Your Knee Pain Started Above and Below Your Knee

Why your knee all of the sudden hurts when you haven’t done anything to your knee. 

Read time: about 10 minutes

Hi I am Kim Nartker for those of you that are new to the show. I worked in a rehab clinical setting for over 20 years and completely stepped away from the information that I learned in that area, because I wanted to help people improve the health of their movement system and in healthcare when you have a license you are made to comply with insurance based care and standards and I did not find any of the treatments that I provided from those learned to be long lasting or to improve the health of peoples movement. Instead I saw these patients slowly decline until they were a candidate for surgery, then another surgery 1 after the other with the decline seeming to increase faster than in people chose surgery. I wanted to help people avoid that trajectory if possible. I found it to be possible and this is what I teach now. 

Today I want to talk about knee pain specifically knee pain that begins for no reason at all. It just shows up one day and you search google for stretches or exercises to relieve the pain, you try those creams, the braces, the gadgets the inserts and some of those things work for a little bit of time then the pain comes back. The route from what my clients tell me is always the same. First you try things on your own. Then you seek help from a professional and for some people the expectation of that help is to not only get rid of the pain but to restore and preserve the health of their knee. Typical treatments are stretching of the knee muscles, Strengthening of the hip and foot muscles. Stretching of the hip muscles and strength training or functional training to build support in the muscular system. Some people see a Chiro, some people get orthotics but from the people that I see later, none of those things resolved the pain and most started to lose mobility in their knees making bending, getting down to the floor, going up stairs and other activities more difficult. These people were told to modify their movements at the gym to avoid the pain so that they can still work out. Is this the answer to the signal we are getting in the knee. 

I disagree with all of it and today I want to tell you why. 

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Today I want to talk about Joint Mobility VS Muscle Weakness 

Which of these is the cause of the knee pain that comes out of no where. 

Most of the people that come in to see me will say I have been managing the pain in my knees for years and they feel confident in managing their pain.Others feel signals of tightness in their hips or knees for years and accept  it as a normal part  of aging.  

Here is what I see when a client comes in to see me with knee pain that came out of no where. 

I first test the joint mobility in the hips, knees, ankle and the entire foot. 

When I do that I can find a joint restriction in joints above and below the knee. I typically find different joints restricted in the foot but typically the same pattern in the hips, knees and ankles. 

In the hips these people have lost more than 20% of the capacity that allows their hip bone to moves in their hips joints. That means their hip joint is restricted  and 20% of that space in their capsule has been taken away. usually is not the only restriction in the hip, but when I do find this restricted I also find several other joint restriction in the hip capsule along with muscle inhibition in the muscles that originate at that particular joint.  When I test the ankle these people have lost the capacity for their ankle joint bones to move in both dorsiflexion and plantar flexion. They have also lost some form of mid foot capacity, rear foot and some capacity loss in the forefoot and toes. The knee is typically found in a locked position. 

Here is what this testing tells me about the knee pain that came out of no where. 

Your knee is a hinge joint like a door hinge, however it also has a rotational component to it. This is lost when the hip above it and the foot and ankle below it has lost the capacity to move inside the joints. The knee stays in a locked position. Your nervous system locks this and continues to lock more joints because that is what it does. It does not unlock the joints. 

You will feel this locking with activities that cause you to bend your knee and straighten your knee. Stairs, squatting, standing or sitting down. You don’t typically feel it with walking. Over time this loss of motion in the joints that I refer to as capacity to move in the joint, your body steals more movement from those joints. Your nervous system, joints, and muscles are all no longer working in a healthy way. Your body is forced to compensate. 

So now lets look at what the industry standard exam detects. That testing detects a weak hip muscle. Typically the glutes or Glute medius muscle. I ask “What caused that muscle weakness?”

So when we use the industry standard care of strengthening our hips, knees and feet, we know from my previous research in those areas that strength training will not unlock those joints that are restricted. Strength training will not give us this capacity back that the body has taken away. Strength training will build strength in what remains. 

This is where it gets really confusing for most people. I know its a lot. Let me try to make this really simple to understand. 

Your body takes away your capacity to move without you knowing it. You won’t feel anything when it happens. But when you feel something out of nowhere. That signal whether its pain, stiffness or tightness that signal is your body asking for you to help it. This is what I see everyday in my healthy movement practice. 

You have the ability to maintain your movement through stretching, strengthening and through massage. You can manage these movements on your own to a certain degree. 

Or someone else can perform assisted stretching on those joints. They can stretch you deeper than what you can stretch yourself, but that stretch does not release a joint restriction. That stretch improves your ROM temporarily. 

These treatments are effective ways to manage a symptom. And society teaches us to manage symptoms. 

For those people that want to restore what is lost. Stretching, strength training, and massage will not restore joint accessory motion. There are professionals that can measure and test for that, but it is difficult to find those providers at scale. To find them you will have to ask the right questions. 

You can get that capacity back that your body took away and here is how you do it. 

You will need to get in to see a professional to test whether your knee pain is loss of joint space, ie a restriction or whether it is actual muscle weakness. Many providers will disagree with me. 

So which is it.  Is it Joint mobility or muscle weakness.

It is the joint. And the reason I say that is not because I work to preserve joints,  It is because when I test somebody whose knee started hurting for no reason, the joint restriction is already there, in the hip and the ankle and the foot, before the muscle symptom shows up.

And I am not the only one who has looked at this.

Researchers pulled together eighteen studies that had measured people’s hip strength first, before anything hurt. Four thousand eight hundred people, none of them with knee pain at the time they were tested. Then those people were followed over the next months and years, and four hundred and eighty three of them developed knee pain.

So the researchers went back to the original measurements and compared the two groups. The people who ended up with knee pain had not started out with weaker hips. No hip muscle group was weaker in the group that reported pain in their knee. 

And in the teenagers it ran the other direction. The ones with the stronger hip abductors were the ones more likely to develop knee pain.

So we can rule out weakness as the root cause of knee pain.

Now weakness gets felt for two different reasons and they are not the same thing. One is actual strength loss, where the muscle has lost function. The other is a communication loss between the joint and the muscle, which feels exactly like weakness but is not. Only testing tells you which one you have.

What That Means For Your Knee

Your knee did not start hurting because you did something. It started hurting because it ran out of ways to compensate for the many joint restrictions in the hip, knee, foot and ankle.  The joints above it and below it were restricted and those joints no longer had the capacity to move. The body restricted the capacity to move. 

You cannot feel that happening.

But you can measure it, and you can track it. And that will tell you whether the effort you are putting in is giving you the outcome you want.

I want to tell you what this looks like when nobody tests for a joint restriction for say twenty years.

I watched people go through rehab and walk out without a walker. And then years later I would see them back on one. I used to think that was just a normal part of aging. In fact that is what I was taught to think. And when I pull the research research supports that theory because no one has tested joint restrictions on healthy people. 

What I found out later is that the joints above the knee and the joints below it were in a decline the whole time. Nobody tested them. Nobody identified it. And it got blamed on aging.

Here is what the research actually shows. When you follow people out past the seven year mark of a surgery, their function declines and their range of motion declines, and their satisfaction stays high the whole time.

