Your comfort zone is killing you

Your comfort zone is not keeping you safe. It is holding you back.

So many of us grab on tight to the "safety" of what we know. That could be a training program, a therapeutic modality, even a sport. Just when things seem their darkest you can be sure a breakthrough is near. New strengths gains, new skills mastered and confidence acquired. All of these come just after most will want to give up.

If you aren't constantly challenging yourself you are moving backward. Whether it be learning a new skill, revisiting a fundamental lift or improving your mental game, if you aren't pushing your limits is one area you are really moving backward.

Once you realize that all your goals are sitting on the other side of your comfort zone the sooner you can take action toward achieving them!

Get uncomfortable and get after your goals!


Trust me, you're gonna want that hip mobility

Hip mobility. All humans need it. Most of us don't have it. So many athletes respond by continuing on running, riding, pressing, squatting until they can't.  This strategy is not sustainable. I've said this before, we are designed with full ROM in mind.  Instant access. Lack of ROM at one joint generally requires a nearby joint to pick up the slack. Classic set up for over stress injury. This is preventable! Get that hip mobility and stop hammering on your low back. It works.

Here are some easy mobilizations and stretches to help you get on top of your hip mobility before you are broken.  

Athleticism 101

I get a lot of questions about the best practices for improving overall fitness and athleticism. Most revolve around crazy intense intervals, plyometrics or some new fitness fad I've never heard about. I love progression, new and exciting training tools are great.  That said, I very rarely meet an athlete that couldn't use a little refresh on their foundation.

Foundation, beginning, base, footing. This is where it all starts! If your foundation is suspect, stacking on intensity, complexity or volume (or even worse all three) you are going to find out where your limitations are quickly. 

When you think of foundation in terms of athleticism you should be thinking, range of motion and motor control.  As a native Pennsylvanian I always envision a keystone when talking about ROM and motor control.  Without these pieces, nothing works. Your body is an amazing machine and for better or worse it can adapt to shit positions and movements, until it can't.

Sure you can squat or run with your knees well in front of your toes for a while. Then you are going to burn up all the cartilage goodness protecting your joint and it will hurt.  Yes you can do muscle ups without full shoulder ROM until your labrum says no and tears.  This isn't meant to be a scare tactic, this is real life.  This is what we see at RevoPT over and over again. 

You body is going to take the path of least resistance. Every time. If you don't have FULL hip extension ROM when you run you are going to over extend your lumbar spine to fake it.  If you don't have FULL ankle dorsiflexion ROM you are going to medially collapse at the foot to fake it. Hammering super high intensity intervals isn't going to make this any better. Mobility work makes this better.  It's not sexy, its not ground breaking. This is athleticism 101. 

Limited ankle ROM at the bottom of your squat? A lot of us experience this.  Try this mobilization to help your ankle joint regain some of its natural mobility.

Tight hip at the bottom of your squat? Mobilize!

Now you have some ROM, you have to control it! Motor control gets thrown around a lot in fitness and training videos. It's not complicated, it's HOW you move. Your default patterning. Shoot 10,000 free throws and basketball and you've got an idea of how motor control works. You do the same movement over and over, next thing you know you aren't thinking about shooting technique anymore, your just do it. 

It's the same for running, squatting, climbing, running, cycling, throwing and living. Create a movement habit, right or wrong, you'll go to that habit when the going gets tough. Are you really thinking about using your glutes while running up a steep climb? I'm not! I'm holding on for dear life. Motor control is that hard wired pattern that takes over when you are busy playing your sport. 

You need ROM.  You need to control it. If you can't navigate a squat do you really need to be adding complexity to your fitness routine? I say absolutely not!  Squat light until you master it!

If you are out there winning races and crushing it in the gym, great! Get self aware and check in on your foundation.  ROM and motor control are the solid footing of elite athletic performance. Don't wait until you are broken to check in on these areas, do it today! 




