Should You Go Deep? The Truth About Deep Knee Bends

[0:00] Jason: All right. Somewhere out there, there’s a trainer who’s still yelling, “Don’t let your knees go over your toes.” Kathy: Meanwhile, that same trainer is walking upstairs and his knees are going way past his toes. Jason: I know, right? It’s exactly that. So, the gym is full of knee myths. And today, we’re busting them. Kathy: The myths, not the knees. Okay. Okay. Good. Jason: Yeah. We didn’t — we’re not having a celebrity mob boss on today. Okay. And that’s because your knees aren’t fragile ornaments. They are built to move. Kathy: Yeah. They’re not just for looking good.

[0:31] Jason: Certainly not mine. Kathy: You move a heck of a lot better when you train them right. Jason: Yeah. So you don’t want to miss this episode. If you value your knees, there might — that might be a couple of you. So this is for anybody who thinks that they might have incurable arthritis or that they can never do a squat again. Kathy: That’s right. This is the PTCH. What happens when a chiropractor and a physical therapist get together to make a health and wellness podcast? Jason: But chiropractors and physical therapists don’t like each other. Oh, think again.

[1:03] Kathy: I’m Dr. Kathy Lynch, physical therapist who likes to help people move and get stronger. Jason: I’m Dr. Jason Young, an evidence-based chiropractor who uses humor just as much as adjustments to help people get better. Kathy: Welcome to the PTCH Podcast. Jason: Remember, there’s no I in PTCH. All right, folks. Welcome back to the PTCH Podcast. I’m Dr. Jason Young. Kathy: I’m Dr. Kathleen Lynch. Jason: Yes. And today we are talking about knees. But before we discuss Dee’s knees, we need to — let’s talk business. Let’s talk podcast a little bit. Okay.

[1:34] Kathy: Down to the biz. Jason: Yeah. So, first of all, thank you to all of our listeners and our watchers. Watching is definitely better than listening. Would you agree? Kathy: Yes. Jason: Yes. Absolutely. Because like right now if you’re watching, one of the things that you’ll see is you will see how you can go to the PTCH Podcast swag store. It’s like it’s written up there. So if you’re a visual learner you want to see that. Kathy: Yeah. Jason: And if you are an auditory learner, which we should do a whole episode about how that’s not even a thing. Kathy: No,

[2:04] it isn’t. Yes. Jason: Go to ptchpodcast.shopswag. Kathy: Right. You can get all of your official PTCH Podcast merch there, courtesy of Corvalis Custom. Thank you very much. So, yeah. Have you gotten your swag yet? Jason: Yes. Kathy: You have? Jason: Oh, I’m behind. I need to order some. Kathy: I got — I got black t-shirts. Jason: I want black t-shirts. Okay. Yeah, I’ve got to get — I’ve got to get on that. I really need the sit-and-reach

[2:34] champion shirt, since it features me with my 1990s high-top fade on it. Jason: Well, I was going to get you that for Christmas. Kathy: Ho ho ho. Jason: Ho ho ho. You just ruined the surprise. Kathy: Dang it. No. Jason: Well, and so let’s talk about another thing though. I hear that the PTCH Podcast is very good for business. Like I had somebody who booked today and my staff was like, “Where did you — where’d

[3:04] you hear about us? Like how did you get referred here?” And he said that it was from the PTCH Podcast. Kathy: Oh my gosh, we’re rich. Jason: And then I’ve also heard from some of our guests too that they’ve had people that have called in and everything. So basically, y’all, this thing is a money magnet. Kathy: It is, right. It is totally. Yeah. So if you want to sponsor — you see that we’re starting to run sponsorship spots. Jason: Yep. That’s how you say it. Kathy: Sponsor. Yeah. Not anymore apparently. Guess we just lost all the sponsors.

[3:35] Jason: No sponsorship spots. Kathy: Yes. And yeah, when we have people on here or we talk about things or we feature a product or something like that, it’s because it’s something that we like, that we believe in. And so, of course, we recommend it to you. So, rush right out there and spend some money. Jason: Spend it. Kathy: Let’s go. Jason: Spend it all. Kathy: You can’t take it with you. Jason: You can’t. No. Kathy: Yeah. So, you should give it to me. Jason: That’s right. Kathy: I’ll take it with you — or with me. Jason: I’ll take it with me. Yes. Well,

[4:06] Kathy, I don’t think that we came to give financial advice today or advertising. Kathy: Do not take financial advice from us. Jason: No. We are not financial planners, right? What is that? Not a real — is that Kathy: nerf. Nerf. Jason: No, but okay. So, this is something that you are very passionate about. Kathy: This is near and dear to my heart. Jason: Yes. Because it goes back to what we were talking about in the beginning. There’s some bad advice out there about

[4:36] squatting and what you can do with your knees and your toes and just general human fragility. So, Kathy, what is the controversy? What’s bugging you? Huh? Kathy: Get it off your chest. Kathy: I mean, I’ve been a PT now for 10 years and also a gym owner. Jason: Helix Training, if you didn’t know. Kathy: Oh, yes. Another one of our sponsors. And I probably on a daily basis when I teach somebody a squat,

[5:06] I will say it’s okay if your knees go over your toes. And I get a shocked — I mean shocked — look. Jason: That’s not what they teach at my church. Kathy: Exactly. Jason: I worship at the no-knees-over-toes. Kathy: That’s not what my pastor said. Yes. To this day, still the myth persists. Jason: Yeah. Kathy: Don’t let your knees go over your toes. Jason: Well, because — give me some background. So,

[5:38] historically Kathy: Mhm. Jason: what is supposed to happen to your legs or your knees if, heaven forbid, your knee should drift beyond your Kathy: Yeah. Total explosion, right? And the blast radius could kill people for meters and meters, right? Yeah. For our listeners in Canada. Jason: And I don’t know if people have even been told why their knees shouldn’t go over their toes.