People get worse and still say they are happy, which is why nobody catches is looking at the health of a joint and muscle. No one is asking for this. But they should be.  Post knee surgery, takes away joint mobility in the bend or flexion. So pain in the knee, that results in a surgery, gives you a stable knee, but takes away your joint mobility into flexion, eventually you lose more mobility in that knee overtime. But people don’t have pain, so they are accepting of that loss.

We do have studies that I have found that showed that people that went in for a knee surgery, the knee surgery did not fix the joint restrictions in the low back, the hip and the feet and many of the people went on to replace their hips and had low back surgeries. 

So as a society there are going to be times we need to have a surgery. Surgeries are mostly elective, but in most cases if we could test the hips, the knees, the back, the foot and the ankle we could find these restrictions restore the capacity inside them and avoid the surgery all together. 

We do know from research that everything above and below the knee is declining silently and its getting called aging.

The authors of that 2024 research wrote one sentence about the decline they measure post knee surgery. Although total knee arthroplasty is a successful surgery, it does not prevent aging.

That is what I want you to take away today. 

We have research and that is good, but healthy joint function and capacity has not been tested on people with out pain. Pain is the tripwire. 

Pain however is not what I would deem a good indicator of health in our joints and muscles. 

We came to this world with healthy joints and muscles and we need a way to identify and track the health of our movement system so that we can preserve the health of this system. Our fitness and medical system does not have the capacity to do that. 

So let me leave you with a question instead of advice.

Whatever you are doing right now. The stretching, the strength training, the appointments, the managing of your pain. How do you know that what you are doing, that  it is working?

Most people answer that with how they feel. They will say that It hurts less or I feel like I can manage it on my own now. 

Here is why that is not an answer.

You cannot feel a joint losing it’s capacity to move. That is the whole point of it. So if how you feel is your measurement, your body will take away joint mobility and decline until the day you feel pain.  I do want you to know that you can restore and preserve that capacity. And when you experience that, you will be amazed at how much you missed not moving well. 

So here are two questions to ask anybody who is working on your knee. A physical therapist, a trainer, a chiropractor. Me too.

Ask them: 

What movement should I expect to get back?

And how will we know if I got it?

If the answers to both of those are about how you feel, then nobody in that room knows whether it is working. That is not a shot at the person in front of you. It is just what most of these models were built to measure. The healthcare system measures pain and a decline in pain means what they are doing is working. Pain we have already said is not a predictor of movement health. 

Walking is usually the last place you will feel pain when it comes down to your knee. The motions that you will experience a signal that your lower body movement has been taken away from you are: Deep knee bends, Going down stairs without a limp or holding on, using a reciprocal pattern. That is one foot down then the other down to the next step. Or you can get down to the floor do a reverse lunge and see if you can do it without holding on to something. Those are just a few tests. 

Signals that you will feel are stiffness, tightness, lack of movement or harder movement when you bend into deep knee bend positions. A word of advice. Don’t start avoiding getting down to your knees, don’t modify it to not bend because that will end in a problem. 

If you are the type of person who wants to keep your movement throughout your entire life, then I recommend that you get your health movement tested. In this test,  You get a Healthy Movement Score and a Movement Age, and you can track how well what you do for your knee and whether it is working or not. You can do this for your full body and this metric will help you see if you are improving or declining. 

In person here at Beckett Ridge, or if you can’t fly in to see me, I can jump into a virtual call with you and you will leave that with a plan that is proven. 

Thanks for joining me today.

Get Your Healthy Movement Score

Every joint in your body has an amount of movement available to it and an amount that has been quietly restricted. Testing is the only way to know which is which.

Healthy Movement Testing looks at your whole body and gives you one number and your Movement Age and a Blueprint you can track for the rest of your life. In person at Beckett Ridge in West Chester Ohio.

Is Sitting Really What Makes Your Hips Tight?

Understanding what sitting does to your body and what it does not do to your muscles after age 50.

The Healthy Movement Podcast

“Sitting is not the beast we have been told it is.” Kim Nartker

Read time: about 10 minutes

In episode #251 Kim continues the hip series for people over 50 who want to keep their hips mobile and healthy for the rest of their lives. This episode is about sitting and if sitting actually is the cause of your muscle tightness in your hips. 

Almost everyone who walks into her studio blames sitting for their tightness. Kim taught that same explanation herself when she worked as a PTA over 14 years ago. Then she went looking for the research behind it and found something she was not expecting.

This episode covers what the studies actually found when they measured muscle length in people who sit for a living. It covers what sitting is doing to you that has nothing to do with muscle length. And it covers what Kim believes is the real driver of the tightness people feel after 40.

A note on the research. Every study named here is real and Kim reports what it found and not what she wishes it had found. Where she is describing what she sees in her own studio or offering her working explanation she says so plainly. She does not diagnose or treat or cure or prevent any medical condition.

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The Short Answer Sitting is not shortening your hip muscles. The research does not support it.

Sitting is doing other things to you and some of them are serious. It reduces circulation in your legs and it changes how you handle glucose and insulin. Those are real important health concerns. The fix for both is getting up and moving. The fix is not a stretch.

But the tightness you feel in the front of your hips is not a muscle that got short because you sat on it. That belief has caused an enormous number of people to stretch their hip flexor muscles in hopes that the stretching would improve the length and flexibility of those muscles. This episode teaches what is real based on research and what treatments will not provide you with the outcome you desire. 

I taught this the other way for years. I want to show you what changed my mind.

What We Have All Been Taught About Sitting:

 Sitting is the new smoking.

Sitting shortens your hip flexors.

Sitting tilts your pelvis and that is why your back hurts.

Buy the ergonomic chair. 

Get the standing desk. 

Stay in neutral position at all times and avoid movement. 

I taught most of that twenty years ago. I now see that movement is the key to longevity and that movement is what we lose when we choose techniques that feel good over techniques that restore what we have lost. Movement restoration and preservation are not the same things as fitness recovery. 

Tightness in your muscles and joints happens without your permission. Many of you have range of motion one day and it is gone the next without doing anything to cause it. Tightness has been sold as something you control. That is not completely true and I know that statement will get pushback.

So let me be clear about what you do control. You can move. You can stretch. You can strengthen your larger muscles. Those things help you maintain and make gains in your range of motion and you should do all of them. But range of motion is governed by a layer deeper than the muscle and that layer is outside your voluntary control.

You did not lose range of motion because you failed to stretch.

What The Research Says About Sitting And Muscle Length Here is the first study. Five hundred and eight people between the ages of twenty and sixty five. They were split into a group with chronic low back pain and a group without it. Everyone filled out a questionnaire about their lifestyle and their work setting. Then researchers measured hamstring length and the curve in the low back.

The result. Hamstring length was not affected by work setting or lifestyle. Neither was the curve in the low back. The authors wrote that their findings did not support the assumption that work setting and sedentary lifestyle lead to hamstring tightness.

The second study looked at seventy first year college students. These are people who sit for hours every day between class and study and screens. Researchers measured hamstring and iliopsoas length.

Eighty percent had normal hamstring length. Ninety six percent had normal iliopsoas length. The iliopsoas is the muscle everyone tells you sitting destroys. Nearly all of them measured normal.

And there is a detail in that study worth pausing on. The muscle length finding that tracked with low back pain was increased hamstring length. Not shortened. That is the opposite of what most people are taught.