Strength and Mobility for Runners

You've asked and now you shall receive!

We will be offering a strength and mobility class specific to runners. We will focus on the motor control patterns specific to runners, how to optimize those patterns as well as common mobility limitations.

Class will run for 8 weeks and will be help Tuesday mornings from 8a-9a.  Schedule before June 7th to receive $50 off your registration.

We will meet at RevoPT once a week to work on technique, running form and mobility.  An online profile on our home exercise platform, Fitbot, will also be provided.  You will be emailed daily with your strength/mobility work for the day.

The programming will be scaled for racers to recreational runners and everyone in between. Come work out with us, be bettered prepared for all your runs and have some fun while you're at it! 

The cost of getting rad

Yes, there is a cost to getting rad. Get over it. If you treat your body like shit, you're going to pay a price. 

Everyone wants to play hard and recover fully overnight with no effort required.  Doesn't work that way. If you spent all week sitting behind a computer and then went out for a 6 hour bike ride on Saturday you are going to need some serious work on your hips. Not a fifteen second hamstring stretch or a few passes on the foam roller.  You need real mobility work. Most of us sit WAY too much and don't spend nearly enough time taking care of our soft tissues. Real athletes need real recovery work. Humans need full range of motion.  Your hips are designed to work with FULL range. Stretching into a range is not full range.  You need full range, instant access. If you've been at a desk job for 5 years achieving full range is going to take some time.

Reality check, today is the oldest you've ever been. You've spent plenty of time in compromised positions.  Get proactive, move well and don't wait until you're broken to make changes. 

Here are a few examples of our favorite hip mobility movements.   

Everyone wants to be successful until they see what it actually takes.

Everyone wants to be successful until they see what it actually takes.

Playing your sport hard at age 30, 40, 50, 60 takes work.  A lot of work. When you were 18 you could go 0-60 without a warm up and do ok.  You could "ride hard and put away wet", forgetting post competition maintenance work and be fine. Turns out you can't run 50 miles a week at age 40 and not doing any maintenance work along with it. Facts are facts.   

Those days are over, sorry. It's going to take effort to keep your body moving the way you want. Pre exercise mobility, activation.  Post exercise mobility, proper cool down. Mobility throughout your work day. The more silly things we do to our aging bodies, think sitting at a desk, throughout the day the more we need to counteract that. The harder you play the harder you need to recover. Fueling properly, hydrating, performing mobility work as often as your body requires is part of the game.  Stop being surprised at how much work it takes to get after it. If it was easy everyone would be out there, instead most are on the couch.

It's not easy.  I know it. The sooner you accept the fact its going to be really hard the sooner you can get on with it and start enjoying your sport.  

Get outside and play today but warm up first. :)

Are your mountain bike handlebars too wide?

It's so enduro to run 800mm handle bars! Wider bars equal more stability right? Short answer, yes. Long answer is well, pretty long. 

The bar width debate starts with increasing the stability of your riding and stops with the health of your shoulders. At 6'3" an 800mm bar allows me to get into a super comfortable position while maintaining external rotation torque on my humerus and ride a super stable platform. Perfect world right there. More often than not sacrifices are made in the shoulder health department to increase the stability/ride quality via a wider bar. Are your shoulders painful? May be time to assess your position on the bike.

First, the humerus is generally in its most stable position while in external rotation and with a properly stabilized scapula. The shoulder blade itself should be seated both slightly backward and downward. The opposite position, humerus internally rotated and the shoulder blade forward and upward is not only not optimal in regard to muscle activation but also adds injury risk to the joint.  We see impingement like symptoms and anterior shoulder pain ie bicep irritation show up with this positioning.    

These bars just may put you at a mechanical disadvantage.  Maybe. 

These bars just may put you at a mechanical disadvantage.  Maybe. 

