Looking Beyond The Noise
I've been working with a competitive skier lately.
They came to me with bilateral knee pain, thoracic spine discomfort and a feeling/observable difficulty loading the left side. Rather than treating the knee or skiing technique in isolation, I traced the problem through gait to the foot, tibia, femur, pelvis, and spine, then connected the movement strategy back to what was happening while she was skiing.
What we started to change, and how
Based on my observations, we began working on the missing movement options, including a lack of traverse or rotational component at the left subtalar joint and tibia. To address this missing piece, we started with a body-weight rotation exercise using specifically placed foot wedges to block frontal-plane movement and encourage transverse-plane movement at the subtalar joint.
For the right knee pain, which is resting in hyperextension, again I started with a rotation exercise that creates a supinated foot shape, coupled with external rotation at the talus, tibia, and femur, ensuring each element of the leg talks to the others. And to support this experience, we used strategically placed foot wedges to promote new movement in the foot, tibia, and femur.
To address the challenge of loading the left side, we traced this to an inability to adduct the left hip, which also ties into the elements above.
Using a split-stance exercise, we encouraged the mass to move over and "rest" on the left foot. To help the body feel safe in this new zone, I wedged the foot to encourage sagittal and transverse-plane movement in the left calcaneus, and wedges on the 1st and 5th metatarsals. This gave the system and the hip permission to adduct, load the glutes and ultimately shift the mass toward the left.
Working through the layers
With the above elements addressed, we're starting to work through the layers, in particular this athlete's limited spinal movement: resting forward in spinal flexion and laterally flexed right in the upper thoracic spine; missing sagittal-plane extension and lateral flexion to the left; relying on lumbar and transverse-plane motion to support daily spinal needs; and the body organizing around these spinal limitations, which again, speaks to some of how the lower body presents.
Adding spinal COG-like movement exercises to the above, we're starting to support missing spinal experiences.
What's Changing
While there are several layers to work through with this client, one of the first things we're creating is new physical awareness and understanding. That said, even in our initial session, we made real-time change in the loaded barbell squat, a movement that was causing knee discomfort. Ultimately, the next step is to see how continued work on the missing pieces in the lower body and spine carries into walking, running, and ultimately skiing.
