Have Knee Pain? Untwist It | Narrow Infrasternal Angle Case

[@alvarorosas5006]

It was a pleasure to meet you :)

[@ZacCupplesPT]

Likewise!!!?

[@Venya3213]

But how is it posiible to have proximal femur ER and distal IR of the same bone? Do you mean ER in SI joint as proximal femur or just consider different axises? I'm totally confused) I guess you're not talking about some bony abnormalities, cause we can't correct them

[@beautifulmotherlove]

dear zac- on minute 8:48 u say there is is a loss of ER in proximal femor. isn't this a loss of IR in the proximal femor? and too much ER in the hip and illium at this side? please correct me if i am wrong

[@ZacCupplesPT]

Yep. Should’ve been flipped

[@beautifulmotherlove]

​@@ZacCupplesPT thank you zac. still need some clarification please: if the Left sacrum is turned/rotated to the Left on the transverse plane: is it actually- * Left sacrum in ER right sacrum in IR * LEft illum to IR right Illum ER * left hip and proximal femor in IR can you please clarify more on these relationship between sacrum-illium-hip socket-femore and how they behave relatively to each other ER-IR wise? thank you for this splendid video - I love your contents so much

[@ZacCupplesPT]

@@beautifulmotherlove Assuming relative motion and femur fixed, yes

[@baderqassim3248]

Hi zac, do you have a link for the ex at 14:54. This distal femur internal rotation position is annoying. Thanks!

[@ZacCupplesPT]

kzbin.info/www/bejne/eGesmpJte9mtr9U

[@steoboylo5395]

Hi, Thanks for the video and learned a lot from it and I feel this is what is going on with me. I am a personal trainer myself and for the last 12 years or more, every lunge, squat, every lower body exercise I have ever done I focused on lining my feet knees and keeping good form etc strengthening VMO Glute med, stretching, loaded stretching and I have had no improvement. For the longest time I am trying to find a before and after with someone who successfully corrected this who is not just extremely week and the bones are collapsing on themselves and all they need is to strengthen there muscles. Have you seen or do you have any before and afters? I hope this question doesn't come across as ignorant I dont mean to be just would love to see some results somewhere.

[@AdityaSingh-nb3hu]

can this twisted knee cause shin spint and right groin pain?specially while running

[@consistentme22]

4:05 That's pretty neat. Didn't know that about the toes So, if the first ray is plantar flexed, which suggests an inversion of the calcaneus, that's an ER representation of the foot, yes? Would that signify a tibia that is distally in IR? Because the body compensates?

[@ZacCupplesPT]

Yessir. TIbial could be in IR if there is a twist, doesn't always happen. Sometimes entire tib can be ER'd

[@consistentme22]

@@ZacCupplesPT interesting 🤔 There must be some strong internal forces being applied at the knee by the femur if both the ankle and the tibia are turning outward, no? Is it ever possible to have all three - the ankle, the tibia and the femur - turning outward and then have the body compensates solely using the hip and spine to generate IR? I can't imagine that representation in my head. I imagine the spine would have to turn and face in the opposing direction or something. Am I wrong? That would be an odd standing fellow. Thanks in advance 🙏🤙

[@ZacCupplesPT]

@@consistentme22 It is, but it likely occurs WAY higher up. Every see someone w/ a lot of hip motion but neck can't turn...that would be an example

[@consistentme22]

@@ZacCupplesPT so that's why I can't turn my neck, eh? Thanks doc 🙏🤙 Problems at cervical spine affect the jaws I assume. TMJ in particular. If so, that explains my jaw joint problems, too. Very interesting

[@ZacCupplesPT]

@@consistentme22 It all kinda goes together, so glad it helps clarify things

[@hichamg2142]

How about a narrow ISA with secondary presentation, Same description below the knee, Plantarflex 1 st ray, ERd Foot, Space between the toes, ERd Tibia, little toe under the other toes, limited knee flexion. However, at the hip very limited on both sides ER and IR, ER less than 30 degrees right > left and IR less than 10 degrees left > Right, SLR limited Left>right, limited Hip flexion right > left what should be done in this case? Thanks

[@Alexgg-qk6og]

Wow, you have describe me. You get some help for this??

[@bhopirl4552]

What if I have very similar measures to him but my ISA looks wide? Am I just measuring ISA wrong?