Below we see Aaron Gwin, shredding a downhill run harder than any of us mortals can imagine.  Notice the shoulders are not elevated up near his ears and he has slight external rotation at the upper arm. The man has incredible strength. A strong posterior rotator cuff and global scapular musculature makes the difference here. Often we see the elbow flare upward significantly as the shoulder shrugs. Its quite difficult to assess your own position while riding so have a friend film you while descending. Assess your shoulder position and elbow positions.  Are you able to maintain external rotation torque while depressing the shoulder blade down toward your back pocket?  If not, you may benefit from a narrower bar. Do some experiments as there is no one size fits all answer here.  In the clinic we use wireless EMG to assess muscle activation patterns with various bar sizes but you can experiemnt in the field with a cell phone camera.  Find the balance between how your ride feels and how well you can control your shoulder/elbow position.  That perfect balance is probably not at the 800mm mark.  

Notice the elbow position.  Closer to the level of the bar instead of closer to the level of the shoulder. Nice. 

Notice the elbow position.  Closer to the level of the bar instead of closer to the level of the shoulder. Nice. 

Elbow too high, too much internal rotation at the shoulder.  Ouch.   image,

Elbow too high, too much internal rotation at the shoulder.  Ouch. 


"The Third Wave" Book Release Party at RevoPhysio and Black Lab Sports


Come join us for a book release party with Steve Case as he releases his new book The Third Wave! Introductions will be made by David Brown, Managing Partner of Techstars & talk/Q&A/book signing by Steve Case. Appetizers and drinks will be served.  A copy of the book will be given to all RSVPed guests. 

Reserve your tickets here. 


Co-Founder, AOL

Chairman and CEO, Revolution LLC

Steve Case is one of America’s best-known and most accomplished entrepreneurs and philanthropists, and a pioneer in making the Internet part of everyday life.  Case co-founded AOL in 1985 and under Case’s leadership and vision, AOL became the largest and most valuable Internet company driving the worldwide adoption of a medium that has transformed business and society. In 2000, Case orchestrated the largest merger in business history, bringing together AOL and Time Warner.

Case is chairman and CEO of Revolution, a Washington, D.C.-based investment firm he co-founded in 2005, as well as Chairman of the Case Foundation, which he established with his wife Jean in 1997. Case was the founding chair of the Startup America Partnership- an effort launched at the White House to accelerate high-growth entrepreneurship throughout the nation. He is also a Presidential Ambassador for Global Entrepreneurship and was a member of President Obama’s Council on Jobs and Competitiveness where he chaired the subcommittee on entrepreneurship. 



In his highly anticipated book, The Third Wave, Steve Case argues that we’re entering the Third Wave of the internet—a period when entrepreneurs will change the way we live our lives by leveraging new technologies to transform real world sectors like health, education, transportation, energy and food. The First Wave saw AOL and other companies lay the foundation for consumers to connect to the Internet. The Second Wave saw companies like Google and Facebook build on top of the Internet to create search and social networking capabilities, while apps like Snapchat and Instagram leveraged the smartphone revolution to become overnight successes. But, Case predicts, success in the forthcoming Third Wave will require a brand new set of skillsets for CEOs, entrepreneurs, policymakers and ordinary Americans. By looking back at his decision-making during some of the most consequential moments in business history in order to explain the current landscape, Case explains how attendees will need to rethink their relationships with customers, competitors and governments alike, and offers a forward-thinking roadmap for navigating in this new paradigm.

You are what you repeatedly do.

You are what you repeatedly do, therefore excellence is not an act, but a habit. - Aristotle

While this quote may or may not be actually be attributable to Aristotle, the person who uttered the words knew what was up. Top level physical performance is not an accident in the same way top level performance in the business world is not an accident. CONSISTENCY is key.

To play you need to show up. To win you need to show up consistently. Willing your shoulder pain to back off is not enough!  Willing yourself to lose weight is not enough You need to get after the root cause of your pain every day. You need to exercise and eat right every day. EVERY DAY!

