Podcast #34: Knee Pain – What’s Not Working with Dave O’Sullivan





Above the water – what you’re telling me, what you’re doing, how you’re moving

Under the water – the nervous system

Load Tolerance

“Tolerate, that’s the key word”.

“We’re not strengthening someone, we’re tolerating the load through the tissues.”

“Load Tolerance is more about coordination and the nervous system as opposed to just strength qualities or range of motion.”

What’s Not Doing Its Job

“Spend 20% of your time on the symptoms, 80% of your time on what’s not doing its job.”

“If you have movement errors or you don’t tolerate load well through other tissues, the vastus lateralis does a great job at absorbing those errors.”

“If the soleus or if the hamstrings or the hip isn’t doing its job, the vastus is going to have to take the brunt of it.”

“I can’t remember the last time I saw a weak low back.”

Mid Foot

“A lot of athletes are very good on their heels and they’re very good on their toes but they’ll tend to skip the mid foot so they won’t necessarily have good load tolerance through the mid foot which means they won’t have good load tolerance through the soleus.”

“The soleus, the vasti, the gastro, and the hamstring – they’re the four big players. All of them need to do their job when he foot hits the floor.”

Poor intent through the mid foot: “The knee will snap back because the vasti will try to act as a hip extensor essentially.”

“Delay knee extension by getting the soleus and the distal hamstring to do its job… what we’re doing there is just getting the vasti to do less work, putting less force down into the knee joint.”

“When you’re slouched over and all your weight is through that mid foot and your back is relaxed, you’ve got no choice at the bottom of the slouch but to use your soleus to get you back up again.”

Strength vs. Coordination

“I wouldn’t like to say that it’s because of a top-down or a bottom-up, I think it’s because of the nervous system and the levels of pre-tension that it’s put into these muscles prior to the foot hitting the floor.”

“Your brain knows what’s coming next. it knows, if it produces force, that force has to go somewhere. And ultimately, is that going to hurt me or is that going to keep me safe?”

“It’s all well and good isolating a muscle but where does that force go next?”

“It’s one thing to have the strength, it’s another thing for your nervous system to use it.”

“Because it’s coordination as opposed to strength, you can change and progress them very quickly.”

Patellar Tendinopathy advice:

  1. Decrease the protective tone of the vastus lateralis (stretching)
  2. Get the soleus and the hamstring to do a lot more work (systematic, graded exposure)
    • Bridges
    • Slouches
    • Lunges
    • Hop and Stick
    • Deceleration

“You need to have thoughtless, fearless movement when you move.”

“You need to feel like you have confidence again.”

Bridge video: https://www.youtube.com/watch?v=cYD4Jx_IXSw

Slouch video: https://www.youtube.com/watch?v=B0COfbIzkIY

Website: https://thegotophysio.com

Instagram: https://www.instagram.com/daveosullivanphysio/