Two honest notes. The second study is small and descriptive and it did not measure how many hours anybody actually sat. Neither study proves sitting is harmless. What they show is that the specific claim about sitting shortening your hip and hamstring muscles is not holding up when somebody goes and measures it.

So What Is Sitting Actually Doing To You?  

Here is what the researchers found:

In one trial twelve healthy young men sat for three hours without moving their legs. Researchers measured how well the artery in the thigh could dilate. At baseline it was normal. One hour of sitting the dilation of the artery had had dropped sharply. That is one hour.

Then they ran the same test three hours again with one change. The men got up and walked on a treadmill for five minutes at a slow pace three times during the sitting. The drop in the artery did not happen at all this time. 

The other well documented effect is on glucose and insulin. Uninterrupted sitting makes both worse and breaking it up helps.

So sitting has a cost. The cost is circulatory and metabolic and it arrives within the hour. And the answer to it is not a hip flexor stretch. The answer is standing up and moving for five minutes.

That is a small study of twelve young men and I am giving it to you with that attached. But the direction of it matches everything else in this area.

If It Is Not Sitting And It Is Not Aging Then What Is Happening in Your Muscles and Joints?

Movement is harder for me in my later fifties. When I look around at people in their late fifties some are not walking as well as I am. When I look at people over 60 I see limping and severe muscle loss and fatigue and tightness and stiffness and soreness. A lot of them are in pain.

Sitting is not causing that. Aging alone has not been shown to cause it either. So what is taking your movement away if its not aging and sitting?

Here is my working explanation and I am labeling it as that. I believe the muscle loses its communication with the deeper layers of the joint through a protective response run by the nervous system. And what gets lost is mass. Mass is a function. Function is the force the muscle can produce. The published research has not tested this order of events directly and I am not going to present it as settled.

What is not speculation is that this loss starts much earlier than anyone tells you.

Aerobic capacity is one example. In a long term study of more than eight hundred healthy adults the decline in peak oxygen uptake accelerated from three to six percent per decade in the twenties and thirties to more than twenty percent per decade in the seventies. And it did that regardless of how physically active people said they were.

Muscle is another. In a study of whole vastus lateralis muscle taken from men aged fifteen to eighty three the authors concluded that the aging atrophy of that muscle begins around twenty five years of age and accelerates from there. The vastus lateralis is your outer quad. If you have ever felt IT band tightness that is the neighborhood.

And in the last episode I covered the hip flexor. In an MRI study of two hundred and ten women aged twenty to seventy nine the psoas was at its largest in the twenties and declined steadily from there while the quadriceps held its size until the forties.

So the outer quad starts down at twenty five. The hip flexor starts down in the twenties. Aerobic capacity starts down in the twenties. None of these people were over 50 when it started.

What Atrophy Actually Takes From You When a muscle atrophies it shrinks. Your body is breaking down muscle protein faster than it is building it back.

Here is what leaves with it.

Muscle mass. The size and volume of the tissue itself.

Contractile proteins. The microscopic machinery inside the muscle that makes it shorten and produce force.

Strength. The muscle loses power and ordinary physical tasks get harder.

Mobility. Walking and balance and joint movement all get harder.

Underneath that your cells are degrading protein faster than they are synthesizing new protein. And when a muscle is not receiving load or a healthy nerve signal the body decides it does not need to maintain that tissue. Muscle is expensive to keep. The body stops paying for what it is not using.

There is a metabolic cost too. Muscle burns energy and helps regulate blood sugar. Losing it lowers your metabolic rate.

Rebuilding lost muscle takes years. Keeping the muscle you already have is a far better deal and almost nobody is being told to protect it in their thirties.

Your Hip Flexor Is Not One Muscle This is worth knowing because when people say hip flexor they usually mean one muscle and they are picturing a rope that got short.

The primary hip flexors are five muscles. The psoas which runs from your lower spine to the thigh bone. The iliacus which sits on the inside of the pelvis and joins the psoas to form what is called the iliopsoas. The rectus femoris which is the quad that runs down the front of the thigh from the pelvis to the knee. The sartorius which is the longest muscle in the body and travels diagonally across the front of the thigh to the inner side of the knee. And the pectineus which sits high on the inner front of the thigh.

Then there are the secondary flexors. The tensor fasciae latae. The adductor longus and brevis and the gracilis on the inner thigh. And the front fibers of the deep glutes which assist with bending and rotating the leg.

All of those have to work together. Some of them are already losing size in your thirties. You feel it in your forties and beyond.

You cannot stretch a group of muscles back into working order when what they lost was mass which is function and signal.

What I Am Seeing In The Studio I test joints. That is what I do all day.

I am finding restrictions in people in their late teens who have no atrophy yet. I am finding thirty year olds with restrictions across multiple regions who are already struggling with how they move. Last week a thirty year old former football player came in to see what I do. He had been through multiple knee surgeries and physical therapy. When I tested him I found restrictions well beyond the knee he had been treated for.

That is one person and one session and it is not evidence of anything on its own. I brought him up because he is thirty and nobody had looked at his joints. They are only looking at his hurt knee but he has other problems that are not addressed, so he has been seeking care for everything else. 

That is the pattern. The healthcare system looks at the muscle and ROM. We build strength and we stretch muscles and we wait for pain to tell us to look deeper. By the time pain shows up the loss could be advanced to osteoarthritis or a diagnosis because many people don’t experience pain. Pain is when we can enter the healthcare system. 

Here is my opinion: 

Stop modifying movement out of fear that you will tear something if you leave a neutral position. Your body is remarkable and it knows what to do. But it only knows how to take movement away when it feels unstable. It has no mechanism for handing movement back to you. Only a specialist can do that, but our healthcare training does not teach that. 

While we argue about sitting and sell stretching as the solution we are not looking at the two things that matter. How much capacity is left in the joint which is accessory motion and How much function is left in the muscle, which is contractile force and activation. There are other factors at play that I have left out. 

If we would test the joints to see if they are restricted then I feel we can help people better restore and preserve our movement system. I would like to see joint testing in the late teens. I am finding restrictions at that age before any atrophy has set in. That is the window where you could actually protect the outer quad and the hip flexor instead of trying to rebuild them at sixty.

Every adult over 40 should have their joints tested. Do not wait for pain. Pain is far too late and is not the best predictor of health. 

Our signal for healthy movement should be awareness of movement or lack there of, tightness, or stiffness. Not moving the way you used to move. Feeling either of these after a workout are NOT normal. And stretching is not proven to be a recovery tool. 

Tightness, stiffness and achiness out of nowhere, Those are the signals.  STOP using pain as the reason to seek professional care for healthy movement. 

I am not saying nobody else can do this work. Chiropractors and physical therapists and doctors of osteopathic medicine are trained in these techniques and qualified to deliver them. What is missing is anybody offering it as an ongoing testable service aimed at preserving movement rather than relieving pain. If you have a provider who wants to see what I am finding please connect them with me.

Where This Leaves You 

Sitting is not what makes your hips tight. Get up every hour anyway because the circulation and the blood sugar effects are real and they arrive fast.

Stretch if you want to. I consider stretching a form of movement and it will improve your range of motion. It is just not the answer to a joint that is restricted or a muscle that has lost mass.

