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Lying Knee-To-Knee Stretch

Written on April 29, 2009 at 7:09 am, by Eric Cressey

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Subscriber-Only Q&A

Q: I have a question about your 22 More Random Thoughts article from October of 2008 on T-Nation.  In the stretch for the hips found above #10, I can’t tell is that athlete bridging or are the hips on the ground.  Also, can you please explain exactly what is stretched and how a little bit about how it corrects out-toeing of the feet?

A: Sure, no problem. Here’s the lying knee-to-knee stretch, for those readers who missed the original article:

lyingknee-to-kneestretch

First off, it’s a stretch for the hip external rotators, and the athlete is not bridging up.  However, it’s also useful to do the stretch in a more hips-extended position, as a small percentage of athletes will feel it more in that position.  To perform this stretch, we’ll do the exact same position, but have the athlete set up atop a stability ball (which keeps the femurs in a more extended position).

Poor hip internal rotation range-of-motion is something you’ll see quite frequently in soccer players, hockey players, and powerlifters, as all spend a considerable amount of time in hip external rotation.  Likewise, I monitor this closely with all my baseball pitchers, as front leg hip internal rotation deficit is a huge problem for pitchers.  When the front hip opens up too soon because of these muscular restrictions, the arm lags behind the body (out of the scapular plane).  As such, it isn’t uncommon for pitchers with elbow and/or shoulder pain to present with a significant hip internal rotation deficit.

There is also a considerable amount of research to suggest that hip rotation deficits – and particularly, hip internal rotation deficits – are highly correlated with low back pain.  There was a great guest blog post at Mike Reinold’s blog recently that highlights all this research; you can check it out HERE.  My personal experience with hundreds of people who have come my way with back pain overwhelmingly supports this “theory” (if you can even call it that).  It’s my firm belief that this is one of the primary reasons Mike Robertson and I have gotten so much great feedback on our Magnificent Mobility DVD from folks who have seen a reduction (or altogether elmination) in back pain.  Teach folks to move at the hips (particularly in rotation) instead of the lumbar spine, and whatever’s going on in their low backs calms down.

mm1

Our goal is a minimum of 40 degrees of hip internal rotation.  This is measured in the seated position (hips flexed to 90 degrees).

In addition to the classes of athletes I mentioned earlier, we also need to watch out for hip internal rotation deficit (HIRD) in the general population because of what happens further down the kinetic chain.  We all know that overpronation at the subtalar join is a big problem for a lot of folks.  This can occur because of a collection of factors, from poor footwear (too much heel lift), to muscular weakness (more on this in a second), to mobility deficits (particularly at the ankle), to congenital factors (flat feet). To understand how pronation affects the hip external rotators, you’ll need to listen to a brief synopsis of subtalar joint function…

During the gait cycle, the subtalar joint pronates, to aid in deceleration.  Basically, the foot flattens out to give us a bigger base of support from which to cushion impact, and from there, we switch back over to supination to get a rigid foot from which to propel.  The picture below shows what our foot looks like when we have too much pronation.

pronation

Here’s where our hip gets involved.  Physical therapist John Pallof once called the subtalar joint a “torque converter,” and it really stuck with me.  What that means is that while the subtalar joint allows motion in three planes for pronation/supination, it converts this motion into transverse plan motion where it interacts with the tibia.  And, as you can imagine based on the picture above, when you pronate, you increase tibial internal rotation. This, in turn, increased femoral internal rotation.  Taken all together, we realize that increasing pronation means that there is more tibial and femoral internal rotation to decelerate with each step, stride, or jump landing.

The hip external rotators are strong muscles with a big cross sectional area, so they can take on this burden.  However, over time, they can get balled up from overuse.  As a result, the hip will sit in a more externally rotated position all the time – and the feet simply come along for the ride.  That said, as I wrote HERE, it isn’t the only cause of this foot position, so be sure to assess thoroughly and individualize your recommendations.

Also, a quick side note, be careful using this stretch with individuals who have previously experienced medial knee injuries, as the valgus stress can be a bit too much for some folks.

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I encourage you to check out this Precision Nutrition Athlete Profile on Cressey Performance athlete and Oakland A’s minor league pitcher Shawn Haviland.  Shawn completely changed his body this off-season and had a nice velocity jump from 87-89 to 91-93mph – and he’s off to a good start for the Kane County Cougars. A lot of this can be attributed to him making huge strides with improving his nutrition.

Have a great week!

EC

  • Lelli

    I’ve been working on getting my right leg to stop having that pronating problem for a while now. It’s just another weak link in the chain that lead to my back problems.

  • Clark

    Awesome stuff Eric, as usual.

  • Rafael Nardi

    Great stuff Eric!

    Do you have a efficient alternative to this stretch? Most my clients complain of knee pain on this one.

  • Kelly

    When you’re shooting for the 40 degrees of hip internal rotation what position do you have the knee at?

  • Richard Hargreaves

    Eric: Maybe I have missed things. I have not seen the word chiropractor on your site and in your articles. As you know, chiropractic enhances athletic performanc, develops injury prevention functions, and promotes injury recovery as NHL, MLB, NBA, CFL, NFL, USOC,etc.all understand. Thanks for reading. Richard

  • Rafael,

    If you are getting a lot of complaints of knee pain, it’s being done incorrectly – or you have a lot of clients with underlying structural knee pathologies.

  • Kelly,

    Seated, hips and knees flexed to 90 degrees.

  • Richard,

    We actually work hand-in-hand with a number of chiropractors. I tend to use the term “manual therapists” as more of a catch-all term to encompass all the valuable professionals whose services we utilize.

  • Josh

    Is turning out of the walk during wlaking/running what could be causing me groin/hip pain? The pain is only on the side with the foot that turns out. How do you correct for that?

  • Are these stretches featured on your DVD Magnificent Mobility?

    Rich

  • Richard Hargreaves

    Thanks for your response. Now I can rest easy knowing that your athletes are truly getting the best of all worlds in order to realize their individual potentials.


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