Pilates Elephants

Everyone "knows" that knees going inwards in a squat is bad, right?
It means the glutes are weak or underactive, and it's not good for the knee.
But is it REALLY?
This episode is a deep dive into the biomechanical, epidemiological, and prospective research on knee alignment during squatting, jumping, running and hopping. Our goal is to answer 2 questions:
Does the knee going inwards indicate weak glutes?
Is the knee going inwards dangerous?

Links:
Knees going in during a squat shifts load toward the glute max here
Knee extensor effort rises with squat depth, hip extensor effort rises with load here
Same depth-versus-load split found again in a separate study here
In elite powerlifters, heavier loads shift the work from knee to hip here
Elite powerlifters hit ~23x bodyweight at the knee joint at 90% of max here
Weightlifters share load between hip and knee; powerlifters are hip-dominant here
Sideways knee load in a barbell squat is a consequence of stance width, not a fault here
Elite weightlifters produce MORE frontal plane hip moment than lower-level lifters, not less here
Elite powerlifters vary widely in how they load their joints, so there is no one ideal form here
Lifters who fail a squat above their max show reduced extension and lower muscle activity here
The knee falls into valgus in ~77% of ACL injuries on video here
But knee valgus does not predict who goes on to tear an ACL here
And the drop jump test cannot predict ACL injury in elite players here

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Almost all of us foam-roll the ITB and tell clients it's tight.
Here's a richer picture, built from the anatomy: the ITB is a thickening of the fascia that wraps your whole thigh, it behaves as both tendon and ligament, it helps stabilise and lock your knee, and it backs up your ACL, contributing an estimated 13 to 40 percent of the resistance to your shin sliding forward.
Which raises a question about trying to make it "release".

PDF slides to accompany this episode here: https://breathe-edu-downloads.s3.amazonaws.com/IT%20band%20lecture%20slides.pdf
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Here's how we know humans are antifragile:
Yoga is pretty dang safe here
But if you REALLY want a safe sport, take up breakdancing here (no, seriously!)
Or Crossfit here
Knees going in during a squat or lunge doesn't predict injury here
Plus here are my TWO episodes looking at this topic here and here

But what DOES predict injury:
Having weak hamstrings here
Having a weak barbell squat here
Doing too little for too long, followed by too much too soon here and here

And what protects against injury:
Strength training is the best injury prevention here and here
High consistent workloads protect against injury here

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This is a live lecture I gave for the Diploma of Clinical Pilates.
You can download the PDF lecture notes here: https://breathe-edu-downloads.s3.amazonaws.com/Diploma%202024%20Neck%20pathology.pdf

You can watch this on YouTube here: https://youtu.be/igS35wdGQU8
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Research paper cited in this episode: https://pmc.ncbi.nlm.nih.gov/articles/PMC11970409/
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