And stop waiting for pain to give you permission to look. The loss starts in your twenties. The feeling starts in your forties. Between those two decades is the whole opportunity to restore and preserve your healthy movement. 

If you are over 20 get your joints tested. That is not a typo.

Next week I continue the hip series. Subscribe so you get it as soon as it drops. And if this episode changed how you think about sitting please send it to somebody who has been blaming their chair.

Research referenced in this episode 

Hamstring muscle length and lumbar lordosis in subjects with different lifestyle and work settings. Journal of Back and Musculoskeletal Rehabilitation. 2014. 

Is hip muscle flexibility associated with low back pain among first year undergraduate students. Journal of Clinical Medicine. 2024. 

Effect of prolonged sitting and breaks in sitting time on endothelial function. Medicine and Science in Sports and Exercise. 2015. 

Accelerated longitudinal decline of aerobic capacity in healthy older adults. Circulation. 2005. 

What is the cause of the ageing atrophy. Total number and size and proportion of different fiber types studied in whole vastus lateralis muscle from fifteen to eighty three year old men. Journal of the Neurological Sciences. 1988. 

Different changes of quantity due to aging in the psoas major and quadriceps femoris muscles in women. Journal of Musculoskeletal and Neuronal Interactions. 2006.

Get Your Healthy Movement Score

Every joint in your body has an amount of movement available to it and an amount that has been quietly restricted. Testing is the only way to know which is which.

Healthy Movement Testing looks at your whole body and gives you one number and your Movement Age and a Blueprint you can track for the rest of your life. In person at Beckett Ridge in West Chester Ohio.

Not near West Chester. Start with the virtual Healthy Joint Mobility intro and get your Mobility Health Score for one area.

This is movement health education. It is not medical advice and it is not a diagnosis. If you are in pain or you have an injury please see a licensed provider.

Can You Open Up Joint Space Without Injections Or Surgery after age 40?

Understanding what stretching gives you and what it does not give you when it comes to the hip flexor muscle after age 40.

The Healthy Movement Podcast

“Stretching the hip flexor muscle is the most common tool used today for hip flexor tightness.” Kim Nartker

Read time: about 10 minutes

In episode #250 Kim continues a series on the healthy hip because almost every person walking into her studio now arrives with a hip restriction of some kind. This episode answers the first question she gets. Why does the hip flexor stretch stop holding after 40. She went through the stretching research and she reviews what she finds and what she sees is missed in the research. How much stretching it actually takes for the stretch to hold.

Then she shows what those same researchers found when they stood the person up and asked them to run.

A note on the research. Every study named here is real and Kim reports what it found and not what she wishes it had found. Where she is describing what she sees in her own studio she says so plainly. She does not diagnose or treat or cure or prevent any medical condition.

The Short Answer Your hip flexor stretch is a great tool but, Is it doing what you are looking for it to do?

Stretching improves your range of motion for as long as you keep stretching. The research supports that when you stretch you improve your ROM. 

What stretching does not do is restore accessory motion. Accessory motion is the glide of the bone inside the joint capsule. This motion is not under your voluntary control and no muscle performs it. We have been taught to focus on the muscle, to stretch the muscle, but the muscle is not tight for no reason. Have you ever asked yourself or a professional that told you that you are tight, why am I tight? And did you get the answer your aging, or do you sit a lot?

I see the research, I see people in my studio that come in one day with restricted hip joints and these people are all experiencing the same tightness and they are not all old. 

What You Have Been Told About Your Hip Flexor 

Stretch it

Sitting Causes your hip flexor to tighten

A tight hip flexor muscle pulls the pelvis forward.

You feel tight in the front of your hip. Or your low back bothers you. So you stretch.

Somebody told you the muscle is short because you sit too much. Somebody else told you the hip flexor pulls your pelvis forward and that is why your back hurts. Both explanations end in the same instruction. Stretch it.

And stretching is the safest thing anyone can tell you to do. You cannot hurt yourself doing it. It feels better while you do it. So it became the default answer everywhere.

The problem is not the advice. The problem is what are you looking to gain with the stretch, what is actually causing the tightness, (it’s not sitting alone….and its not aging) there is more that I will break down in order to help you better understand your hips. And what age are you when you feel the tightness signal. 

I dug into the research on stretching the hip flexor. What the stretch does do, what it doesn’t do 

What I found is that stretching does improve ROM. But ROM gains do not stick so you have to stretch over and over to maintain the ROM gains. 

I also found in the research that the people that were stretched passively and stretched on their own gained ROM in both passive and active stretching, but none of the stretching transitioned to function. Meaning the stretching gains were limited to feeling looser, after stretching. 

What Not One Of Those Studies Measured was how to improve movement and function. Everyday I see advertisements promoting move better, but the modality used is stretching. 

Stretching the hip flexor is very effective for post sport and workout recovery. But the myth that the stretch will improve muscle length has not been proven in any study that I found. 

As we age there are changes that occur in both the joint and muscle, but age is not the only factor for those changes. The joint changes by stiffening, losing centration, leading to instability. The muscle function declines and no one can answer why this happens. From the research that I have found, I speculate that joint and muscle decline predictably in people that don’t get their joints tested for a restriction. I do not have proof of this, but I do see major improvements in testing my clients joints and in their hip especially I see them lock down without any reason at all and in those people that do not have a provider testing their joint restrictions, these people get tighter, and tighter and not only lose ROM in their hips, they lose function in the joints and muscles. 

We have great research on people that have been diagnosed with arthritis, or other diagnosis, but these people did stretching at some point in life, and the stretching did not hold. This is what you are experiencing right now. So if stretching was not answer for all of those people that ended up in surgery, I ask, will it work for you. 

In the episode I did a deeper dive and discussed Two Kinds Of Stretching 

Active Stretching and Passive Stretching (Assisted)

There is active stretching which is you stretching yourself. You go to your own tolerance and you stretch fascia and muscle. It is useful and it is limited because you can only take yourself so deep.

Then there is passive stretching which is somebody trained doing it to you. Fascial stretching. Muscle stretching. PNF. Contract relax. In physical therapy the same thing is charted as passive range of motion. In a stretching studio it is sold as stretching. All of it works on soft tissue and soft tissue means muscle and fascia.

Both of those live in the layer you can reach the muscle layer. 

The deeper layers below your hip flexor muscle lives a ligament, a joint capsule and bones that are supposed to move. Those surfaces are not reached with stretching your hip flexor muscle.

So how do you stretch the joint to improve the health and function of your hip flexor muscle?

Joint stretching which is a different type of stretching stretches the surfaces below your muscle. Physical therapists trained in it call it joint mobilization. A chiropractor does it with an adjustment. A doctor of osteopathic medicine does it with manipulation. My own work is much gentler than any of those and I am stretching the joint capsule so the bones glide better and the nervous system can turn down the protective response. 

Here is what I want you to notice. Every form of muscle stretching is available at scale on every corner in America. Joint work is available for pain relief, but not used to restore and preserve joint and muscle health.  I have gone looking and I have not found it offered as an ongoing testable service anywhere. When I say testable service, I am referring to testing for joint restrictions and tracking our movement health scores so that we can see if our stretching is working or if we need to do something else. 

