Rehab Trainer – Medial Tubing Pull for Grumpy Quads GQ13

I hope I didn’t confuse you last week with the ball-squeeze debate… let me say clearly that I believe it is better for activating VMO to have the tubing AROUND THE OUTSIDE of the knees.

This actually increases the activation of the VMO, which shows itself in increased EMG readings (see todays video from 2011 in Iceland where we were trialling different techniques with Physio friends Stefan and Einar). Up to 25% increase in VMO activation happened simply with applying tubing in a medial direction.

Click on the Link to read article and watch video:

Grumpy Quads GQ13


Wednesday Rehab – Myofascial R2 Mobility for Grumpy Quads 7


R2 mobility? WTF? Sounds like a technique on a certain Star Wars character 😉

All it means is the very limit of a tissue’s extensibility; its true passive end range. Probably some discomfort associated with holding it at this point but not painful (unless you are stretching nerve tissue without realising it).

Muscle and fascia are at full stretch; any “knots” (read Trigger Points aka “Landmines”, or scar tissue) in muscle, fascia and ligaments are holding back the ability of structure to fully lengthen.

Hence today’s big message for loosening muscles effectively:

…do R2 (end range) Myofascial Release FIRST BEFORE before doing R2 Passive Stretching. 

Reduce Myofascial “knots” (today’s video) then learn how to do Stretching immediately after (next week) . This rule applies to ANY myofascial tissue, as a matter of fact – if you don’t R2 myofascial release the tissue before R2 stretching, you simply lock in the trigger points further. The knots in the rope analogy applies perfectly:






“Try lengthening that out by pulling at both ends!”


And it applies really well to joint and neural mobility work as well. Myofascial release first, then see what you are left with before attempting the deeper layer of loosening of joints or neural tissue.

So, take yourself up to full stretch of your Quads somehow, listen to how they feel; then do your myofascial work for 3-5 minutes, then repeat and see how much range of movement you have gained!

Wednesday Rehab – VMO Trigger Activation for Grumpy Quads 6

Without wanting to get lost in the science and research around muscle inhibition, knee pain and how to fix it, you can trust us that some muscles get overactive, tense and dominant in response to Trigger Points, and others do the opposite: become inhibited, elongated and weaken.

This is the essence of what we have always banged on about: “Muscle Imbalance” and one of the easiest to understand is the imbalance between overactive Vastus Lateralis, and underactive Vastus Medialis Oblique (VMO) that occurs so easily with Grumpy Knees.

So, a novel idea, also taught by other high level rehab institutions (e.g. Kinetic Control see here), is that of doing Trigger Point work on VMO in order to activate it. Later on we can do activation through carefully targeted exercises and the use of theraband tubing, but to begin with it can be so powerful and effective to release this small muscle area from inhibiting Trigger Points!

Not only that, but as you can see from the diagram, if those Trigger Points are “active” their referral patterns of pain may actually be the source of some of the Grumpy Knee feelings! Could it be that some or all of your Grumpy Knee pain is directly coming from Trigger Points in your VMO?









Watch Ulrik demonstrate VMO Trigger Points in the video in order to activate it!

Watch the Video:

Wednesday Rehab – Hypersensitive Fascia Grumpy Knee 5

Don’t you hate myofascial rolling through those sore areas in your Quads and ITB? Areas that are not necessarily the deeper lumpy “Landmines” (Trigger Points) we discussed last week, but rather areas where the surface is simply sore to touch?

My theory is that those areas are fascia that is hypersensitive. In the same way that scar tissue can be hypersensitive to touch. And because there is soooo much fascia in and around the hip, thigh and knee, it stands to reason that most of us are likely to have super-sensitive areas. Especially if you have Grumpy Knees!

So to assess this tightness on your client I recommend the simple method in todays video – check left and right difference to see if it is tighter on the sore knee. If so, that’s your green light! Go hard with myofascial rolling in order to relieve niggling knee pains (well not too hard initially because you don’t want to scare off your client 😉

IT WILL HURT because if its tight, there will be areas of hypersensitivity in the fascia preventing easy expansion and movement of the local tissues down to the knee (the fascia that wraps from the ITB into the patella is termed the “Lateral Patellar Retinaculum”).







Connective Tissue is prone to hypersensitivity when tight or tethered


One Personal Trainer mentioned scar tissue on her lateral quad where a dog bit her a while back. Same side as her knee pain. Could there be hypersensitive ITB fascia and scar tissue contributing to her knee pain? Guilty until proven innocent I say!

