintaining joint mobility and drilling tissue remodeling so when all of the above hits the fan, you leave the strong safety picking up his jock.

Or maybe he was a weak safety.

Little valgus there on one of my all-time favorites.

Little valgus there on one of my all-time favorites.

  • December 13, 2014

Leave a Reply 3 comments

Mat Reply

Charlie, great stuff. What are JMD, TED and SMCD?

Charlie Reply

JMD = Joint Mobility Dysfunction
TED = Tissue Extensibility Dysfunction
SMCD = Stability Motor Control Deficit

Rob Mahon Reply

Found you via Dan Pfaff. Great stuff. A PT who really/actually gets it! Thank you for your contribution.

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