[6:08] Kathy: No, it’s — Jason: they just have been told not to do it. And I don’t know if they’ve even asked why — well, why shouldn’t I? Kathy: But I think that they have been told not to do it because they think it’s dangerous and it will hurt your knees. Jason: Well, it’s like this. It’s going to cause you the arthritis. Kathy: The arthritis. Jason: The arthritis. Kathy: Yes. Jason: Yeah. Well, and I think that that’s kind of been the thing — it maybe goes back to some old paradigms of what does cause arthritis, right? Like, oh, it’s wear and tear. You know, I have — I have

[6:40] arthritis because I played basketball. Oh, you played professional basketball, sir. No, I played pickup basketball in middle school. And so clearly, clearly that’s why I have bad knees now. Yeah, that’s been scientifically studied. Jason: Yeah. Right. Kathy: Those middle school games are rough on your knees. Jason: Totally. Yeah. I mean, it’s tackle basketball, you know, in middle school, but man, I — we need to get like a shrink on here sometime because I talk about middle school a lot. You do?

[7:10] Jason: I clearly have issues. Kathy: I do. I have a good friend who is one and I think maybe she’ll come on and help you with your — Jason: Is that — is she a psychiatrist, which, you know, they give out the medications? Kathy: No, she’s a — Jason: Okay. She’s a nerd. Okay. Kathy: She’s with us. Jason: All right. Kathy: She’s one of us. Jason: She’s one of us. Kathy: Yeah, she’s a nerd. Jason: So, but yeah, it just kind of contributes to a culture of like selective fragility that’s not based Kathy: in science. And so,

[7:41] so here’s my question to you. Why does it even matter though? Why does it matter if we have a whole bunch of people that are, let’s just say, they’re being careful. They don’t want to put the knees over the toes because just out of an abundance of caution. Is there any harm in that, Kathy? Kathy: Well, I mean, harm is a relative word, but you’re not going to get — if you’re squatting for strength, you’re not going to get the quadricep activation that you may want and therefore not build your quads.

[8:11] Jason: Ah. Kathy: So it’s not just a matter of playing it safe as a way to go. You’re actually potentially hurting your chances of making good progress Jason: if you follow that bad advice, Kathy: right? Now, the other thing is the trade-off. So, if you don’t let your knees go over your toes when you do a squat, what’s going to happen? Kathy: Your hips go backwards, Jason: right? And so, your shins don’t move when you do your squat. So, then you’re going to put load more on your hips and back. So, it’s a trade-off.

[8:41] Jason: Yeah. Right. Kathy: And backwards hips — that sounds very painful, too. Jason: Well, I mean, it’s not the hinging type. It’s not the hinging type that we want from your hips, Kathy: right? Jason: But you know what? Let’s go back in history. Kathy: Okay. Jason: Is that — is that Wayne’s World? Kathy: Yes, Wayne’s World. Jason: Where the heck did this myth start? Kathy: Yeah. Where did it start? Jason: I had to dial in and find out. Kathy: Okay. I’m curious though. Did you find the answer? Jason: I did.

[9:11] Kathy: You found the pot of gold at the end of the rainbow. Jason: At least it satisfied me. Okay. Kathy: Okay. You’re not going to believe how long ago this study came out and we’re still talking about this. Jason: Was it the — was it the 70s? Kathy: 1961. Jason: Oh, even before the 70s. Okay. All right. Kathy: Dr. Carl Klein. Jason: Klein. Yeah. Kathy: Oh, we got him. Carl Klein. Yeah. Jason: You know, like Seinfeld with Newman. Newman. Kathy: Newman. Jason: Yeah. Kathy: Klein. Of course, it was Klein.

[9:42] Jason: What did he say? Kathy: Oh, man. How did he screw this up so bad? Jason: He studied weightlifters doing the deep squat — back squat with barbells. So Kathy: they were lifting heavy and his conclusion was that squatting, which involved knees traveling past the toes, caused a debilitative effect on the ligamental structure of the knee. Jason: Okay. Kathy: Causing laxity of the knee.

[10:12] Jason: Okay. So, I’m just curious and I know that you don’t have one, but do we have a picture of this guy’s legs? Kathy: I just — I can only imagine that they’re just like pencils, right? Jason: Totally. Kathy: Actually, guys, you don’t want to cause some ligamental laxity of your knees. Jason: 1961 and we’re still yelling, Kathy: “Don’t let your knees go over your toes.” Jason: I know. Kathy: Are we serious about this? It’s lazy bro

[10:42] science. Jason: Yeah, Kathy: that’s what it is. Jason: And then that got extrapolated. Kathy: Mhm. Jason: Sports Illustrated — Kathy: the swimsuit issue. Jason: Okay. It probably wasn’t the swimsuit issue, but okay. Kathy: They had an article. They had an article cherrypicking what Klein found out and it was titled, “Are squats bad for your knees?” Jason: Oh jeez. Kathy: Yeah. Jason: Fearmongering. Kathy: Got amplified. Jason: Mhm. In Sports Illustrated. Kids,

[11:13] if you don’t know, this was like the social media of the 80s. Kathy: 100%. Jason: Yeah. You had to get the magazine. You had to wait every month for it to come. Kathy: The best. Jason: And, at my house, it only came 11 months out of the year for some reason. Kathy: So, and then like you read it in there and it’s like, well, these guys know what they’re talking about because, you know, Jason: Sports Illustrated, Kathy: Magic Johnson’s on the cover. So, yeah. Geez. Jason: Yeah. Yeah. So this article also

[11:44] reiterated what Klein said and they basically sensationalized the message Kathy: that squats with knees over toes are dangerous. It took root and became a widely accepted training dogma. Jason: Oh jeez. Kathy: And here we are 2025. Jason: You can just see there’s a whole generation of people with their — with their knee-high socks, the ones with the stripes, the long white ones. Kathy: Tube socks. Yeah. And those tube socks — like they probably put the lines on them just to make sure that like you didn’t

[12:15] create some sort of knees-over-toes violation, right? Jason: How many people do you think were dying every year from putting those knees over the toes? It was a lot. There’s cemeteries full — Kathy: Yes. Jason: full of them. Kathy: Knees over toes. KOT, Jason: right? Away from KOT, right? Mm-hmm. Kathy: And he was in a war. Jason: Yeah. Kathy: The war.