[@JakesYan]

Hey zac awesome video! My legs are currently twisted this way. It used to twist in another way where the left foot pronates while right supinated which i got it fixed thanks to your other untwisting the legs video. It seems i keep twisting my legs back not knowing why.. Do you have any idea how someone keep ending up in this situation?

[@nenadkamenovic1874]

Hey Zac, amazing video. One question though, at 8:57 I think you made a mistake, maybe I am wrong. He is lacking Ir at the femur proximally, but you said Er. All the best to you bro, see ya in Slovenia 💪

[@ZacCupplesPT]

Ahhh yes, I did misspeak. Thank you for pointing that out! Excited to meet!

[@nenadkamenovic1874]

@@ZacCupplesPT 👌👍. Excited to meet too

[@jennrhode2373]

Hi my sister, she complains that she feel her legs and knees and twisting on a regular basis amd just walking causes he pain, she had a number of mris and exams done on her legs which show nothing. Is this condition something that wouks shows up on an exam and get treatments for or something youd need to fix yourself by doing these excerises?

[@lifengtian3416]

Hi Zac, at 14:10, you said "to turn to the left , we need to capture left External Rotation", shouldn't it be "Internal rotation"?

[@ZacCupplesPT]

Nope. Turning left requires left posterior expansion (ER) and right anterior (IR). I have to create space to move into

[@lifengtian3416]

@@ZacCupplesPT Hi thanks Zac for the reply. Isn’t left posterior expansion left IR of femur?

[@ZacCupplesPT]

@@lifengtian3416 The femur can relatively IR from that position and I need some posterior expansion to IR, but posterior expansion = ER, anterior expansion = IR

[@lifengtian3416]

@@ZacCupplesPT I see. Your ER was referring to the posterior pelvis, my IR was me thinking of femur IR. Thanks Zac!

[@ZacCupplesPT]

@@lifengtian3416 Yeah. I pretty much always refer to the axial skeleton. This is a good clarifying question. I'll make sure I state that in videos more frequently. Thank you for making me better :)

[@bjornverburgh7516]

Hey Zac, did this guy had a hip shift as well? If yes, to which side? Did he have pain around his kneecap? And did the painful kneecap turn inwards in this case? Was there also a hip hike? If yes, on which side? Might be all useful info ✌️

[@ZacCupplesPT]

I’m uncertain if he has any pain. But turning right slightly given the asymmetry in hip measures

[@bjornverburgh7516]

@@ZacCupplesPT I tried your exercises last night and once again this morning but my knee pain got worse. Especially the last exercise is very painful for my knee. The pain is felt around the patella tendon and even goes into the top of the shin bone (tibia). I am 99,9% sure I am a narrow ISA. I asked this before but is this exercise made for someone with a right hip hike (right hip that is higher) and who's stuck on the right side (LAIC - difficult to use right glute to push to the left). I know you can't answer everything in detail but I would like to start somewhere to release the tension in my knee.

[@ZacCupplesPT]

@@bjornverburgh7516 Hey Bjorn, It's really hard to say without evaluating you. Could be wrong exercise choice for you, could be some tweaks in technique, could be many factors. I would say if you are getting pain wtih the moves, it's probably worthwhile working with someone professionally on this. If the hip hike is right, I'd probably look at the wide version of things - kzbin.info/www/bejne/kHKtfo1tiZhjf8U&t

[@xthinker2552]

Mr Zack if the goal is to turn to left. . In my head am thinking the goal is to work on the right side to get the ir and the foot cues to push us there .. I was thinking of sled drag to left. And if that is so. Pls any exercise apart from sled drag. That can push someone to Left. Only pushing with the right. And thanks for ur content.

[@ZacCupplesPT]

Depends on either wide or narrow. If narrow I like a same connect with right foot on ground

[@peat5102]

hey zac, great video. what about if hip is shifting forward,and tilted forward, left side more shifted forwards, both knees are twisted,feet turns out and calcaneus colappsing, first mead head diesnt touch the ground,tiny toes twists externally?

[@ZacCupplesPT]

I’d probably start with easier movements first. Lots of the A to P expansion drills would be a good starting point

[@vaishnavkd4192]

I have this problem.and I am unable to fix it by myself. If I do leg extension with my twisted knees will it cause any problem .

