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Improve Squat Patterning with Fascial Stretch Therapy - Part 2: The Knee


Learning objectives:

  1. Learn how to implement Fascial Stretch Therapy to correct common knee problems in the squat,
  2. Discover how some knee pain conditions can be eliminated using new Stretch To Win – Fascial Stretch Therapy System® techniques, and
  3. Understand how to use STW-FST techniques to improve neuro-motor patterning.

This article explains and demonstrates an advanced modified PNF system that can be used to remove the restrictions that are the barriers to good movement. The squat is used as an example and we will focus on the hip, knee and ankle to complete a 3 article series. This is article 2 on the knee; please review article 1 discussing philosophy, principles and technique applied to the hip: http://www.ptonthenet.com/articles/improve-squat-patterning-with-fascial-stretch-therapy-3769.

As discussed in the first article, faulty squat patterns are often whole body issues. Before discussing Fascial Stretch Therapy (FST) solutions, the following is a list of major items that must be screened and integrated with FST for a complete approach. It is important to note that the knee is often the “victim” that may experience pain, weakness or instability. This is on account of it being “caught” between the “criminals” of the hip and ankle/foot. Any problems of imbalances identified in the hip and/or ankle/foot should be addressed first before correcting the knee in isolation.

Therefore, the entire kinetic chain should be taken into account for a more accurate assessment. (Note: not all items listed below are necessarily completed at the same time. Some items are completed only when indicated with an accurate and proper screening):

Even with the best of assessments/tests, corrective training and re-assessments, there will be clients with continued knee pain or other discomfort, mobility and/or motor pattern faults and some with excessive muscle tension or over-recruitment problems. These are the problems that respond best to FST.

Due to the lengthy material involved in the topic of assessments, this article will concern itself with useful and practical information that the fitness professional can immediately incorporate into a fitness program. This information comes from the author’s 24 years experience in successfully correcting movement patterns with a focus on FST integration.

2 Common Problems, 2 FST Solutions

The FST solution to many of the knee problems seen in the squat is to first assess and address it with a full body approach before looking at only one body part. We say, “Go global before local.” FST uses innovative, undulating mobilization and stretch movements with specific sequences along targeted myofascial chains to elicit quick and effective corrections.

One common example is anterior kneecap pain. Even when hip imbalances, knee position and/or ankle mobility is corrected, pain may still be present. While some clients with this symptom may have some degree of patella-femoral joint degeneration without knowing it until they started squatting, many can still be helped with FST techniques.

The second example we will discuss is posterior knee issues. One may have pain posteriorly for a variety of reasons. Another example is a client that has sub-optimal power in triple extension coming up out of the squat. One aspect of this that is often ignored is a tight posterior knee joint capsule and/or popliteus muscle. Another is glued tendons of the hamstrings and gastrocnemii that block full knee joint extension and inhibit full quad activation. Together this decreases knee joint stability, making it more prone to injury.

Those aforementioned knee problems and FST solutions are further discussed below, but first contraindications and FST tips must be reviewed before attempting the technique.

FST Contraindications

Please follow any contraindications and precautions as dictated by your client intake form and your training/experience. Others peculiar to certain stretches will be noted.

FST Tips

FST Techniques for the Knee

Technique 1: Superficial Front Line (SFL) stretch – anterior knee fascia focus

The difference between an isolated assisted quad stretch and an SFL stretch to affect the muscles and joint of the knee is huge. If one attempts this stretch with a client in the side lying position, and one performs a traditional, isolated stretch by flexing the knee in the sagittal plane, one will only stretch mostly the distal portion of the rectus femoris and some of the rest of the distal, anterior quad attachments. Adding hip extension adds more stretch to the rectus femoris, leaving out the rest of the quads that cross only the knee joint.

In contrast, if the trainer expands his/her concept of the anatomy and includes short and long lines of fascial connections, then one’s eyes open to see many more factors that play a role in function that can also affect the knee. Fig. 1 notes the fascial connections from, literally, head to toe, and displays the bigger picture of how the knee serves in just one of many full body fascial lines. With many common knee problems, the fascia of the SFL is often glued and shifted in a specific direction. This can affect the entire kinetic chain or have dominance in one region, like it often does at the knee.