[12:45] Jason: Yes. Survive grenades, gunshots — knees over toes. Kathy: Got him. Jason: Anyway, Kathy: KOT. It’s a problem. So — so it’s not — the myth is false. Let me just say that. But does biomechanics kind of feed into the myth in the sense? Yes. Because during a squat, the shear force on the

[13:15] Jason: Patellar tendon does increase.

Kathy: Mhm.

Jason: But how else do you strengthen your quads?

Kathy: Ding ding ding.

Jason: Right. Yeah. Well, and it’s kind of a trick question, right? Because the shear force and the compressive force and the torque and the rotational force — all those things increase.

Kathy: The reason is because —

Jason: Well, you’ve got weights. Yes.

Kathy: Right. So, squats are not a relaxation technique.

Jason: No,

Kathy: they aren’t. They are — it’s a stressful

[13:46] exercise. But you and I both love squats because it’s so functional. You have to squat in life.

Kathy: Like, you know, we put these things on YouTube and one of our clips that does the very best is you talking about when you’re 90,

Jason: right?

Kathy: Yeah. You got to get off the toilet.

Jason: Yeah. Nobody. Nobody’s going to help you off the toilet.

Kathy: Nobody.

Jason: And it’s because of the squat, right? Everybody has to do it.

Kathy: Squats for life.

Jason: Yeah. I see an amazing number of

[14:18] patients who come in and we’ll talk about like their back pain or whatever, and maybe we see some sort of deficits in how they move, and we get to exercises and I say, okay, well I want you to start by doing some bodyweight squats, which is a very safe exercise. And then, “Oh, I can’t do that.” Oh, why can’t you do squats? “My doctor told me not to.” And why do you think your doctor told you not to do squats? And I, you know, I’m really starting to

[14:49] doubt that there are doctors out there that are telling people not to do squats.

Kathy: That’s convenient.

Jason: Yeah. I think that it’s one of those “my dad could beat up your dad” things. Like, people don’t want to do squats and they just imagine that maybe their doctor

Kathy: might imagine that this is bad because, well, “my doctor told me to be careful with my knees” or “take care of my knees” and stuff like that. I don’t know that there’s really too many doctors out there that are like, “Don’t do squats. Don’t get physically active.”

Jason: I have heard — well, again, through the

[15:19] patient — I’ve heard people say, “You shouldn’t do squats. Why do you need to do squats?”

Kathy: Yeah. Because I want to stay alive.

Jason: I want to get up off that couch.

Kathy: Mhm.

Jason: I want my loved ones to continue to love me.

Kathy: Yeah. That’s right.

Jason: Mhm. So, if the shear forces do increase, is that harmful to the knees? No — just because the force increases doesn’t necessarily mean it’s harmful to the knee. And what we’re finding too with modern

[15:51] biomechanical studies is that forward movement of the knees doesn’t actually eliminate the forces.

Kathy: If you keep your — like I was saying earlier — if you keep your shins where they are, it just distributes the force backwards.

Jason: Right. Right. Right. Yes. So, the weight is still the weight. The force is still the force. It’s just where’s it going?

Kathy: Mhm.

Jason: And I think, you know, if you’re moving your knees forward —

Kathy: Yes.

Jason: — and your toes are in the middle, it kind of actually balances things out.

Kathy: You have to. Yes.

Jason: Right.

[16:21] Kathy: Your knees have to go forward or else you’re going to fall backward.

Jason: Yeah. And that’s going to hurt.

Kathy: Yeah.

Jason: We already did a whole episode on falls.

Kathy: Right. We’ve come full circle.

Jason: Yeah. Yeah. And to be honest, we joked in the beginning where we talked about — you know — the trainer walking up the stairs, his knees are going over the toes.

Kathy: Yeah. Well, in daily life, you’re getting up from a chair, you’re tying your shoes, you’re walking up the stairs — your knees are going over your toes.

Jason: Yeah.

Kathy: So, you have to be able to get your knees over your toes.

Jason: I would just challenge anybody who’s

[16:52] listening: try and do a full day where your knees don’t cross your toes.

Kathy: Yeah. Like, the way that you could do it is if you got like some dowels, right? And you just taped them to the front of your shoes — you just got to go the whole day without those dowels touching your knees. You would have maybe the most awkward day ever.

Jason: Ever. Right. Yeah.

Kathy: And have you heard of the guy? His name is — he’s a social media influencer. He’s going to get lots of clicks now. His name is Knees Over Toes Guy.

[17:22] Jason: Knees Over Toes Guy.

Kathy: Yeah. All he does is knees over toes.

Jason: Yeah.

Kathy: That’s all he does all day long.

Jason: How does he stay alive?

Kathy: I don’t know.

Jason: Oh my goodness.

Kathy: Well, and I mean, you look at it culturally, too. Like, there are cultures where they do a lot of squatting — like a lot of Asian cultures and things like that. They’re squatting all day. And it’s not just that — in the Western world, we’re glamour squatters, right? It’s like, “Oh, look at me, now I’m going to squat.” Everybody. Yes.

