Podcast #59: Restoring Knee Mechanics in Patellar Tendinopathy with Alex Effer


“It’s not a hinge joint that people think it is. It’s a rotation joint. The bones don’t connect to each other. They’re not touching. So it can’t be a hinge.”

“If I want to bend my knee, I need a tibia that is gonna turn inward…. relative to a femur that is going to externally rotate [distally].”

“At the hip itself, I need internal rotation…. that allows knee flexion.”

“People that complain of knee pain… they just can’t bend their knee very well… they can’t distribute force very well.”

“The VMO muscle is going to contract to create a distal femur external rotation.”

“If I land with a supinated foot, a more of a rigid foot, then I’m not able to distribute force very well.”

“The VL is one of the main distributors of force during walking… it’s the one that always gets jacked up the fastest.”

“Patellar tendon issues are really loading… let’s make sure that we are loading the tendon in the right joint position. Whereas patellofemoral pain is like, let’s make sure the joint is in the right position.”

“There’s a big association between the ability to extend my big toe and my VMO to contract.”

“My VMO is really a forward moving muscle. It contracts as my knee is moving forward.”

“The VL is a muscle that contracts as my knee is going backwards.”

“The majority of knee pain is from somebody who doesn’t have internal rotation of the tibia.”

“The heel is the rudder of the foot. It’s gonna determine the shape of my foot, if I’m gonna supinate or pronate.”

“Hamstrings are good at producing force… Your quad is a huge force distributor.”

Leg extension: “Think about trying to push more with the inside of the shin. That is going to help with more tibial internal rotation and then keep the knee slightly flexed. That is going to keep the VL off.”

Calf weakness with patellar tendinopathy: “My knee gets so hyperextended that my calves now become lengthened at both ends.”

Top three:

  • Leg extension
  • Wall sits at different degrees
  • Split squats are king

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Website: https://www.resilientedu.com