Our assessment today then is more about end of range flexibility testing (R2), than early tension testing (R1).

And so the myofascial release looks different – more dynamic and superficial than deep and slow. For some this rougher approach is excrutiating, for others its a lot less sore. And nothing works as well as the Posture Pro!

Perhaps it depends if your Grumpy Quad is more trigger point infested (primarily “tense”), or fascially tight and sensitive (primarily “tight”)?


Or both?!

Watch video here:

Wednesday Rehab – Triggered Quads Grumpy Knee 4

Good Afternoon,

Last week we looked at our Quadricep R1 (subtle tension that kicks in due to neuromuscular tension rather than tightness), so now it’s time to get out your favourite myofascial release tools and have some fun!

We are searching for “landmines” (or Trigger Points)!

How to know you have a Landmine?

You will roll over a lump that can be exquisitely painful. It may refer an ache to another part of your leg, when you are compressing it. You may even experience an involuntary ‘jump’ or twitch every time you roll over it. That’s the truest sign of an angry trigger point!

Don’t be worried about working deeper into Trigger Points once you start to get used to the pain. You will increasingly tolerate it, and the good news is that you can do yourself no harm, and instead there will gradually follow a releasing of that tense pain, less of the twitch and increased knee mobility and strength.

Surprisingly, trigger points seem to happen in predictable areas of the muscle:






In the self-myofascial release video today, your Quad and ITB are not on stretch, so you might get painfully deep into your Vastus Laterals and Iliotibial Band without much effort.

Be warned: ease into it gradually, gently, firmly. Hold tense trigger points for 10-15 secs, and watch them “melt” under the sustained pressure. Do 4-5 reps on each trigger point you find. Don’t go so hard on them you have to twist your face into knots!! Breathe through it.

You can use heat pack before or after if you so desire – it helps relax muscles and feels great.

So – it’s time to go searching for Landmines in those Quads!


Wednesday Rehab – Grumpy Quads Grumpy Knee week 1

Here’s the crunch: the focus should stay clearly on the stuff we can change. And you CAN CHANGE how the Quads work, slowly and steadily, over a few months. Many have done it.
Jenny McConnell the famous knee Physiotherapist concludes from much research: “Poor quadriceps function, as well as increased body mass index have been associated with increased OA knee pain”. Paul Hodges again: “decreased quadriceps strength is strongly correlated with increased knee pain, patellofemoral cartilage loss on MRI, and tibiofemoral joint space narrowing.”

Here’s the rub: The Quads are extremely difficult to improve (to quote Paul Hodges again), because even the “fear of knee pain decreases quadriceps function”.

WTF?? Even anticipating that a Squat or Lunge will hurt, will decrease your Quad function, and increase the likelihood that it will hurt?

Talk about a dysfunctional muscle! Weak, extremely pain and swelling sensitive (even a teaspoon of saline injected into the knee has been shown to reduce Quad function), prone to tightness, muscle imbalance, fascial dysfunction, and of course inhibition, atrophy and weakness.

If you have a Grumpy Knee, you MOST DEFINITELY HAVE Grumpy Quads. Guaranteed. So how can we break the cycle for ourselves and our clients?

Now if you wrote in to me about your knee pain…. make your Quads the focus, NOT your pain. Not your “OA” or other diagnosis you’ve been given. Ultimately it all comes down to Quad function – that’s your journey; that’s the work you need to focus on. A ton of things like pain and swelling might get in your way, and you’ll need more patience than you think you have capacity for, but stay ON THAT BUS until eventually you reach your destination. Pain-free, loose, balanced and functionally strong Quads.

HOW to improve Quadriceps function? There’s a ton of ways to slowly overhaul your Quads if you really have what it takes. And many don’t, it’s sad to realise. Certainly not clients who are scared of any pain and hard body work. You will have your work cut out convincing them to do their homework!

Next week we begin a series of videos showing you how to get the tightness and trigger points out of your Quads. Nothing is more important for rapid improvement of this muscle’s function, and consequently how your knee feels. [If you only start with strengthening, you will get there, but you are taking the harder road in my opinion.

START your Grumpy Knee rehab with loosening, releasing, triggering, de-sensitising the Quadriceps.

So why don’t you step up this effort before I see you next week? Can’t do any harm trying….Quadriceps.

Wednesday Rehab – 4 Realities for Grumpy Knees (Rehab Knees are hard work)

Thank You for your replies! No doubt it forced you to think about your knee(s), where the pain, clicking, or swelling is, how long it has been going on for, how it started, and what aggravates it. Your story is valuable and I will try and extract useful trends from it over the next few weeks.

