“If the knee is whining and doing things it should not be doing, the wise clinician first looks at the foot-ankle and the hip-pelvis complexes, where the blood has dried. Don’t look for the fresh blood at the knee” – Dr. Allen
If you cannot control pelvis position on the femoral head, or hip rotation or initial foot arch mechanics, the knee is going to give in to the directional loading response and that typically means medial valgus movement. This is internal tibial rotation or spin.
Here is an analogy i use with all my patients. The knee is like the middle child. In the simplest terms, you have 3 lower limb joint complexes. The foot/ankle, the knee and the hip. The knee is the middle of these 3 joint complexes.
Similarly if you put 3 children in the back of the car, the one sitting in the middle is the one directly impacted by the child on the right and the left. When you hear the middle child screaming and whining, the smart parent first looks at the two apparently “innocent” children looking out the windows (with blood dripping off their elbows).
Similarly, the knee takes this same seat. IF the knee is whining and doing things it should not be doing, the wise clinician first looks at the foot-ankle and the hip-pelvis complexes, where the blood has dried. Don’t look for the fresh blood at the knee
Changing landing strategies with the focus of control of tibial rotation, requires the astute clinician to look at all the children.
Dr. Shawn Allen, one of the gait guys.
Landing strategies focusing on the control of tibial rotation in the initial contact period of one-leg forward hops – Chen – 2016 – Scandinavian Journal of Medicine & Science in Sports – Wiley Online Library