As a society we've become obsessed with "overnight success". Staring at a smart phone for most of the day we expect info/results fast. There is no such thing.  Skill mastery is a long road. Running, riding, lifting are skills.  To become a master you need to own your consistency. 

We often advise athletes that movement retraining is a long term investment. No overnight success in the sports world.  No one is undefeated. Get out there and own your recovery, your weight loss, your performance goals. Invest in yourself, everyday!   

Warm it up or shut it down

Everyone has their routine. Whether it be a 10 second hammy stretch, or an arm swing and foot wiggle, most people have a preferred pre-activity warm up.  We tend to get a lot of questions regarding this particular routine. Do I stretch? How long should it take? What EXACTLY do I do? Our response is the resounding non-answer; it depends. A sport specific warm up is necessary, especially for activities requiring max efforts. You don’t need to spend a ton of time priming the legs for a max bench press competition. A cyclist doesn’t take a ton of time to activate their rotator cuff musculature. Duh. You want to direct blood and neuromuscular control to the right areas. That being said, there are a myriad of benefits to a generalized warm up, which also happen to be transferable to just about all exercise. Some of the benefits:

  1. Increase core body + muscle temp: You wouldn’t step out of bed and immediately play soccer. We need to warm up the engine block before the road trip.

  2. Increase viscoelasticity of tissue- In very cold weather the fan belt on your car may squeal when your first turn on the engine. Our tissue essentially does the same. As the fan belt warms up, it makes less noise and becomes more elastic. Pull on our tissue too hard without warming it up is a sure fire way to injure yourself.

  3. Increase synovial fluid in joint space- Synovial fluid is our natural joint lubricant that essentially keeps our joints healthy and resilient. Without movement and a gradual warm up, that fluid stagnates and can not provide its health benefit to your joints- like running a car engine without enough oil.  

  4. Muscle Priming- This is a great way to remind your body to recruit a particular muscle group. We always default in recruitment of specific muscle groups during certain exercises, so this is a great way to “prime” our preferred mind → muscle connection. By pre-activating, or priming, you are providing contractile stimulus, as well as proprioceptive feedback for the activity you are about to participate in. An example would be a cyclist who is very versed at using their quads, but has a hard time with glute recruitment. By priming their glute musculature, they are essentially reminding their brain to recruit that muscle group during exercise. 

  5. Mental prep- Often overlooked, deliberate warm up time provides a great mental seagueway and transition time to put some mental attention to what you are about to do. A conscious warm up gives you time to prepare yourself psychologically, as well as physically. 

So, some final take homes:

  1. A warm up is important, and in most cases, necessary for optimal performance.

  2. Warm up activities should be directed and deliberate. They should mimic effort, actions, and physiological demand of the activity you are about to participate in.

  3. Start with a whole body approach and fine tune as necessary.

  4. Take the warm up time to get your head right.

  5. Warm it up, or shut it down!

Did you just get a bike fit or a bike sizing?

Not all bike fits are created equal.  Sorry.  It's true.  A lot of people get sized to their bike but not truly fit to it.  I may have a different view of the whole bike fit world than most companies but I think its warranted.  Let me explain.

Bike sizing is a fairly brief process, or at least should be.  Are you on the correct frame? This is the question being answered from a bike sizing. Hop on the bike.  Look reasonable? Pretty simple in theory. 

A bike fit should answer a completely different question or questions.  Are you in an optimal position on your bike? Are you riding pain free? Are you accessing the most power generating muscle groups while riding? Are you having fun on your rides?  

Keegan Swirbul of BMC Development and current USA U-23 National Champ understands the importance of off the bike movements on his riding. 

Keegan Swirbul of BMC Development and current USA U-23 National Champ understands the importance of off the bike movements on his riding. 