So the muscle layer has plenty of providers selling this service. The layer below the muscle has providers that sell pain relief. We are missing services at scale that help us restore and preserve our joint and muscle throughout our lives. 

Why is this important?

After 40 you are not only losing flexibility in your hip flexor muscle,  You are losing range of motion and accessory motion and strength and power at the same time in your hip joint. The restriction begins first, this alters the message to the muscle and causes a cascade of loss in the muscle.  And the fast twitch fibers go first. Aging muscle loses type two fibers preferentially and those are the fibers you use to move quickly and catch yourself. We lose those first. 

When general loss of muscle mass and strength progresses far enough it gets called sarcopenia. Then we are encouraged to build strength, while preservation of muscle is much more effective and helps us keep our movement quality. Once you lose muscle to rebuild the muscle it takes years. 

Here is the practical difference I see. My twenty and thirty year olds still have muscle mass and muscle function and enough capacity to compensate their way through a restriction in the joint. They stretch and see the limited results, but do it anyway, because they are told to. 

My clients over 40 have joints that have been restricted for twenty or thirty or forty years and they have multiple areas of inhibited muscle stacked on top of that. The loss is more layered in someone over forty, but the loss is not due to aging alone. This is why when you are over 40 and stretch your hip flexor muscle you don’t see the same benefits you did at 20 and 30. Your joints and muscles have been in decline and now you have lost a lot of muscle mass. That mass is a function that is lost with atrophy. Research has proven that the hip flexor muscle starts that process in our 30’s. 

What Do I Do With Someone Over 40?

I open the accessory motion in every joint in the body and not just the one that is tight.

I use a technique that works with the nervous system to release the protective response that has the joint locked down. It is gentle and it holds better than stretching the psoas ever did for me. I stopped stretching that muscle years ago.

I load the hip twice a week and I want it as heavy as you can safely handle. That is joint health and bone health at the same time.

I test movement for muscle inhibition which is the most complex part of what I do.

I load tendons slow and heavy and I use in range holds and slow eccentric lowering.

And when I work a hip I program the low back and the foot and the ankle with it because those joints talk to each other. Replacing one joint and ignoring the three around it is how people end up back in a clinic two years later.

That is what I see in my studio. It is a group of people I follow closely and it is not a controlled trial and I am not going to pretend otherwise.

You Did Not Do Anything Wrong Almost every new client says a version of the same sentence. I have no idea how I got here. I did not fall. I did not hurt it. I woke up one day and my hip was tight.

They are right. They did not do anything wrong. They did what they were told and it worked on the muscle until the muscle loss did not allow for improvements. 

You cannot feel a joint restriction. There is no pain and no pop and no moment you can point to. Your body compensates immediately and that compensation is what lets you feel normal while the loss continues in the joint and muscle. 

Nobody tests the joint for a restriction. Fitness measures your output. Healthcare measures pathology and diagnosis. The restriction sits in between those two and gets measured by neither. That gap is where the Silent Shutdown Cycle does its work.

Where This Leaves You If your goal is range of motion then stretch. Stretch consistently and understand you are renting the result and the rent is due every week.

If your goal is to still get off the floor at seventy five then range of motion is not the number you should be tracking.

Here are the two questions I want you to ask before you agree to any treatment for tightness.

What movement can I expect from this treatment? 

And can I restore and preserve my joint accessory motion with the treatment you will be providing.

We track cholesterol. We track blood pressure. Almost nobody is tracking the system that decides whether you can still get down on the floor and back up when you are 80.

Next week I continue the hip series and I go deeper into what the restriction actually does to the muscles around your hip. Subscribe so you get access as soon as it drops.

Get Your Healthy Movement Score

Every joint in your body has an amount of movement available to it and an amount that has been quietly restricted. Testing is the only way to know which is which.

Healthy Movement Testing looks at your whole body and gives you one number and your Movement Age and a Blueprint you can track for the rest of your life. In person at Beckett Ridge in West Chester Ohio.

Book your Healthy Movement Testing 

Not near West Chester. Start with the virtual Healthy Joint Mobility intro and get your Mobility Health Score for one area.

This is movement health education. It is not medical advice and it is not a diagnosis. If you are in pain or you have an injury please see a licensed provider.

Can You Open Up Joint Space Without Injections Or Surgery after age 40?

Understanding how to keep your ROM throughout your lifespan.

The Healthy Movement Podcast

“You cannot clean a rusted hinge by pulling on the door.” Kim Nartker

Read time: about 9 minutes

In episode #249 Kim answers a question she gets in the studio almost every week. 

Can you actually open up space in a tight joint after 40 without surgery and without injections. The answer is yes.

 But not with the thing most people are already paying for. She breaks down the two types of motion inside every joint. One of them you can partly control and it is the layer that the entire stretching and rehab industry is built on. 

The other one lives inside your joint capsule and you have no voluntary control over it at all. 

Kim spent over twenty five years in physical therapy as a PTA and ran her own practice before she started looking at the joint instead of the muscle. She explains what a range of motion score actually measures and why it cannot tell you where your joint ROM loss is coming from. 

A note on the research. What Kim states as established is tied to the published literature and named in the episode. Where she goes beyond what the research has tested she says so plainly. She does not diagnose or treat or cure or prevent any medical condition.

You Have Been Working On The Muscle Layer

You stretch. Maybe you foam roll. Maybe you pay somebody once a week to stretch you deeper than you can stretch yourself.

And it works. For a while. You get off that table and you feel loose and open and you think there it is. That is what I needed.

Then a few days go by and your body is right back where it started.

So you go again. And again. And you keep going because it does feel good every time and because the alternative seems to be doing nothing.

Here is the question almost nobody asks. Your range of motion is being maintained. Is it improving?

For most people who have been doing this for years the honest answer is no.

What You Think Is Happening

Most people decide one of two things.

Either they are not stretching enough. So they add another session or another twenty minutes or another app.

Or they decide this is just what forty five feels like. Or fifty five. Or sixty five.

Both of those explanations put the problem in the muscle or in the calendar. And the tightness you feel really is in the muscle. That part is not wrong.

But your muscle is not where this started.

What Is Actually Happening

Here is the whole thing in three sentences.

Your body restricts the movement of the bones inside your joint capsule. Your muscles respond to that restriction by tightening and holding. What you feel is the muscle.

That is the simple version of something genuinely complex. But the order matters more than anything else in this article. The joint restricts first. The muscle responds second. And you only ever feel the second one.

Which means every hour you have spent working on the muscle has been spent downstream of the thing that changed.

The Day I Started Looking At The Joint

I worked in physical therapy as a PTA for over twenty five years and I opened my own practice after fourteen years in the field. I opened a physical therapy and wellness studio in 2013 because I believed that if I just had more time with people to stretch them and strengthen them I could help them move better.

That is not what I found.

What I watched instead was people getting discharged doing great and then coming back. And not coming back a little worse. Coming back having gone from walking normally to having a hip replacement. We were not tracking outcomes in any real way so nobody was asking out loud what I was asking in my head. 

What is happening to these people? Why are they always severely declined?

Stacy was the physical therapist at my clinic. She is out on her own now and we are still good friends and I still go see her because she can open up the available space in my joints. All of us need that.