Jason: And let’s only do it in the gym. But

[17:54] there are other places in the world where culturally this squatting position is important. You know, it’s really built into how people are doing their jobs and their daily lives all day.

Kathy: And I mean, you’re not seeing a ton of extra ACL or meniscus surgeries.

Jason: You know, they tend to have pretty healthy legs because they’re squatting so much. And so, we glamour squatters tend to be the ones who are struggling more with that.

[18:24] So, yeah. Is it the Japanese who kneel when they eat? Is that —

Kathy: Yeah, I think they do.

Jason: Those people get up and down off the floor all the time.

Kathy: Yeah. No, I don’t want to do that. I don’t want to kneel down when I eat.

Jason: Okay.

Kathy: That’s — no, that’s not my thing.

Jason: Okay.

Kathy: No. Like,

Jason: but I’ll walk and eat or something like that. I don’t want to kneel down. You know what commercial did not air in Japan?

Kathy: “I’ve fallen and I can’t get up” — because they can get up.

Jason: That’s true. They can get up. They’re

[18:54] doing it all the time, right?

Kathy: Yeah. So, they don’t need the little —

Jason: Yeah, armband to help them get up off the floor.

Kathy: Yeah.

Jason: Well, let me ask you this. Is there anybody out there that you would say, “Yeah, you shouldn’t do knees over toes, though”? So, you know, when people come in, if they have anterior knee pain, then I definitely hold back on deep knee squats because, yeah, you’re putting more pressure on the patellar tendon,

Kathy: right? So, anterior knee pain — that would be like right underneath the kneecap,

Jason: right in the front.

[19:24] Kathy: Okay. Jason: Okay. Kathy: Yeah. So, for those people, but that doesn’t mean I’m not going to work up to getting them to do a proper squat. Jason: Yeah. And so when I try to teach a squat, you want your knees to bend more than 90° and you want to try to get your hips lower than your knees when you do your squat. Kathy: And I think about the shin angle when you’re doing your squat. Your knees have to go forward towards your toes. And that angle should also be the same angle

[19:54] as your torso as you squat down. Jason: So that’s what I try to teach when I’m teaching a good squat. Kathy: Yeah. Yeah. And again in our culture, you know, mobility is not a priority for us. And so some people have a lot of trouble getting down low on their squat. Jason: Yeah. Mobile phones are a priority. Kathy: Mobile phones are number one. Jason: But mobility is not. Kathy: No. Jason: Body mobility no good. Kathy: We made — if we made a knees over toes app… Jason: Yes.

[20:24] Kathy: Then people would just play the game. Jason: Trademarked. Trademark. Don’t anybody take that. It’s trademarked. No. Yeah. Kathy: Yeah. So I think this myth has been busted. Jason: Yeah. I mean, there’s just no real good reason to avoid something like that. To avoid, you know, moving the knees over the toes. And I think that some people even think, well, I’m doing a lot of weight. I’m doing a lot of really, really heavy weight. And

[20:57] practically, like, people who say that are not people who are actually doing a lot of weight, right? They’re talking about, you know, what if — like, hypothetically — because if you look at people who are doing a lot of weight, Kathy: they’re training below that 90° plane. Jason: Yes. Kathy: Because practically it works. Jason: It does. Um, so just to backtrack a little bit, what are some things — say I have some anterior knee pain Kathy: and I want to get into doing a deeper

[21:27] squat — maybe like you have convinced me, I will do knees over toes and I will do them Jason: in a car, I will do them with a bar, you know. Um, so what can I do to kind of introduce myself to that movement? Like, what’s a safe way to start getting into maybe that greater range of motion, because I’m worried that my knees are going to crack or pop and things like that. Like Kathy: how would you help me?

[21:57] Jason: So, if we’re going to start with basics, what I would start with is mobility, Kathy: right? And so, with some people, I will try to get them into a squat position and see if they can hold it. Jason: Mhm. Kathy: Now, if that doesn’t happen, if we can’t get you down — your knees can go over your toes without pain — then we’ll back off of that. And so I might go into a wall sit. Jason: Okay. Kathy: And start there. Jason: Mhm.

[22:27] Kathy: And then I might start with a wall sit and having your knees at 90°. Jason: Mhm. Kathy: And then we can strengthen your quads there, because a lot of times you’re having knee pain because your quads aren’t strong. Jason: Yes. Likely. Kathy: And so we start there. As your squats get stronger, then I might pull your feet in closer to the wall, which bends your knees, which then your knees go over your toes a little bit more. Jason: So then you’re doing it, but you’re doing it with the support of the wall. Kathy: Yes. Jason: Okay. Kathy: Yeah. Jason: And then also, we might start with a

[22:57] squat with a ball behind your back Kathy: on the wall. Jason: So you can squat up and down Kathy: and then trying to get your knees over your toes in that position. Again, another supported squat. And these are just kind of the basics where we’ll start with that. What do you think about — Jason: because what I’ve done with some people too, because sometimes it’s an ankle mobility issue, right? Kathy: Yeah. Jason: And so then like getting them down on one knee, kind of in a lunge position, and just kind of mobilizing — like leaning forward,

[23:27] get some of that mobility in the ankle. Kathy: Mhm. Jason: And I think one thing that’s kind of funny is if you have somebody on their back and you were to bend their knee and put it over their toes, there’s like no danger there, right? Kathy: I just magically can’t do this when I’m vertical. When I’m horizontal, it’s great. Jason: Right. Kathy: Yeah. Jason: But, if mobility really is an issue, then even — like taking the gravity out of it, Kathy: right? And starting out on your back and

