Knees Over Toes - Myth Bust Monday

Knees Over Toes - The Case Against The Ministry Of Silly Walks...and Squats

You’ve all felt it - pain in one of your knees during a squat, while you’re crouching, or walking down stairs. You think it’s a one time thing, so you ignore it, then two weeks later it’s still an issue. Obviously you go see your trusty *Insert preferred initial healthcare provider that your family has been working with for generations since the stone age here*. He or she screens you, assesses you, probably orders plain film (x-ray) that shows SOMETHING that isn’t perfect, but is likely not relevant, however that’s a different rabbit hole for a different fairy tale/day/blog.

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He or she finally has you perform the painful activity (for this example we’ll roll with the squat) and exclaims, “Eureka! I know why your knee hurts when you squat. Look how far forward it goes; putting all that extra pressure on the patella. You shouldn’t squat with your knees going past your toes. It’s going to lead to………………………………..”

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How did we get here? That’s a great question, and to be honest, I don’t actually know, and I don’t care to know at this point. I do remember going through a lab in PT school where our professor simply asked one of the students to squat down, and she dropped right down into a squat where she came up on her toes and her knees were as far forward as possible.

The professor then asked us all to comment on it. I remember one student who had prior experience in athletics (I’ll leave out in what regard as I don’t want to cast a blanket over another profession) very confidently saying it was bad for her knees and that she “could picture ACLs rupturing.”

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I don’t remember the conversation that followed, but to this day I’ve often thought back on that moment and think about all I’ve learned about stress, adaptation, tissue remodeling, graded exposure, etc. and can not think of one thing I don’t like about the squat, for that specific task. I think the only relevant question to ask in that specific scenario would have been, “Does it hurt?” because then we would know if that squat, for that task, is threatening to the body.

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Back to knees over toes. Have you ever tried to go a day without your knees going over your toes? The next time you get out of bed, go to the bathroom, wipe, flush, and then go to stand up, tell me which one is easier: standing up with your knees over your ankles, or your knees over your toes.

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Then after you’ve gotten ready for work, and you head downstairs (four floor walk-up in NYC, if you’re me), I challenge you to walk down the stairs without your knees going over your toes. And make sure someone is there to get a video of it, as I’m sure it will look like something from the Monty Python skit, “The Ministry of Silly Walks.”

In life, our knees go past our toes, so why would we avoid it in training? What is the point of training, but to improve how we perform in sport, athletics, life? Shouldn’t we want to improve our capacity, or at least not lose our capacity, to go up and down stairs, to get up and down from the toilet, and to get stuff from under the sink. And to do so, we must expose are joints and connective tissue to stresses that will do such.

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Now, if someone has pain in their knee or knees with a squat, then we have to figure out what’s driving this pain and work to address it, so that person can get back to squatting with their knees over their toes, as quickly and safely as possible. Some painful squats will require adjusting the squat, or taking away the squat for a period of time, while others will require changing the load (extra/less weight), volume (total amount of weight squatted in a given period of time), or tempo (speed).

While there are times and places to adjust and be keen on monitoring biomechanics, the knee, just like the rest of the joints of the body, should be trained through ranges, speeds, and tasks how it will be used in activity, or activities, outside the gym. Working with a good practitioner or coach who can determine if your joints can get into all the right positions to handle stress will determine where you start in the squat, (or knees over toes position), hierarchy. Don’t spend the rest of your life looking like you’re a part of a Monty Python skit...unless you’re getting paid to do it ;-).

Kyle Balzer is a practicing physical therapist and strength coach out of Drive 495 in Manhattan. He can be seen there for physical therapy, for training, for consulting, and squatting with his knees past his toes.

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