Stacy had extra training in the joint itself. I had my soft tissue skills and my modalities and my passive range of motion. And we used to banter about it in the office. I would be stretching somebody and she would look over and say go ahead. Work harder.

Then she would say the thing I have never forgotten. She said she was going to go address the accessory motion in the joint because that joint is the major communicator between the muscle and the brain. And that it was going to loosen faster than what I was doing. And that I could spend forty five or fifty minutes stretching somebody and I might not get the same effect she just got.

She was right. And she is the reason I started looking at the joint instead of the muscle.

The Two Types Of Motion

Every joint in your body has two.

The first one is physiological motion. This is your range of motion and it is the one you know. It is what your larger muscles produce and their whole job is to move your joints. You raise your arm overhead. You take your leg out to the side. It gets measured in degrees with a goniometer and there are industry standard normal values for every joint movement in the body. Your shoulder should reach one hundred and eighty degrees of flexion. Your therapist writes that number down for your doctor or your insurance company.

Range of motion can be active which is you moving on your own. It can be active assisted which means somebody helps you. Or it can be passive which means a professional moves your limb while you relax.

A stretch therapist uses active assisted and passive stretching plus techniques like contract relax to stretch your muscles deeper than you can stretch yourself. In physical therapy that same thing is called passive range of motion. In the stretching world it is marketed as stretching. Both of them stretch soft tissue. Soft tissue means muscle.

Now here is the part that matters and almost nobody explains it.

Range of motion is a combined measure. When somebody writes down that your knee bends to one hundred and ten degrees that number is the muscle and the tendon and the fascia and the ligaments and the joint all reporting in as one score.

It does not isolate anything. It cannot tell you where the loss is coming from. And it lets your body compensate while it is being measured.

You can have a strong muscle and still have limited range of motion. You can improve that number without ever touching the thing that restricted it.

The second motion is accessory motion. This is the movement of two bones on each other inside the joint capsule. It is not under your voluntary control. There is no single muscle that performs it. You cannot decide to do it.

And this is the one that decides how far the first one can go.

You cannot stretch it because stretching pulls on the tissue around the joint and never reaches between the surfaces inside it. You cannot strengthen it because it is not a muscle. You cannot foam roll it. You cannot walk it back into place.

It responds to one thing. An outside force. Something has to move that bone for you.

This is my working explanation for what I see and it is how I understand the mechanism. The published research on manual therapy has not tested this order of events directly.

Why You Never Noticed It Leaving

Here is what makes this so hard to catch.

When you start losing accessory motion there is no signal. There is no pain. There is no pop. There is no moment where something happens and you think well that was not good.

It simply restricts. And your body starts building around it. That building around it is compensation and compensation is not well understood and it is not tracked by anyone. That is the part I find hardest to accept.

We have terrific tools. We have skilled specialists everywhere. Stretching studios on every corner. Physical therapy clinics now offering stretching and recovery. Massage and cupping and dry needling all available to anyone who wants them.

Every one of those works on the layer you can reach.

None of them is available to you at scale for the layer you cannot.

The Rusted Hinge

Think about a door in your house that does not open or close the way it used to.

It opens partway and it stops. And you pull harder. Everybody pulls harder.

How hard you pull is not the problem. The hinge is rusted.

A rusted hinge is not going to free itself. The rust does not go away one day. It builds. And the longer that door sits stuck the worse the hinge gets and the harder that door becomes to open.

So notice what does not fix it. Doing nothing does not fix it. Pulling harder does not fix it. Pushing harder does not fix it. Neither one of those releases the rusting process. It disturbs it for a moment and then it is right back.

That is the same reason stretching a joint or strengthening around a joint does not reach a joint restriction.

You cannot clean that hinge by pulling on the door.

Your Four Choices

Spray it. Hit the hinge with penetrating oil and hope it gets deep enough to reach the rust. Sometimes it helps. Often it only reaches the surface.

Work it. Somebody oils it and then moves it back and forth until it frees up so the oil works its way in. Then they keep working it so the rust does not come back. That is ongoing and that is the point.

Scrub it. Take the hinge off. Scrub the rust off. Oil it and put it back. That is closer to a procedure. Cleaning up arthritis or removing a bone spur.

Replace it. Take the door down and put a new hinge on. That is the surgery.

And here is where the analogy stops being fair to your body. A new hinge really does work close to new. A new joint does not.

What A Replacement Actually Gives Back

A healthy knee bends to roughly one hundred and thirty five degrees. After a replacement the goal commonly set in rehabilitation is around one hundred and twenty.

There is a meta analysis of seventeen studies covering more than sixteen hundred knees that found maximum knee flexion after a replacement was not significantly different from what that knee could do before the surgery.

Knee straightening did improve with replacement. The bend mostly did not.

Think about what that means in order. By the time somebody reaches a replacement they have already lost a lot of that bend to degenerative change in the joint and in the muscle around it. So you walk in with a symptomatic knee that maybe bends to one hundred and twenty. The replacement gives you back roughly what you walked in with. And plenty of people do not hold even that over the following year.

So you get a new knee without more motion. And you never get back the motion you were born with.

Which tells you what the surgery is actually for. Pain relief. And it delivers it. Most people I ask are glad they had it and a lot of them wonder why they waited. That is real and I am not talking anyone out of anything.

But they traded relief for motion. And there is one more thing I watch happen after that.

They got the knee replaced. The hip is still restricted. The ankle is still restricted. Most of them also have something going on in the back. Nobody tested any of those joints. And at some point those joints start sending signals of their own.

What The Research Has And Has Not Looked At

Physical therapists are trained to open accessory motion and the technique is called joint mobilization. Chiropractors do it with an adjustment. Doctors of osteopathic medicine do it with manipulation. My own techniques are much gentler than any of those and I work on stretching out the joint capsule so the bones glide better.

Here is what I found when I went looking. All of it is studied in people who already hurt.

The one exception is in the chiropractic literature where maintenance care has been studied and reported to reduce repeat pain episodes. But that is care for people who already had the pain episode.

I could not find a study on asymptomatic people. People with no pain at all. That study is the one I want to read and as far as I can tell nobody has run it.

There is a study from the year two thousand that I keep coming back to. Eighty three people who already had knee arthritis on x ray and who had pain. Half of them received manual therapy applied to the knee and to the lumbar spine and the hip and the ankle along with supervised exercise. The other half received a subtherapeutic ultrasound that was doing nothing at all.

The treated group improved substantially and at one year they still had those gains. At one year twenty percent of the placebo group had gone on to a knee replacement compared with five percent of the treated group.

That study is twenty six years old. As far as I can tell nobody has done another one like it.

And here is what I sit with. If we tested joints for restriction in our twenties and preserved that accessory motion across the whole body and kept doing it for life could we change the surgery numbers. Could we change the fall numbers. Could we change the chronic pain numbers.

I speculate that we can. I see it in my studio. But speculating is not the same as knowing and I am not going to pretend otherwise.

What I See In My Own Studio

I test accessory motion in every client who walks through my door and I watch joints restrict again between sessions. That is normal. This is a system that needs tending and not a problem you fix once.

The clients I have worked with for more than five years are the ones who show me something. Those people have deep stability and their deep muscles are actively firing and they have held on to their large muscle strength and their muscle mass over years. Statistically we lose a lot of that after sixty. My long term people are not losing it the way those numbers say they should.