[23:57] yeah, like sliding up as close as you can and try to tuck those knees towards the chest. Jason: Yeah. Is it a hip mobility issue? Is it knee mobility? Kathy: And that’s a good point when you talk about ankle mobility. So, if I’m talking about a little bit higher level patient who’s already squatting but wants to squat lower but gets some knee pain with that, I’ll put either a plate or something under their heels to raise their heels up. And you’d be surprised at how much lower people can get. Jason: Yeah. Kathy: And so sometimes that is

[24:28] ankle mobility, because it takes the dorsiflexion part out of it. Jason: But sometimes it just changes the physics of it. Kathy: Yeah. Jason: And so it takes a little bit of stress off of the front of the knee. Kathy: Yeah. Well, and that’s also a good trick for people who are even trying to increase some of that hip mobility, too. Like, I’ll have people who come in and they’re like, “Oh, I can’t touch my toes,” and I roll up a towel and slide it underneath their heels and then all of a sudden they’re like all the way down to the ground. They’re like, “What?” Jason: It’s like some sort of magic, and I tell them I don’t know why it happened

[24:59] because I’m a chiropractor Kathy: and so it’s a mystery. Jason: You’re just going to have to have faith in me. Kathy: It’s probably — yeah, it’s D.D. Palmer magic. That’s what it is. Jason: So yeah, and I think that that’s really good, because it’s kind of fun, I think, just to show people little tricks where it’s like you have mental blocks that are keeping you from doing this movement. Kathy: Because if we flip the script, we change things a little bit, you know, you can

[25:29] actually do it. Jason: It’s kind of like the people who were like, I can’t do a squat. And it’s like, okay, I need you to stand up, right? And then they go and they stand up and it’s like Kathy: you just completed the second half of a squat. You stood up so you can do a squat, right? Or when people — when I was coaching a lot and we would do push-ups or something like that and I’d have like kids saying, “Oh, coach, I can’t do another push-up. I can’t do another push-up.” Okay, how are you going to get off the ground? Jason: They do a push-up, they get up off the

[26:00] ground. And so a lot of times I think some of these mental blocks are just like, “Yeah, come on. Kathy: You can do it.” Jason: Yeah. Kathy: Yeah. So, what do the letters VMO mean to you, Kathy? Kathy: We’re moving on. Yes. Oh my gosh. Jason: You know, I don’t know if I’ve stated this or not, and maybe my — the rest of my muscles shouldn’t hear this, but my favorite muscle is the quad. Kathy: Settle down, guys. Jason: Yes,

[26:30] the biceps — do not fail me, but I’m just whispering — the quad is my favorite muscle. Kathy: Okay. Can I just take a total tangent here? Jason: Yeah, let’s go. Kathy: So, I know why quads are called quads, and you do too, right? Because there are four main muscles there on the front of your thigh. Those are the quads. Jason: Yeah. Kathy: All right. So, your semimembranosus, your semitendinosus, your biceps femoris — why are those called hamstrings

[27:01] and not triads? What is a hamstring? Jason: It’s a string of — like, I guess it’s like somebody looked at these muscles and said, “You know what? This reminds me of Kathy: a hamstring.” Jason: This reminds me of a string of hams, right? It’s like — and when you think about the ham, right — what’s the ham part of the pig? Kathy: Yes. Jason: It’s the glutes. Kathy: Oh. Jason: So maybe it’s like the strings coming off of the ham. I don’t know. But Kathy: that’s a really good — I never thought — you

[27:32] just blew my mind. Jason: Well, I could — I mean, because we live in the future so I could just use ChatGPT or something like that. But I thought I’d just talk to you about it instead. Kathy: I was thinking about that the other day when I was working on a patient. I was like, we’re working on your ham, and then like — that’s when, like, the movie version — it would Jason: zoom into inside of my brain. It’s like, why are these called hamstrings? Yeah. So Kathy: why are we always hamstrung? Yes. Jason: Oh, hamstrung. So, here’s what I’m gonna do. I’m not

[28:02] gonna Google it. I’m not gonna ChatGPT it. I want somebody who is watching to just leave it in the comments. Kathy: Yes. Jason: You can teach us. Kathy: Yeah. Jason: First one to tell us Kathy: gets Jason: a PTCH t-shirt. Kathy: A PTCH t-shirt. Yeah. Okay, I’m down with that. Jason: Email us. Yeah. Email us your address. Kathy: Yes. If you’re the first in the comments — yeah — Jason: on Spotify, YouTube, Kathy: we’re giving out two t-shirts, it looks

[28:32] like. Okay. All right. So, if you’re the first in the comments Kathy: yeah Jason: to tell us why hamstrings are hamstrings, which has nothing to do with what we’re actually talking about today, uh, we will get in touch with you and we will send you Kathy: some PTCH Podcast merch. Jason: Yeah. Oh, Kathy, what a great idea. Okay. Anyway, quads. Kathy: And we’re back. Jason: Yes. Don’t tell the other quads. Kathy: Yes. Don’t tell the other quads. The VMO is where it’s at. All right. Proceed. Jason: Proceed. What does VMO stand for?

[29:02] Kathy: Vastus. Jason: Oh, you’re asking. Kathy: Oblique. Jason: Oblique. Yes. Kathy: It is one of the four quad muscles. Jason: That would probably be your gladiator name. Yes. Kathy: That is mine. Jason: I am Vastus Medialis Oblique. Kathy: Yeah. Jason: You killed my father. Yeah. Oh, no. That’s a different movie. Maximus Decimus Meridius. Kathy: What is the VMO and why is it so controversial? This is one of my — this is one of my least favorite

[29:33] referrals I get from a physician. Jason: Train the VMO. Kathy: Yeah, Jason: they’ve got VMO problems. Kathy: They’ve got VMO problems. Jason: So, the VMO is the quad muscle that’s the most medial. Kathy: Okay, Jason: if that’s a word. Kathy: The medial-est of your thighs. See, if we were to say it’s the most mid, Jason: like Kathy: that would be misunderstood. Jason: It would be misunderstood. Kathy: It is not mid. No, it’s not. Jason: It is sigma. I’m going to have to check with — I’m going to have to check with Griffin.