For example, if the SFL is shifted up then the patella may appear in a higher position than normal. Or it may be shifted down in the opposite direction. Both can lead to knee pain and/or instability/weakness during the squat. FST can correct both issues quickly and restore the squat to normal if this is the cause of the aberrant squat pattern. Performing a traditional and isolated rectus femoris or quad stretch will often not do the job.

(Note: terms found in Thomas Myers book “Anatomy Trains” will be used including individual muscles found in those fascial lines that we are targeting).

Fig. 1 Fig. 1. Superficial Front Line (SFL)
(kind permission from Myers & Primal Pictures)
Fig. 2 Fig. 2. Superficial front line stretch - anterior knee fascia focus Fig. 3 Fig. 3. Stretch to Win-Fascial Stretch Therapy: The Scorpion Stretch™

Technique 2: Deep Front Line/Superficial Back Line stretch – posterior knee fascia focus

As stated previously, the pain may be in the posterior knee for a variety of reasons. Some common examples are repaired ACL, PCL and some other knee surgeries. Many clients never achieve full extension of the knee after rehab and most never achieve full, normal hyperextension (up to about -3˚). Coming up out of a squat without fault may be a problem for these clients, as the full extension lockout position at the knee may be inhibited and/or painful.

(It is the author’s opinion that even if one does not fully lock the knee during some triple extension functional movements, it is essential to train. It enforces full neuromuscular activation, joint stability and proprioceptive training for all activities involving triple extension. The squat is one exercise that can effectively train this movement, with a focus on knee lockout, if indicated).

While scar tissue may still be the cause for many, the FST solution for this problem is quite effective, often eliminating scar tissue in the process. This is because the technique targets the deepest fascia in this region - the posterior capsule. It also targets the deepest muscle of the knee, the elusive popliteus (see Fig.4). (The popliteus sits in the Deep Front Line because of its initial position in development).

In addition to or separate from a tight joint capsule, a tight popliteus may be unable to lengthen enough to allow the knee to fully extend and lock out. It may also act to prematurely contract from a stretch reflex thus causing early buckling of the knees inward upon initial descent. In any event, a glued up popliteus will interfere with proper sequencing of motor patterning and needs to be addressed.

Finally, fascially glued tendons of the interlocking hamstrings and gastrocnemii will block full knee joint extension and inhibit full quad activation (see Fig. 5). Together this decreases triple extension and knee joint stability, making it prone to more injury. The following FST method will address scar tissue, the joint capsule and the myofascia problems just described.

Fig. 4 Fig. 4. Deep Front Line – Popliteus/posterior
joint capsule (kind permission Myers & Primal Pictures)
Fig. 5 Fig. 5. Superficial Back Line
(kind permission from Myers & Primal Pictures)
Fig. 6 Fig. 6. Popliteus-posterior capsule-hamstring-gastrocnemius-DFL/SFL stretch

Summary

This article is the second of three to introduce you to the Stretch to Win-Fascial Stretch Therapy (STW-FST) System. The focus was on learning how to assess and remove restrictions in the joint and muscles around the front and back of the knee by way of myofascial lines. Re-testing the squat after each problem and solution example that was given in both articles will reveal the dominant problem causing faulty movement patterns, along with secondary ones.

You have also learned that STW-FST is different than traditional, isolated stretching. This was defined in article 1, with the 10 Principles that address all systems of the body to make it a complete approach.

In article 3, we will complete this series with a focus on the ankle and foot, as well as the myofascial lines connecting above, that influence how the knee functions, tracks and contributes to faulty squat movement patterns.

References

  1. Frederick A., & Frederick C. (2006). Stretch to win. USA: Human Kinetics
  2. Myers, T. (2008). Anatomy trains. UK: Churchill Livingstone
  3. Mancino, M. (2005, March 7). The squat: Hip vs knee. PTontheNet.com. Retrieved from http://www.ptonthenet.com/articles/The-Squat-Hip-vs-Knee-2381
  4. Rippetoe, M. (2009). The squat. USA: The Aasgaard Company
  5. Schleip, R., Findley, T.W., Chaitow, L., & Huijing, P.A. (2012). Fascia – The tensional network of the human body. UK: Churchill Livingstone Elsevier
  6. Alter, M.J. (2004). Science of flexibility (3rd ed.). USA: Human Kinetics