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Thread: How Do You Address Excessive Anterior Pelvic Tilt In Your Intermediate Lifters?

  1. #11
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    Hey Mitchell

    Below is a form check video. I've found this to be a more effective way to communicate than typing over the internet. Feel free to use all of the suggestions or none of them. In general, I reserve making videos like this for clients because it takes longer than typing, so this is the only one you're going to get.


  2. #12
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    Quote Originally Posted by Will Morris View Post
    There is an awful lot wrong with your squat that is far more likely to piss a quad tendon off.
    Care to elaborate? Please stick to the 2nd video, obviously there was plenty wrong with the first one that have been corrected.

    Quote Originally Posted by Mark Rippetoe View Post
    This is the kind of thing that can't be fixed on the internet. Where do you live?
    Indianapolis.

    Quote Originally Posted by Will Morris View Post
    There is an awful lot wrong with your squat that is far more likely to piss a quad tendon off.
    Also, I feel compelled to mention that my quad tendon was still pissed off during the entire like 6 month period where I wasn't squatting or lifting much at all.

  3. #13
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    Tendons tend to stay inflamed long after the insult has passed. It's not your back.

  4. #14
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    Quote Originally Posted by Mitchell Smith View Post
    Care to elaborate? .
    As soon as you place my services on retainer, I’d be more than happy to work with you through this issue.

  5. #15
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    Quote Originally Posted by Nick D'Agostino View Post
    Hey Mitchell

    Below is a form check video. I've found this to be a more effective way to communicate than typing over the internet. Feel free to use all of the suggestions or none of them. In general, I reserve making videos like this for clients because it takes longer than typing, so this is the only one you're going to get.

    Hey Nick, really appreciate you taking the time to make that video for me.

    I'd like to take a moment to address your suggestions.

    1. Bar Position/back angle - Balance is most certainly not over heels, midfoot is the cue I keep top of mind during my squat reps. Bar may be too low, but it doesn't move down during the set so I'm not 100% on that.

    2. Knee locking - Your observation that my knees stay soft is correct, and I'm fully aware that locking the knees between reps is the proper way to do things. The soft knees thing is just something I've been experimenting with. You see, since the pain first starts during eccentric loading, the soft knee kinda lets me feel early on whether or not I'll be able to do a pain-free rep. If I had started the video earlier, you'd see me walk it out, deliberately unlock the knees to feel for pain, then breathe/brace/squat. It's sort of a stop gap solution for now, not planning on continuing to do so long term. I actually have the opposite problem, which is that I almost always have my knees locked and rely completely on my back/hamstrings for bending over and picking things up during normal daily activities. I basically do straight leg deadlifts anytime I need to get something off the floor to avoid unlocking the knee (and experiencing the pain that comes with it).

    3. Pelvic tilt - The crux of today's discussion. No active tilt, no squats. It's that simple. I don't like it, as I'm far more comfortable producing a strong lumbar extension, but that's the case right now. I really don't know what to do about it. I can't tell from this angle, but I am fairly confident that even though I'm actively flexing my lumbar spine, I'm still in a neutral position or even slight lumbar extension. Like I said, I am essentially incapable of actually producing flexion in the lumber spine. I can get back to neutral at best.

    4. Tendonopathy - That's the term the sports med physician used. Unfortunately it's just a general term that doesn't give me much actionable information.

    5. Programming - This piece of advice I will be taking (smaller jumps). Not because I think it's going to help the knee, because honestly squatting hasn't made the knee any worse (as long as the pelvic position is right), but because it will allow my abs to keep up and be able to control my pelvic position under the heavier loads. With 10lb jumps I'm having a harder time controlling my pelvic position.

    Thanks again Nick.

    Quote Originally Posted by Mark Rippetoe View Post
    Tendons tend to stay inflamed long after the insult has passed. It's not your back.
    Well it's been about a year and a half now. I've had long periods of inactivity, long periods of training around it, and several periods of "poking the bear" so to speak. The only thing that produced any difference whatsoever was when I was working with the PT (different one than the needling one). He asked me to temporarily switch to front squat, bench with a flat back, not pull any deadlifts, and do a bunch of movements similar to and including the Postural Restoration Institute's 90/90 Hip Lift. The guy was a little nuts, and had some really far-fetched theories about things, so I stopped working with him...but for a short period of time my default hip positioning improved and my knee pain was gone. Trouble was, I have no idea how any of the shit he was doing worked, and he couldn't tell me when I could expect to be able to go back to regular squats and pulling deadlifts (although he was a fan of both movements generally speaking) without fucking up my improvements.