A great bike fit will answer these questions AND provide a WHY.  Often the WHY is more important than the WHAT. Our goal with bike fitting is to assess YOU as much if not more than your bike. Yes we can get you on the correct saddle and optimize your cockpit position but your anatomy and physical limitations play a much larger role.

A true physical examination as well as a global movement screen OFF the bike is critical.  9 times out of 10, your habits off the bike translate to how your move on the bike.  If you get a bike fit and don't get your movement assessed how can the changes to the bike change the way you move? THEY CAN'T!

Now the WHY.  If the WHY gets missed all the changes made to your bike are being made blind. Understanding the root cause of a riders dysfunction is a must. Knowing a riders hip flexion is limited may require an elevated cockpit.  A history of hamstring "tightness" may lead me to believe their glute group is not firing correctly. If situations like those are not given proper attention a fit may not look so great even if the rider hits all the traditional marks. Everyone is different.  Cookie cutter fits don't work.  

Long story short, if you just got eye balled on the bike and your saddle height got moved slightly you didn't get a bike fit.  Look for someone who understands anatomy and human movement to address the whole picture. You'll be happy you did!     

RevoPT 2.0, we are moving!

The last 9 months of operating RevoPT have been incredibly exciting, humbling, exhausting and rewarding at the same time. We are so thankful to our clients, supporters and community as a whole for embracing our company and our ideas. We would not be here today without your support! 

We have exciting news for all of you, we are moving into a new space! We have been searching for a new space for a few months and we found a great match not even a mile from our current location. This May we will be moving our practice into the Black Lab Sports building here in Boulder.  


Black Lab Sports is a sports/tech accelerator and entrepreneurial arm for athletes.  They have combined a sports technology incubator, and entrepreneurial educator and a go-to-market platform under one roof.

We feel our teams will be a great match and be able to provide unmatched value to both our patients and Black Lab's strategic partners.  The gym area will be 8,000 square feet of open space.  Perfect for our movement assessments and treatments alike. Our motion capture technology and wireless EMG system will flourish in this environment.  Field turf is already in place and will aid our sport specific training and return to sport testing protocols. We will have more private treatment areas available as well as open space for movement retraining.  Stay tuned for more info on equipment upgrades!

We could not be more excited and look forward to pushing the limits of tech driven PT and sports performance while providing the best care available for all Boulder athletes.   

A few mock ups of the new space!  Real photos coming soon. 

A few mock ups of the new space!  Real photos coming soon. 


Treat the cause, not the symptom. Seriously.

Stop treating your symptoms and start treating the cause of those symptoms. Your time and money are valuable.  Don't waste them by spending time on treatment that doesn't address the root cause of your dysfunction.

I firmly believe a vast majority of the pain I see in the clinic is driven by movement faults. Almost daily I see dynamic valgus, pelvic drop, excessive internal rotation at the shoulder and quadriceps dominance to name just a few.  All of these patterns result in varying patterns of pain such as anterior knee pain, iliotibial band pain, shoulder pain, etc. 

Let's take anterior knee pain for example.  One brand of this pain is patellar tendon irritation. A symptomatic treatment style might include cross friction massage to the patellar tendon itself.  I wont spend time arguing the merits of cross friction massage but will instead argue for the superiority of a movement treatment style.  I see these patients generally present with quad dominance and tend to load the anterior knee/patellar tendon significantly more than the hip and glute group.  If you want to stop the pain lets focus on loading your hip more and your knee less.  Simple. 



Movement retraining. Train the brain!

Movement retraining is a hot topic in physical therapy and performance literature. Everyone is talking about training to stop the valgus knee (medial collpase) or increased lumbar spine extension (arching the low back). 

Strength work alone is not enough to correct these movement faults.  A lot of folks hear their glute is weak because they exhibit a valgus knee in running or cycling.  Weakness in the glute max can allow this to happen but there is more here than meets the eye.