[30:03] Kathy: Okay. Jason: My youngest. Kathy: Yeah. Jason: I think that it’s supposed to be sigma. Kathy: Yeah. Okay. Would be like a max. Jason: Yeah, that’s the best. Okay. I think. Yeah. Kathy: Griffin told me he listens to the podcast, so he Jason: he does. I think that he’ll get this. So, we’ll find out in a few weeks. Kathy: Yes. If somebody puts the definition of sigma in the comments, we’ll just laugh at you. Yeah. Jason: There’s no shirt for you. Yeah. Kathy: Why has the VMO been criminalized?

[30:34] Jason: That’s a great question. I hope that’s rhetorical because I don’t have an answer. So the VMO is the muscle, like I said, more on the inside of your thigh. It’s one of the quad muscles. So you have the rectus femoris, which is the one that people can poke Kathy: yeah, Jason: in the middle. Kathy: You have your vastus lateralis which is on the outside. Jason: Uh, vastus Kathy: intermedius — Jason: intermedius. Right. And then you have your VMO. Kathy: Your VMO.

[31:04] Jason: Mhm. It has been blamed for years, decades, for causing knee pain. Kathy: Mhm. Jason: A weak VMO. You must train the VMO because your patella isn’t tracking correctly. Kathy: Yes. Maltracking of the patella. Jason: Maltracking. Kathy: That’s my nightmare. Jason: Trademark that. Uh, Jake, would you trademark maltracking? Kathy: All right. Jason: That’s the medical term. That’s not what you learned in chiropractic.

[31:34] Kathy: Trackment. Is that a word? Okay. Jason: That’s what my menopause brain just came up with. Kathy: Okay. Sweet. I like it. Mhm. Jason: Maltracking is probably what I should have said. It’s been blamed for — Kathy: I like trackment. We’re going with that. There will be a maltrackment shirt Jason: in the future. I’m going to make it happen. Kathy: So people that go to the doctor and say, “My knee hurts on the outside of my knee,” the doctor immediately says, “Oh, it’s your VMO.” VMO,

[32:06] Kathy: your VMO is not strong enough. It’s not pulling your kneecap to the inside enough and so therefore it tracks to the outside causing pain on the outside of your knee. It’s Jason: a very simple idea. Kathy: Yeah. Jason: However, Kathy: however, another myth that needs to be busted. Jason: It’s false. Kathy: It is very false. Jason: Yes. Kathy: And you cannot — you cannot just isolate the VMO. Jason: No. You cannot just train the VMO more. I’m here to say it. I said what I said. Kathy: Come at me. Jason: You’ll die on this hill.

[32:37] Kathy: You’ll die on this hill. Jason: Yeah. Yeah. Well, and it’s ridiculous. And I think people want there to be one cause of a problem. Kathy: Yes. Jason: Because it’s so easy. I’m in a profession that was built on that idea. We want everything to be a spine problem because if it is — shushing. Yeah, Kathy: that’s right. Jason: Yeah. And it would be great though. I mean, think about how the world would be if it was all just a VMO, bro. And you

[33:09] could just rehab that VMO and suddenly your hair grows back, your children respect you, and your boss loses the ability to speak, you know, things, you know, Kathy: your boss gives you a raise. Jason: But no, it’s not that simple. Kathy: Do you think — who do you think is more criminalized, the VMO or the IT band? Jason: Oh jeez. Well, I think there’s more — I think there’s more people that know what

[33:39] the IT band — Kathy: Yeah, this is true. Jason: Yeah, Kathy: this is true. Jason: Yes. Kathy: Yeah. Jason: Um, I do like it though when people say “it’s my ITB band, my iliotibial band,” right? Kathy: Okay. So let’s get into why you cannot isolate the VMO. Jason: Okay. Tell me. Kathy: I give up. Well, number one — well, first off, there are many reasons, but it’s — all four quads are run

[34:11] by the same nerve. Jason: Okay. Kathy: So you can’t just say, “Hey, let’s turn on that VMO.” Jason: Yeah. Kathy: And the nerve says, “Okay, we’re just going to go to the middle — the middle muscle here, right? Let’s leave the vastus lateralis out of this.” Okay. Jason: Rectus, Kathy: thank you. But no, thank you. Right. We’re not going to need you on this one, buddy. Jason: No, no. It doesn’t work that way. Kathy: So we can’t just isolate in that sense. The nervous system Jason: is not going to say, “Hey, you guys take

[34:42] a break.” Kathy: Everybody’s got a part. Jason: No, it just sends the signal and they all get the signal. So that’s the number one Kathy: Yes. Jason: reason why, Kathy: okay, Jason: you cannot — one of the reasons why you cannot isolate. Kathy: What about all these exercises that isolate it? There have been studies done that tried to isolate the VMO — Jason: there are techniques out there that I learned early as a PT

[35:12] and taught — oh, you got to train the VMO. Kathy: Yeah. Jason: You know, this is how you train it. You know, you — you point your toe outward Kathy: right Jason: while you’re doing these exercises. And therefore that external rotation of the hip is going to point to the VMO and make the VMO work harder. Kathy: Yes. Jason: So Kathy: which — here’s the silly thing about that. If that was the way that it actually worked, Jason: we would not be doing an episode on knees over toes. Oh,

[35:42] Kathy: we would be doing an episode on “don’t point your toes out,” because the second you do that and you contract your VMO, Jason: your patella is going to explode off of your knee Kathy: because the other muscles are now not doing anything. It’s just your VMO. Jason: Yeah. Kathy: And so I mean — do you get some extra — proportionally, do you get some extra VMO activity Jason: there? I believe that there was a study that showed there was like a