They also follow the five drivers of healthy movement and they eat for muscle. And they know their own signals now so when one joint locks down they get in quickly and we open it back up.

That is not a study. That is a small group of people that I follow closely and I want to be clear about the difference. But it is enough that I would like somebody to go look properly.

Where This Leaves You

So can you open up space in a joint after 40 without surgery and without injections.

Yes. That is the good news and it is real.

It depends on how much change is already there and it takes a professional who is aimed at the outcome you actually want. And that last part is where most people get lost. Most of the people who have come to me over the years only wanted out of pain. Lately more of them are coming in wanting movement. That change is the most exciting thing I have seen in this field.

So here are the two questions I want you to write down and ask before you agree to any treatment for tightness.

What movement can I expect from this.

And how long do I keep it after the treatment stops.

Almost everyone will answer the first one. Watch what happens when you ask the second.

We track our cholesterol. We track our blood pressure. Almost nobody is tracking the system that decides whether they can still get down on the floor at seventy five.

I hope that changes. I hope tightness and stiffness and soreness stop being things we wait out and start being read as what they are. Signals that something upstream has already changed.

Get Your Healthy Movement Score

Every joint in your body has an amount of movement available to it and an amount that has been quietly restricted. Testing is the only way to know which is which.

Healthy Movement Testing looks at your whole body and gives you one number and your Movement Age and a Blueprint you can track for the rest of your life. In person at Beckett Ridge in West Chester Ohio.

Book your Healthy Movement Testing

Not near West Chester. Start with the virtual Healthy Joint Mobility intro and get your Mobility Health Score for one area.

This is movement health education. It is not medical advice and it is not a diagnosis. If you are in pain or you have an injury please see a licensed provider.

Why Does My Knee Feel Pressure When I Bend Down?

Understanding Knee Health To Maintain Knee Mechanics Throughout Your Lifespan

The Healthy Movement Podcast

“Knee pressure is easy to dismiss because it is not constant. It shows up only in a deep bend, and most of us are not down on the floor very often.” Kim Nartker

Read time: about 8 minutes

In this episode Kim takes apart a knee signal almost nobody pays attention to. Your knee is not a hinge. It locks and unlocks through a rotation you have no voluntary control over, and when that mechanism stops working there is exactly one movement in an ordinary day that will tell you, because walking uses less than two thirds of the bend you have. She walks through what the research actually measured, what she finds when she tests above and below the knee, and the order that activities signal you as you lose key available motion in your joint capsule. Then she introduces three real women in their thirties, fifties and seventies who are not three different conditions but three people standing at different points on the same predictable movement decline path.

A note on the research: what Kim states as established is tied to the published literature and named in the episode. Where she goes beyond what the research has tested, including her working explanation for how hip and foot restriction connects to the knee, she says so plainly. She does not diagnose, treat, cure, or prevent any medical condition.

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The Signal Almost Nobody Pays Attention To, And What It Is Actually Telling You

You walk every day. You take the stairs. You get in and out of a chair without a second thought. Your knee feels completely fine with all of these activities.

Then you go down to the floor to pick something up or to play with a child, and you feel a pressure deep in the knee. Not quite pain, but enough to make you stop bending down on that knee. 

Most people blame this deep knee pressure as a normal part of aging. 

We are taught to believe that aging is the typical reason, but I have found aging to be not the reason behind this pressure at all. 

That pressure is a signal, and it is showing up in exactly one position for a reason that is measurable. Your knee has a lock and unlock mechanism that is completely outside your voluntary control. When that mechanism stops working the way it was built to work, when you bend down into a deep knee bend you will feel this pressure which is a signal most of you ignore.

A woman in her mid thirties came to my studio with no pain at all. She did not have pain with walking. She could do stairs with no problem. The only time she felt anything was going down to the floor to play with her young child. She had already decided it was knee pain and that she was getting older.

She is not overweight. She had no injury. She is in her thirties. She wanted answers and asked if she should be concerned with the pressure in her knee with bending. 

She scheduled a Unlock Healthy Joint Mobility Session to learn about her experience and this is what I found when I tested the joints in her lower body during her introductory session.

Both hips were restricted in every plane of joint movement. The hip on the side of the knee that she reported pressure in was found to be restricted into all planes of motion. Her foot on that same side was also found to have greater joint restrictions in her ankle, her forefoot, her midfoot, and her rearfoot. The opposite hip and forefoot had similar restrictions that were just as limiting. Her knee that she reported pressure with the deep bend had lost its unlock mechanism.

So when she went down to the floor to play with her child, the pressure in her knee caused her to get off that knee pretty fast. When she went down quickly, she noticed it and said out loud, my knee is getting old. 

Why We All Ignore This

We are trained to believe our movement health is fine until something hurts.

Pain is a late signal. By the time you feel it, you either have a diagnosable condition or you are close to having one. Waiting for pain is not a strategy for anyone who wants to still be moving well in the second half of life.

And knee pressure is easy to dismiss because it is not constant. It shows up only in a deep bend, and most of us are not down on the floor very often.

Here is what makes that dangerous, and it is measurable.

Researchers put sensors on the knees of twenty healthy older adults and measured how much knee bend ordinary activities actually require.

Walking on flat or sloped surfaces required less than ninety degrees. Stairs and rising from a chair required ninety to one hundred and twenty degrees. Getting into a bath tub required about one hundred and thirty five degrees.

Getting down to the floor was not even on their list.

A healthy knee bends to roughly one hundred and thirty five degrees. So walking uses less than two thirds of what you have.

You could lose a large amount of your available bend and never notice it walking. The floor is the only thing in your ordinary day that asks for all of it.

And no, this is not aging. Researchers measuring hip and knee range of motion across age groups found differences of only three to five degrees between the youngest and the oldest person tested, and concluded that at least to age seventy four, any substantial loss of joint mobility should be viewed as abnormal and not attributable to aging.

We have been taught that we are in control of our joint mobility. We have been instructed to move, stretch, eat well and use recovery tools after we exercise. But what we have not been educated on is this fact:  Our joint capsules lose accessory motion through a restriction that is out of our voluntary control. We do not get a signal of pain when this motion is lost, our muscles tighten and hold around that restricted joint.  In this case this thirty year old Mom, has already started losing key mobility in her hips, 1 knee, feet and ankles and this loss has nothing to do with her age. 

Your Knee Is Not A Hinge

Everyone calls it one. The anatomy texts do not. They call it a modified hinge joint, and that word modified is where this whole story lives.

Your knee bends and straightens like a hinge. It also rotates. And that rotation is built into the function of the bone and the joint. 

At the bottom of your thigh bone are two rounded knuckles called condyles, one on the inside of the knee and one on the outside. They are not the same size. The one on the inside has a longer surface.

So as you straighten your leg, the shorter one runs out of room first while the longer one keeps traveling. When one side stops and the other keeps going, the joint has no choice. It rotates.

In the last twenty degrees of straightening, your shin bone rotates outward about fifteen degrees. That is called the screw home mechanism, and it locks your knee. The surfaces seat into each other. The ligaments wind tight. Your knee parks itself, which is why you can stand around with straight legs and almost no muscular effort.

