Podcast #41: Muscle Physiology in Knee Pain with Greg Hawthorne


Funnel Types

“The wider you are up top versus the narrower you are on the bottom, the better force producer you’re going to be.”

“You’re taking a whole lot of stuff and you’re pushing your guts down into a smaller bowl…. I’m going to build up that pressure fast.”

“Really wide hips… really small shoulders… you’ll never see good jumpers that have this.”

“The wider your hips are relative to your upper body, you’re going to have more valgus occurring.”

Muscle Orientation

Concentric Orientation: “The muscle is positioned from a joint perspective to be shortened and on.”

VMO eccentric orientation is often from “too much of a tibial ER and too much of a tibial IR.”

“The biarticular (muscles) can be eccentric at one joint and biased more concentric at another joint.”

“No fluid means no nutrition.”

Knee Pain

Knee pain: “You’re always going to have some sort of concentric orientation within the quads.”

“Your vastus lateralis will push your femurs in from the outside.”

“A muscle doesn’t just contract.”

“The bone is going to block my expansion on the interior aspect [of the vastus lateralis].”

“VMO is having to fight this pull of this gigantic muscle called the vastus lateralis… and eventually the VMO loses that battle and it gets eccentric.”

People with itty bitty VMOs and huge VLs: “They have really really bad patellofemoral problems.”

“Stim the eccentric stuff, massage the concentric stuff and kinda get them to sync up a little bit better.”

Pelvic Position

Basketball players: “Everybody has more issues on that right hip.”

“If you have a hard time getting internal rotation, producing force on the one side, the more you’re going to tip [pelvis] to do that.”

“The flatter the foot, the harder they’re pushing into the ground.”

“Most people I see (besides basketball), they’re going to have a flatter left foot and a more supinated right foot. Basketball guys, they’re both flat… but they’re also getting a flatter right foot.” Knee issues, low back tightness.

Producing force: “If they can’t do it with the appropriate musculature of the hips, they do it with their back.”

“Loosen up that left lower back and the right mid back to get them back.”

“A really pronated foot is a great force producing foot. You don’t have as much variability… you can produce force a lot quicker, you don’t have to go through the full range… it’s not a bad thing until it’s a bad thing.”

Getting the pelvis underneath with the hamstrings… “more options to transfer that forward momentum to a vertical momentum.”

“If you have a valgus knee or you have a strong tibial IR, you know you need to get some hip IR.”

“If you have a really flat foot, odds are, you need to get hip IR if you’re having knee pain.”


“If all we do is lift heavy…. we don’t do a lot of pump stuff… what we’re going to drive is a very, very, very, very, very, very, very dense vastus lateralis.”

“You fill up a kickball, it’s stiff. You fill up a balloon, it keeps stretching. So look at your muscles like that. The connective tissue are going to be the casing.”

Vastus Lateralis. “You need to create expansion in that muscle.”

“Expansion is options and variability. Compression is less options, less variability.”

“The more V’d-up you are, more expansion. More funnel you are, more compression. And that’s systemically.”

“If you have tibial ER… your tibial tubercle is facing to the outside compared to where the midline of your knee is, your vastus lateralis is already biased, period.”

“High rep, light weight, burn out that VL… then positional activity… then an integrated activity.”


“Patellar tendinopathies are load management issues.”

“Patellofemoral issues, they’re tricky… you’re trying to rewire your house from a neuromuscular standpoint and you have to rebuild it at the same time. You have to get the physiological changes as well as neurological changes.”

“Get your hamstrings strong, get the fluid out of your VL… focus on getting your pelvis back… get the adductors a little bit stronger while you’re in that posterior tilted position.”

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