[36:12] little bit — the VMO was a little bit more active when they did an EMG. Kathy: And so that’s where that came from, Jason: right? Kathy: It’s like, oh, we can get a little more VMO here if we do a little external rotation while you’re doing, you know, a squat, Jason: right? Kathy: A lunge, a leg lift, Jason: right? So there were subsequent studies that compared trying to isolate the VMO with these certain kinds of exercises and then also

[36:43] just doing general quad strengthening. And what they found was it was the same — and actually just general quad strengthening was better than just trying to isolate the VMO. Jason: Yeah. Because it’s going to be a balanced effort anyway, right? You want that sucker tracking right up and down the middle. So why not train movements that make it track right up and down the middle instead of trying to move the patella a few inches this way or a couple inches that way. Just Kathy: train the patella to move where you

[37:13] want it to move. Jason: Right. Kathy: Yeah. And really what they found too was that that also is part of the myth of knee pain — is that patellar tracking doesn’t — in extreme cases it can cause lateral knee pain, but it’s not, again, the cause of a lot of patellofemoral pain. Jason: That could be another episode we could talk about — is the patella just being criminalized in all of this too. Kathy: Good old PFPS.

[37:43] Jason: Yes. Kathy: Yes. Yeah. Jason: And I remember, in all honesty, coming out of chiropractic school like 18 years ago and thinking, yeah, patellofemoral tracking syndrome — everybody look out Kathy: because this is the root of your problems. Yeah. Which is one of the things that’s nice about science — science is always discovering new things that we thought were true, you know, like things that we had read in Sports Illustrated that we thought were true,

[38:15] and it’s been replaced by new knowledge. And I know that that’s frustrating for some people because they’re like, “Why can’t these guys just make up their mind?” Kathy: but it’s also kind of fun because it’s like you find new interesting things, and sometimes the answers that you got — you didn’t get them for the reasons that you thought, right? You find that maybe your previous study wasn’t that good, or we built on this assumption but that assumption wasn’t real, right? So Jason: you made the wrong assumption. You know

[38:45] Kathy: What happens when you make the wrong assumption?

Jason: Yes. Make an ass out of you and right —

Kathy: — and Dr. Carl Klene.

Jason: Yes, Klein.

Kathy: Klene, he did this. He wasn’t involved in the VMO.

Jason: No.

Kathy: Yeah. So, my suggestion for people — and I — usually if people come in and say, “Hey, my doc says I need to isolate the VMO.”

Jason: Mhm.

Kathy: I don’t try to bust the myth right then and there, right? I just

[39:15] Jason: — because you’re also busting the doctor, and we’re — we’re never out to embarrass people, right? Unless — unless we’re on Twitter.

Kathy: Yeah. And then we definitely try to do that.

Jason: Yes. It’s a blood sport. Go ahead.

Kathy: Blood sport. I kind of, you know, again, I don’t try to bust the myth because I want to try to build a therapeutic alliance with my patient.

Jason: Absolutely.

Kathy: I want them to trust me. So, I kind of go along with that and I say, “Okay, well, we’re going to build up your quad.”

Jason: Yeah.

Kathy: You know, and if they bring the subject up again — is this really isolating my

[39:45] VMO? — a couple visits in, I may say to them, “Hey, just so you know, I know your doctor told you this, but recent research shows that we can’t isolate the VMO and that general quad strengthening is just as good, if not better. And then we also need to strengthen your hips and —”

Jason: Yeah.

Kathy: — and all that — that can be another episode too, knee pain. But —

Jason: Well, I think it’s good to take a practical approach, too, because it’s like — you know, what is it that you’re trying to do? What is it that you want to do?

[40:15] And let’s facilitate you doing that.

Kathy: Yeah.

Jason: Instead of focusing on an exercise that is supposed to do X, Y, and Z.

Kathy: Because honestly, sometimes we can identify deficits, weaknesses, insufficiencies, whatever you want to call it,

Jason: and we can think this is the cause of the problem. This is the root cause — which we could do a whole episode on the root cause.

Kathy: But that’s not always the case. And I’m not saying that those things are

[40:46] meaningless or that these assessments don’t help or don’t work, but at least in my experience, sometimes I find deficits that aren’t the cause of the person’s day-to-day real life problems.

Jason: Right. Coincidence, right?

Kathy: Yeah. Yeah. And some people have problems, but they are very well adapted to those problems. A great example is scoliosis.

Jason: Yeah.

Kathy: Like I have people who come in and they’re like, “I’ve got a bad back.” Why do you have a bad back? “Well, because of scoliosis.” Are you having back pain? “No.”

[41:18] You know, are you having trouble doing this, doing that? “No.” Okay. So, why is your back bad? “Well, because it’s curved. It’s curvy.” And it’s like, okay, well, you’re all right.

Jason: Yeah.

Kathy: Curves are in now.

Jason: Yeah. Exactly. Not those lateral curves. No.

Kathy: Yeah. No.

Jason: So yeah, functional training is — I think — really where it’s at. It’s more reliable. I think we’re getting people better.

Kathy: Prove me wrong.

[41:49] Jason: That’s right. Come at me. Prove me wrong.

Kathy: Hey, want to play a game?

Jason: Let’s go. Game time.

Kathy: All right. This is called Jason’s Neato Trivia Quiz.

Jason: Oh, man. Okay.

Kathy: I’ve got lots of neato trivia. All right. I don’t know. Maybe this isn’t the most creative one because I feel like I’m doing the same game over and over where it’s like, let’s give you some trivia.

Jason: Yeah, with — this is like our Tyler Early episode, right? Where it’s like

[42:19] the answer is always heart, right?