    So far as I can tell, something about my hip position is doing something that is making that quad tendon angry. When I remove the pelvic position from the equation it goes away in a snap.

    I really don't understand it, but the bottom line is this. Perhaps if I can find a way to shift my default, everyday hip position back towards neutral, and thus remove whatever is pissing off the knee 24/7, I can get back to squatting while holding a hard arch and not worry about the knee because it won't be irritated from whatever is angering it the other 23 hours of the day. Hence, my very first question in this thread was whether or not you knew how to change the default position around a joint. If there were strategies I could implement (and understand unlike the wacko PT's) that you'd used. Clearly the answer to that is no. Which is ok.

    Thank you all for your time and thoughtful responses.

  6. #16
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    Summary: Nobody believes your lumbar extension is causing your knee pain but you, since there is no mechanism by which it could be. Get some wraps and add some compression to the knee when you squat. Glad we could help.

  7. #17
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    Quote Originally Posted by Mark Rippetoe View Post
    Summary: Nobody believes your lumbar extension is causing your knee pain but you, since there is no mechanism by which it could be. Get some wraps and add some compression to the knee when you squat. Glad we could help.
    I realize this is probably becoming a tiresome discussion at this point, but hey, details are important and I have a couple more.

    1. I've tried using both knee sleeves (7mm neoprene) and knee wraps (wrapped loosely and wrapped tightly) on multiple occasions. Neither have made a shred of difference at all.

    2. I've been thinking harder about the potential mechanism at play here, and while I still don't have one, I did recall some more potentially useful information. First, when standing with my feet forward, my patellas point outward at roughly a 35-40 degree angle(which was concerning to the PT). The right (the painful knee) points out slightly more than the left. Second, according to the PT's exam, I have 0-5 degrees of internal hip rotation(normal is 40 degrees) and 90 degrees of external rotation (45 normal). During the intervention period in which I started to have a slight shift in my default hip position, I gained some internal rotation (only like 5 degrees), my gait pattern changed a bit and my toe angle started to come in while I walked (indicating internal rotation). This piece of information leads me to believe that the external hip rotation caused by the anterior tilt may, in some way, be influencing the knee pain. Perhaps the rotational force is what is pissing off the tendon. I'm really out of my area here, but it seems logical the the tilt results in external rotation of the femur, which results in a rotational force being applied to the tendon...I don't know. Seems plausible.

    Do with that what you will.

  8. #18
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    Quote Originally Posted by Mitchell Smith View Post
    I'm really out of my area here
    Except that you don't actually feel that way.

  9. #19
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    Quote Originally Posted by Will Morris View Post
    Except that you don't actually feel that way.
    I'll bet those psychic skills of yours must really come in handy Will.


    Look, I'm not trying to be a dick here, I've been very appreciative of the advice given in this thread. That being said, only a fool would look at this situation and think "well, I've used knee wraps before and that didn't help at all, so I guess I'll go put on the knee wraps and that should fix the problem". I've provided a description of the pain, under what circumstances it occurs, what makes it better, what makes it worse, what I've tried to address it, and what I think might...somehow...be involved here. All while saying at least 3 times that I'm A. Open to other explanations, and B. Speculating about the mechanism. I've even asked if anyone wanted me to provide extra information or perform any tests to try to determine if there is a different cause, but no-body said anything.

    Now if you don't have a constructive comment about the situation, that's just fine. I didn't expect people on the internet to be able to solve all my problems in a single message for free (hence why I've paid out about 2 grand on medical services relating to the problem). All I was looking to do here was see if Rip or anyone else had ever worked with a trainee with an excessive APT that had caused them issues and found a solution. No is clearly the answer, and that's fine.

  10. #20
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    I think you are unlikely to find anyone here, or anywhere really, who has had a trainee with knee pain directly related to hyperlordosis/APT - although I suppose it is possible. Unfortunately when you are having unexplained pain that is persisting, you kind of have to just keep trying stuff until something works. Rehab stuff, technique changes, programming changes, etc. Since knee pain seems to be the main problem, a consult with a good PT(PT/SSC is ideal) would probably be the place to start. Just my 2 cents

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