Some stuff can’t be said in a quick paragraph – and many of you really need hope and clarity urgently as your knee/s really affect your functional movement and exercise and state of mind.

I hope I can do your trust justice and give you knowledge and hope that will carry you through the inevitable hard work that lays ahead in rehab.

Rehabbing KNEES is particularly hard work – why?

4 Realities and 4 Questions for you…)

Knees have lots of bits to get Grumpy – Lots of non-muscular tissues like bones, ligaments, articular cartilage, tendons, tightly wound connective tissue and meniscus – and all these things take more time than we would like to heal (3 months minimum, up to 2 years!). Patience and endurance is required.


 Q1 Have you prepared yourself for the long slow road, or are you hoping for a quick fix? 

Tip of the Iceberg – Knees are affected by what’s happening north (hip / low back) and south (ankle / foot) – more often than not if you do hard work on the areas you will reap benefits at the knee. At least 5 shared stories of how improving their foot function altogether fixed their chronic knee pain! And the research is full of info on how improving strength and control of Gluteus Medius and other hip muscles can improve the knees.






2 Have you assessed and begun working
on your feet and / or hip function?
Work on those weaknesses above or below.

Hard to unload Knees – We load them all day whether we realise it or not; even when we sleep they may lie in a loaded position: hyperextended when lying on your back or stomach, or twisted in side-lying. A few mentioned pain being present even before getting out of bed in the morning! And when we stand and walk there are multiple positions that the knee might be pinched to its end of range, twisted, or crushed – unknown to us often! Most of it revolves around habits that are hard to change.

So the fragile inflamed structures of the knee never can truly heal because we unwittingly continue to load into them, completely unaware. We react after because it is sore or puffy, but can you grow in your awareness to prevent the trigger? Takes a lot of “listening to your knee” – hearing what it is saying and what it wants with a mind to preventing; rather than reacting afterwards.

Imagine your finger joint constantly being bent back to its limit through the day and night, or twisted or made to carry loads for long periods – you would have a chronically grumpy finger Joint!








Q3 Are you listening closely to what your knee is saying about
changing your habits – in lying down, standing, walking, running, lunging or squatting? Are you making changes?

Stubborn Quadriceps – this muscle is surprisingly vulnerable to inhibition and atrophy, and doesn’t like operating when pain and swelling is present. It’s a real Catch-22…weak quads result in knee problems, which result in weak quads. Chicken and egg.











 Q4 Have you found any ways to strengthen your Quads that
a) don’t aggravate your knee, and that 

b) really make your Quads burn and come alive?

Feel the challenge of Grumpy Knees? .. for those of you who wrote with your Grumpy Knee Story which of the 4 Realities most relates to you?


Wednesday Rehab – Grumpy Knees

Greetings following the last series on Upper Body we now switch our attention to our lower body, it’s about time we dealt with one of the most common of client, trainer and even physiotherapist complaints – grumpy knees! We will devote a good series to this challenging and vast topic. Today I need you to tell me quickly about YOUR sore knee so be prepared!

We are about keeping it practical, but with some intelligent, researched, creative and compassionate opinions from colleagues who are Rehab Trainer Educators (some of who have Grumpy Knees!).

The kind of topics I see us tackling over the next month (or three) are:

  • Common Pain Presentations of the Modern Personal Trainer – YOU 😉
  • Knees – the Icebergs of the lower limb!
  • Knees over Toes in squat and lunge?
  • Common functional movement dysfunctions of the knee to correct
  • Latest relevant knee rehab research. 
  • Understanding noises and swelling inside your knees.
  • Novel new Cues for enhancing inhibited quads
  • Building balanced quadriceps
  • Athletic late stage knee rehab

On the ground research about the common types of pain that fit people like you get.

Please fill in the attached Survey and send it back:


Quick Knee Questionnaire for You to do right now


I want to hear about YOUR knee pain – email me back right now:

  1. Where it hurts on your knee/s (front, back, inside, outside); any click?

    Answer: ____________________

  2. How severe the pain is out of 10 (e.g.. 8/10 if it really stops you doing the movement)

    Answer: _/10

  3. When (how long ago?) and how it began (what activity)

    Answer: ____________________

  4. What makes it worse?

    Answer: ____________________


Thank you!

Looking forward to your quick reply on Knee Pain summary so we can all be wiser as to how to deal with this scourge on the fitness industry. This info tells me what types of topics might interest you in this Grumpy Knee Series…