Kathy: The answer here is always going to be knee.

Jason: Well, some form of knee. It’s going to have knee in there. All right. Six questions.

Kathy: If you get all six questions correct, then that makes you perfect.

Jason: All right.

Kathy: Well, like what have you done today that was perfect, right? This — you can be perfect. Are you ready?

Jason: I’m ready.

Kathy: Here we go. No phone or friends either.

Jason: Oh —

Kathy: Here it is. Okay. Number one: this children’s song would be sung by a psychologist, an

[42:49] orthopedic surgeon, a PT, and a podiatrist. Actions and all.

Jason: Yeah. What is it? Hands, shoulders, knees, and toes.

Kathy: Close. What is it? Hands — would a psychologist work on hands?

Jason: Head.

Kathy: Head. Head, shoulders, knees, and toes.

Jason: Yes. Knees and toes. Okay. All right. Good.

Kathy: Got it. Yes. One down. In the south, this is a measurement involving an insect and it’s used for children.

[43:19] Jason: It’s for children. Measurement at your knees. Knees to —

Kathy: In the south. This measurement involving an insect is used for children.

Jason: An insect with a knee. Cricket’s knees. Bee’s knees. No. No. Close.

Kathy: Knee high to a grasshopper.

Jason: Yeah. “Known you since you was knee-high to a grasshopper.”

Kathy: Yes. All right.

Jason: Here we go. This is —

[43:49] Here’s the pop culture category. In the hit series Game of Thrones, this term is used meaning that you pledge your loyalty.

Kathy: Bend the knee.

Jason: Bend the knee. Yes. Did you ever see my reel on bend the knee? Oh my gosh.

Kathy: I’m going to have to go back and look.

Jason: Yes. Body of Health Instagram. Watch every single reel that I have and you will find the one about bending the knee.

Kathy: That was so fun to make. Okay. Question number four. Also known as genuflecting, this term is used to

[44:19] describe a poorly thought-out decision or reaction. Also known as genuflecting.

Jason: Poorly thought out. Oh man. On your knees — shoot. It’s a knee-jerk reaction.

Kathy: Oh, knee-jerk. I said it earlier today.

Jason: I did. I know. When we were getting ready for the episode, I was

[44:49] like, “All right, here we go.” This is the only standard piece of safety equipment in volleyball.

Jason: Oh, knee pads.

Kathy: I didn’t know that.

Jason: Yes. I just learned something today.

Kathy: And then another name for literally any joke that I tell.

Jason: A dad joke. No.

Kathy: Think about knees.

Jason: Oh, niece. Think about —

[45:21] Kathy: A knee-slapper.

Jason: Oh —

Kathy: Yeah. Oh, there she goes.

Jason: There it is.

Kathy: Yeah. All right. Well, Kathy has like 50%.

Jason: Yeah. Sorry. So there’s no — like close to perfection. I guess we’ll do it again. We’ll play a game every single show. I promise.

Kathy: All right.

Jason: Yeah. So let’s break it all down then. Our takeaways — kind of recap what we learned — and we’ll wrap this up. So, may I start with my takeaways?

[45:54] Think one of my takeaways is that I really like the information that you gave about where this came from. And that’s just so common that you just have this one study that somebody in pop culture latches on to, and it just doesn’t make me think just about this but about other things that we kind of latch on to too. So I really appreciate that.

Jason: 1961.

Kathy: 196—

[46:24] Jason: Come on.

Kathy: Yeah. That’s 60 years. 60 years of messing it up.

Jason: I mean, they say it takes 10 years from research to actually hit the clinic. Yeah. I mean, we’re talking — what’s that?

Kathy: Yeah. Whoops.

Jason: 39 plus 25.

Kathy: It’s a lot. It’s — yeah, it’s like 64 years.

Jason: Yeah. Come on.

Kathy: Come on, Carl.

Jason: Killing us.

Kathy: I mean, this myth is on Medicare. It can start taking distributions from its IRA and its 401k and everything

[46:54] continues 5 years later.

Jason: My goodness.

Kathy: What about your takeaway from this episode?

Jason: My takeaway from this episode — which, by the way, you basically did. You were doing the heavy lifting here. You were knees-over-toes lifting. So thank you so much for that.

Kathy: My knees were over my toes doing this.

Jason: Absolutely. Intellectually. And yeah,

Kathy: my takeaway is that you’re going to start doing more squats.

Jason: I am.

Kathy: That’s what I heard you say.

Jason: I am going to start doing more squats

[47:28] more and more. Yeah, that I should. I will. Okay. Yes, doctor. I will. Okay.

Kathy: Okay. So I think that pretty much wraps it up for this episode. We want to give our standard invitation to like

Jason: and subscribe to this podcast. And if you’ve heard things today that you want to slap your trainer upside the head with — right, just take your phone, queue it up to the PTCH Podcast on YouTube, Spotify, or Apple Podcasts, anywhere that

[47:58] you get your podcasts, queue it up,

Kathy: hit play, and throw it at them.

Jason: Right.

Kathy: Next time somebody tells you, “Don’t let your knees go over your toes.”

Jason: Exactly. You just hold still. Hold very still, you know. But I think that it should also be put out there that if you listen to this and you’re thinking, man, maybe I could be doing more, and you feel like you don’t really know how — find a professional to work with. Like if you’re in this area, don’t call me, call Kathy. Encore

[48:30] Physical Therapy or Helix is a great place to go and train. If you can’t get to us, go find a personal trainer, a physical therapist. And the first question that you ask them is, “How’s my VMO?

Kathy: Can you look at my VMO, please?”

Jason: Yes. Yes. Have you ever seen a VMO like this? Yeah. And I think that the most important thing that everybody should remember is that there’s no

Kathy: there’s no “I” in PTCH.

[49:01]