In the case of knee valgus, the femur internally rotates as the knee collapses medially. The muscle responsible for controlling this position is the glute max.  The engine of the lower extremity! As you see above, the glute max attaches proximally at the sacrum and the ilium and travels laterally to attach onto the femur and the IT band.  As this muscle contracts is creates femoral external rotation, hip abduction and hip extension. Long story short it rotates the leg so the knee remains stacked over the foot versus collapsing medially.  

So lets assume you're an athlete and you are training your glutes so we don't suspect weakness as the cause of your knee position problems. What is really happening here?

We find that the problem is motor control.  Think of motor control as a habit.  If you're a basketball player, shooting free throws is an automatic movement.  You don't think much about it after 10,000 shots. The same is true for the way we squat, jump, land, run. You are hard wired to perform a certain way. If we develop poor habits in these movements we can get into some trouble.  

Classic quad dominance.  Vertical trunk.  Significant anterior knee translation.  Huge stress at the knee and ankle while the hip remains relaxed. 

Classic quad dominance.  Vertical trunk.  Significant anterior knee translation.  Huge stress at the knee and ankle while the hip remains relaxed. 

The pattern shown above is referred to as quad dominance. As the knee travels further forward the quad is activated while the hip (glute max) remains relaxed.  Try it right now, squat with your knees forward and feel your quads. If this is your default movement you are going to tend to load quad much more than the glute.  If the glute isnt doing its fair share, knee valgus is likely.  

Now, the brain.  The control center. We need to think about the primary motor cortex here. You may have seen a picture of the homunculus before.  Let me shed some light on this sstrucutre.  This is a visual estimate of the representational area of each body region. The larger the representational area, the more motor control you have.  Notice the size of the face and hands, huge area.  Lots of precision and movements here.  Hip/glute, not so much. Shit.   

Big deal, just squat with your knees above your feet and you'll be fine. Not quite. There is one sticking point here.  If glute max is not active in the first place how do you get it working during your sport? Moving from activation, think clam shells or fire hydrants, to changing your motor pattern during skiing is a whole different story.  This is where we need to train more than your muscles. Need to train the brain!

Training various movements, various variables and scenarios is key. Focused practice is not easy. Taking a back to basics approach is critical. Mastering the fundamentals is a prerequisite before advanced movements. Nail down the double leg squat with a perfect hip hinge. Transition to single leg work. The more advanced the movement the more you need a physical therapist, athletic trainer, coach, etc watching you. Feedback on your performance enhances your motor learning so don't go this alone. The focus of the feedback has been shown to make a great difference in the speed of motor learning. An external focus of attention has been shown to be superior in instances of motor control training. For example in basketball, an internal focus would be concentrating on the movement of your wrist as you shoot, an external focus would be focusing on the back of the hoop as your target while shooting.  

Train your brain by using an external focus of attention while retraining your movements and experience new levels of efficiency. 

Check out our favorite activation series below. Start with 30 second static holds followed by 30 reps for hydrants and skates. We learn motor patterns faster when we start with a static hold. Follow that up with a monster walk series until you feel a good burn and 30 reps of perfect squats. As always, movement quality over quantity. 

My back hurts when I ride my bike!

Are you experiencing back pain while riding your bike?  Not cool!  Lets talk about it. 

I've never met a cyclist who had appropriate anterior hip mobility.  When I talk about the anterior hip I am referring to the hip flexor group of psoas and iliacus.  These muscle live deep in the pelvis and have attachments to the spine as well as your femur.  The picture below shows the muscles themselves as well as their referral patterns.  The red dots respresent where you may actually feel a dysfunctional muscle.  The muscle may be deep in your anterior hip but as you can see the sensation may actually show itself in your low back.

The root cause of your pain may be in your psoas muscle but you may actually feel it in your back. 

The root cause of your pain may be in your psoas muscle but you may actually feel it in your back. 