If rotation locks the knee, rotation has to reverse before you can bend it again. You cannot stretch out of a locked knee. It has to unlock to bend. 

There is a small triangular muscle deep behind your knee called the popliteus. The anatomy texts call it the key that unlocks the knee. Its only job is to reverse that rotation so bending can begin. When you lose the knee joint accessory motion, this deep muscle loses key activation in the process of the restriction. 

So what happens when a knee cannot fully unlock?

You would not feel it walking. You would not feel it when getting up or down from a chair. Both of those activities do not require end range joint mobility. 

You would feel it going down to the floor. Because this activity requires the knee to fully unlock. For this mom, she had a hip restriction and ankle foot restrictions that did not allow this lock out mechanism to unlock completely. Her joint was restricted and still in a locked position due to the multiple joint restrictions at the knee, above and below the knee joint. 

So when she went into that deep position, she felt a pressure that alarmed her. That is the feeling that I am hoping I can teach to people to help them gain awareness of their body when it moves. 

The Restriction Is Not Only Found In The Knee

When I test people who describe this, here is what I find.

The shin bone sitting in external rotation, which is the locked position. The knee restricted in its accessory motion, meaning those small movements between joint surfaces that you cannot produce on your own are restricted from moving. And above and below it, the same thing. Hips restricted in rotation and in accessory motion. Midfoot, rearfoot, ankle, great toe. Some of them or all of them restricted from moving. 

That is not a research finding. That is what I find when I test, and I find it often enough that when someone tells me about knee pressure, I go looking above and below the area of the pressure feeling but also look at the joints of the opposite side. 

Here is why that makes sense mechanically. When your foot is planted, to unlock the knee requires the thigh bone to rotate outward on the fixed shin. That rotation has to come from somewhere, and the joint above it is the hip. A hip that is restricted from moving does not allow that knee to unlock fully, so it stays stuck in the locked position.

Below the knee, the foot and ankle are what let the shin find the ground and adapt to it. Researchers took thirty healthy people with no history of injury and artificially restricted their ankle motion during a squat. The knee bent less, traveled inward more, and the muscle work shifted to a different muscle group in this study. When the ankle is restricted from moving the knee has to do something different. So the ankle, knee and hip all need the accessory motion in the joints to work properly to be positioned correctly with a deep knee bend position.

The Predictable Movement Decline Path

I have been working in the healthy movement space for over 30 years. I have found predictabilities that occur in every person that walks through my doors. The body tests the same predictable way and it does send us feelings or signals, but we have never been taught to understand what our bodies are telling us. 

Here is where we lose accessory motion in our joints 1st as it relates to our knees.

Kneeling down to the floor requires the most joint mobility approx. 135 degrees is needed. We lose this motion in the capsule of the knee when the screw home mechanism and that deep muscle are no longer healthy and are restricted in movement. 

We lose more motion over time through restriction and muscle inhibition making sitting on lower surfaces more difficult. 

The next activity that you will feel the knee joint restriction is descending stairs as this requires more motion loss than the previous activities.  

When you have lost more motion you will feel that loss when sitting in a chair, many people will start automatically compensating during this time, to avoid that loss of movement or pressure feeling. 

You won’t feel the restriction in the knee with walking until you have lost more than 90 degrees of motion. 

Which means by the time somebody notices it walking, an enormous amount of joint mobility and joint function are already lost to a restriction and decline. 

The larger problem that we have is that when we lose this motion, we adapt, we compensate or modify our positions to avoid the loss of motion. We stop sitting on lower surfaces, we start using our hands and stepping down 1 step when we go down stairs, we avoid positions that require that motion. 

So as you can see. Our bodies adapt and we adapt and accept this loss every day. Mostly because we can still move without pain. 

Pain is a late signal. And by the time you experience pain, you will already have a diagnosable condition.

I have watched this movement decline in people at every stage of life. A woman in her thirties with restricted movement that can still perform activities without pain. A woman in her late fifties with those same restrictions, plus muscle inhibition and a movement system that is overworking everyday to allow her to move with symptoms that waver from day to day due to these restrictions and other factors.  A woman in her seventies with all of that, plus established structural change diagnosed as Osteoarthritis, giving her joints stability while stealing the mobility in her toe, foot and midfoot joints placing her knee in a locked position at all times limiting her movement. 

Those are not three different conditions. They are not only age related. They are the same signals we have learned to ignore because we can move and we don’t have pain.  This is the predictable movement decline path. 

And the woman in her thirties has forty years to go to reach the woman in her 70’s about to have a knee replacement surgery. 

What The Research Has And Has Not Looked At

There is a study from the year two thousand that I keep coming back to. Researchers randomised eighty three people with knee osteoarthritis. Half received manual therapy plus supervised exercise, twice a week for four weeks. And the manual therapy was applied to the knee as well as to the lumbar spine, the hip and the ankle as required. The other half received a subtherapeutic ultrasound that was doing nothing.

At eight weeks the treated group had improved their walking distance and their symptom scores substantially, and at one year they still had those gains. At one year, twenty percent of the placebo group had undergone a knee replacement, against five percent of the treated group.

What I love about this study is that these people saw improvements with PT treatment and those gains lasted at least 1 year. I would love to see a study done on people that are addressing joint restrictions in every joint of their body for life to see if we can see real changes in the surgical statistics, musculoskeletal disease statistics and mobility decline statistics that causes many of you to lose mobility in the last half of your life. I may be dreaming here, but we don’t know until everyone steps up to learn more about joint restrictions and keeping the joints unlocked first then building key strength through our fitness system after. 

That study is twenty six years old. As far as I can tell, no one has done another one of these studies. In my opinion this is overdue. 

Where This Leaves You

The pressure you feel in a deep bend is telling you something has changed in your movement system. 

That is all it is telling you. It is not telling you how much change, or where the joint restrictions are, or how long it has been going on, or whether the muscles that support the joint are still doing their job. That is what my hope is. That you will see this movement decline path and see that just because you can move, and you don’t have  pain, it does not mean your movement system is not working in a healthy, efficient way. 

With this data, I speculate that just like car maintenance, dentistry, and longevity testing, you will see that testing the health of your movement system is as important as any other preventative test, and you take action to test your healthy movement system today.

As you can see in this article, your body restricts the bones moving inside the joint capsule to control and stabilize your joint. Once the body starts this process it is outside your voluntary control. This process continues to run throughout your life, but it can be identified through specific testing. I see that as good news. We track our cholesterol levels, our blood pressure levels and we should track our movement health in that same way. 

What nobody can tell you yet is what happens over twenty years if you identify the joint restrictions with testing, open up that accessory motion in the restricted joints, then restore the health of the 5 drivers of healthy movement. That study has not been done. One day I hope to see that it will. 

I have created a test that identifies these joint restrictions. I test clients in the Beckett Ridge area and provide them with a healthy movement score and movement age that allows them to track their movement health throughout their lifespan. 

If you want to know what your joints are actually doing rather than guessing from how they feel, that is what Healthy Movement Testing is for.

Once you identify the joint restrictions, you can restore and open that accessory space up and keep it open through routine sessions for life. This coaching model is not a race it is built to help you move well throughout your life and do everything you want to do without limitations of lost mobility. See you in the studio.