[@ZacCupplesPT]

It’s hard to say without seeing you. Depends on pain, if you have limited motion, and what effect that move has on the body. Some people do well. Some don’t

[@kurtlu591]

Do you think your client is in a left aic pattern ?

[@ZacCupplesPT]

I forgot what that all entails, but foot presentations don’t present classically like they describe

[@rakzz1720]

When it came to all of your treatment regarding being able to comfortably nasal breathe, looking back at it would,you have only gotten your tongue tie surgery and septoplasty without the need for a palate expansion or was there a need for all of those treatments? Also how long was the total time period for the treatments? Thanks.

[@rakzz1720]

??

[@ZacCupplesPT]

It’s hard to say and play back. I think you forget how you felt before you do something. I think each thing did something different. I don’t think the palate stuff necessarily helped with my nasal breathing, but did help with tongue posture, neck pain, and sleep, and swallowing (food would feel stuck). The upper airway stuff is complicated. Treatment is still ongoing

[@michaelaburgmueller1873]

The untwisting is very interesting, but how would this be different in a wide ISA?

[@ZacCupplesPT]

You’ll find out next week 😘

[@michaelaburgmueller1873]

@@ZacCupplesPT oh the suspense, love it ;) Thanks

[@Doggomorph]

Does this affect powerlifting energy output not sure if it make sense specifically SBD

[@ZacCupplesPT]

SBD squat bench deadlift? Short answer is maybe. Could see for some it being a rate limiting step.

[@Doggomorph]

@@ZacCupplesPTthank you so much would like a video on this

[@ZacCupplesPT]

@@Doggomorph I'll see what I can do

[@Doggomorph]

@@ZacCupplesPT thank you boss

[@ZacCupplesPT]

@@Doggomorph you bet big fam!!

[@consistentme22]

11:28 Wouldn't you magnify external rotation(not IR) proximally on the side pushed forward because of the acetabulum and increase IR on the opposing side? That would be congruent with the limited leg raise on the left side because you need IR for the leg raise, no? Or am I confused?

[@ZacCupplesPT]

Forward in this case is an anterior tilt, which would magnify IR. Anterior translation (think swayback) would magnify ER. Both are not relative motion though

[@bRabbit227]

If I’m suffering from this problem, should I repeat the circuit until it is cured? Like do the exercises over and over as needed until it is untwisted? Please let me know!

[@ZacCupplesPT]

It's really hard to say without seeing you. It's not to be done in a circuit. I would be focusing on getting really good on the early moves, then progress over time to the later ones.

[@bRabbit227]

@@ZacCupplesPT okay, thank you! And if I’m noticing the twisting/pain the most in my right leg would I do exactly as you did in the video? Meaning the same exercises with the same legs? Thanks!

[@ZacCupplesPT]

@@bRabbit227 Not quite. There are some subtle side to side difference in range of motion based on our internal anatomy. You could proabbly keep the same moves, just flip the final move to your right side.

[@yellow1612]

Thx

[@ZacCupplesPT]

Any time

[@rakzz1720]

Looking healthier my boy

[@ZacCupplesPT]

Tryna!

[@АндрейМалышев-ц6е]

I'm gonna wait a little bit when, with the help of grandpa Joe, the ruble exchange rate approaches the dollar to ask you for a service, Zac) Seriously, you are very cool, and to my great regret, we don't even have anything close to that. Thanks for the video, very informative!

[@ZacCupplesPT]

Hopefully soon. Misha Noga is in Russia and is solid

[@АндрейМалышев-ц6е]

@@ZacCupplesPT wow thnx for advice!

[@victoradebanjo7345]

Heyy zac, I texted you on insta, i have an apt and my legs are like this, I’ve lost a shit ton of weight and it has affected my face, my jaw is twisted left too

[@ZacCupplesPT]

Looking forward to working together!

[@victoradebanjo7345]

@@ZacCupplesPT hi zac, I know you’re a very busy man, but it’s been 7 days sensei

[@ZacCupplesPT]

@@victoradebanjo7345 did you ever get a reply? Easy to get lost in dms

[@victoradebanjo7345]

@@ZacCupplesPT yeah you asked me to feel the inquiry form, I’m waiting on an email response I think

[@ZacCupplesPT]

@@victoradebanjo7345 could you re-email me and I’ll send you my calendar. That’s weird