This type of muscular pain is quite common as we all sit too much and as a cyclist we are spending way too much time in hip flexion.  To address this issue we need to stretch the anterior hip.  Our thought process here is a low load, long duration type stretch so we actually create change in the hip extension range of motion.  Tuck your tail, keep your trunk tall and try to move your hips forward for 2 minutes at a time.  The more you sit the more you need to do this stretch. Keep it a gentle stretch!

Muscular restriction or trigger points could be causing your symptoms but the way in which we move is most likely playing a part as well.  The most common fault we see is over extension in the lumbar spine. This movement is characterized by an anterior pelvic tilt and an arching or your low back. This not only feeds into the restriction at the fron of your hip but it also compresses the facet joints in your spine.  These joints do not like to have lots of pressure on them during an entire ride.  Give them a break!

At home you can test yourself with a simple functional squat.  An over extended spine may look like this...

Notice the arch in the low back and the whole pelvis rolling forward.  Not sweet for your back.

Notice the arch in the low back and the whole pelvis rolling forward.  Not sweet for your back.

A squat with a neutral hip and spine position should look like this...

Neutral hip and spine position.  That looks so comfy!

Neutral hip and spine position.  That looks so comfy!

Now you may be wondering why a functional squat matters when we are talking about pain on the bike.  We certainly see this pattern translate to your seated position in the saddle.  It may not be as exaggerated as the squat above but small faults performed for long periods of time can equal big time pain.  On the mountain bike especially we see the over extension problem show its face while descending.  10,000 small impacts, add in a few big drops while you are over extending the lumbar spine is not going to be fun! 

For example, a mint attack position...

Looks very similar to a good squat

Looks very similar to a good squat

Now the over extended position...

Back in arched, knees are translating forward, lame!

Back in arched, knees are translating forward, lame!

So, what do we do about this other than stretching the front of the hip?

Retrain the glutes of course! If you stand up and actively arch your low back or rotate your pelvis forward you will be able to correct this position by squeezing your butt.  Try it! Step one is always nailing down the squat.  Think about moving the hips backward first, moving your knees out, keeping your knees above your ankles and maintaining an active glute group throughout the movement.  A band above your knees can help you keep the glutes turned on during a squat.  

Stop the back pain!

Side note, here is a cool video about RevoPT, enjoy!

Knee pain and cycling, where to start

The most common site of pain we see at RevoPT is the anterior knee. The knee is comprised of three bony structures, the femur that creates the top section of the knee, the tibia that creates the bottom section and the patella or knee cap acts as a lever on the front of the knee for the quad muscle. Obviously the knee is doing quite a bit of movement while cycling. Small movement faults can turn into major pains quickly.

Assessing your own movement is a great place to start tracking down the cause of your pain. We like to start with a squat or a lunge. This movement gives us lots of information about your default movement strategies and how your load the lower extremity.  In the case of anterior knee pain we want to pay special attention to how you are loading the knee joint as you move into knee flexion. The movement we associate most with anterior knee pain is termed dynamic valgus. This is characterized by a medial collapse at the knee as you move into deeper flexion.  

Notice the internal rotation required to allow this motion.  Glute max creates hip external rotation, abduction and extension...maybe that will fix this problem???  Knee is positioned inside the ankle.  No good!

Notice the internal rotation required to allow this motion.  Glute max creates hip external rotation, abduction and extension...maybe that will fix this problem???  Knee is positioned inside the ankle.  No good!

The knee valgus seen above in a split squat/lunge will usually show itself on the bike as well. If you find yourself knocking your top tube with your knee or collapsing medially at the bottom of the pedal stroke odds are you are stressing the front of your knee excessively. As your femur internally rotates the condyles at the top of the knee also rotate.  This changes the contact patch between the patella and the groove of the femur.  Less surface area equals a spike in pressure.  Do that 10,000 times a ride and you're going to have some pain at the front of your knee. 

Ideally we will see the knee stacked directly above the ankle on and off the bike.   

Knee stacked over ankle/pedal.  Nice!

Knee stacked over ankle/pedal.  Nice!

Knee stacked over ankle/pedal.  Nice!

Knee stacked over ankle/pedal.  Nice!

So you did a lunge in the mirror and your knee is collapsing inward.  What happens next?

When the knee is collapsing inward we know the external rotators/abductors of the hip are not doing their job.  Turn them on!  Below are two videos showing you a fire hydrant and a skate to activate your glute max and glute med. Start with 30 second holds followed immediately by 30 repetitions.  If you feel a small fire on the back of your hip you are doing it right! You should also give this a try right before you get on the bike to "prime" your glute and ensure it is ready to work.

Riding bikes should be fun, not painful! Ask us more questions to be answered on the blog at 

Knee valgus? Ok, so now what?

Knee valgus, medial collapse, movement dysfunction.  These terms get thrown around a lot in the physical therapy and sports performance world.  So what exactly is this pattern and what can you do about it?

First of all, knee valgus refers to the femur moving into internal rotation and adduction.  This is often referred to as medial collapse as the knee tracks medially toward the center of the body.  We know this movement is linked to ACL injury, anterior knee pain and IT band pain among others.  When you see this pattern you intuitively know its not supposed to happen but the fix for this dysfunction does not come quite so easily.

Long story short, this movement pattern is a habit.  We call this motor control.  Its not always the case that the body doesn't have the required strength to stop valgus from occurring.  Most often the pattern is a result of repeated poor movement choices.  These choice eventually become the default. The more we choose this pattern the more ingrained it becomes. As we are not programmed from birth to move this way we need to assume it was a learned behavior. "Unlearning" this movement can be difficult.  Consider altering your golf swing or changing your free throw shooting technique.  Sounds like a feat to me!

Retraining motor control is a long term investment in your own health.  Detailed assessment and repeated practice are the keys to long term athletic performance and injury prevention. Strength work is sexy and its fun.  Strength work alone is not enough to ensure proper motor control for your sport. Take a close look at yourself in a mirror performing a step down as pictured above.  If you can see your knee moving inward with the naked eye, its too much!  Now comes the movement quality focus of your training.  Glute max is the primary muscle responsible for controlling/stopping this movement of the femur. Moving in a "hip strategy" or a hip hinge pattern is paramount. For example, in the squat, the hips must move backward first.  The joint that moves first is loaded maximally at end range.  Meaning if the hip moves first we load that joint and its surrounding musculature more than the knee and ankle.  This is a great place to start your training.

Nailing down perfect squat form will set you up for success in your relearning of safe motor patterns.  Perfect your movements before loading with excessive weight and watch your athletic performance improve and decrease your risk of non contact injury.                



What is Revo Physiotherapy and Sports Performance?


REVO stands for a Revolution, an Evolution. We are different, and that is our goal. At REVO PT we are providing sports medicine services unlike anything Boulder has seen.  The complete package of injury prevention, rehabilitation, and sports performance, all provided by Doctors of Physical Therapy. We hold ourselves to the highest standards, and are athletes ourselves. We wanted to be able to do more for our patients by providing a better approach: more one-on-one treatment time, more in depth analysis, more objective measures, more research driven treatments, better methods of patient education and interaction.

REVO PT gives the people of Boulder a choice. You no longer have to settle for the traditional sub-par, high volume care mandated by disconnected insurance companies. You will save time and total cost of care as our model empowers you to take control of your body and athletic goals.  We are working smarter, not harder for you - utilizing real sports science and the best technology of high speed video analysis and EMG to tease out impairments and correct movement patterns.

REVO is a results driven entity and we want your results to do our talking. We stand by the services we provide and pride ourselves on doing everything in our power to help you attain your goals. That is why we are different and are revolutionizing and evolving the sports medicine standard of care.

Dane, Brian and Matt getting rad in Moab before REVO opens!

Dane, Brian and Matt getting rad in Moab before REVO opens!