I always wonder where some of the more common misconceptions in our professions came from. One, in particular, is the concept that if your knees pass your toes, it’s bad for your knees.
That’s such a shortsighted and broad statement.
But, rather than asking if a movement is good or bad, maybe we should just understand the biomechanics and stress?
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#AskMikeReinold Episode 275: Knees Over Toes – Is it Really Bad?
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Show Notes
Transcript
Kim Lai:
Ryan from Massachusetts asked, can you discuss the knees over toes debate? Do you let people do movements like squats and lunges with their knees going over their toes? And does it change depending on the person’s sport, goals, or previous injury?
Mike Reinold:
Ooh, we get another debate. We’re going to dispel more debates or myths here. So that’s funny the knees over toes, I always wonder. Let’s start the episode of this, the knees over toe debate, I guess is that a lot of people or some people in the past, there’s a common misconception probably out there that people say that if you do an activity like a squat or lung or step type movement and your knee translates, you bend your knee so much that it translates over your toes. So assuming you’re getting depth that it puts a lot of stress on your knee joint, it’s too much stress. A lot of people say, don’t let your knees pass your toes. That’s a very common kind of phrase. Right? So I’ll start the episode off with this and just say like, I just always wonder if this is one of those things that social media, and maybe even some early career professionals, take this a little too serious, right?
Mike Reinold:
Meaning, nobody really thinks your knees are going to blow up if they go up over your toes. Even the first person that ever said that, probably didn’t say that this is one of those things that I think somebody took too far. Right? So in both ways, there’s probably some people in the medical community and fitness community that took it too far and said that you know you should never go knees over toes. But I would say the vast majority of people understand that’s a little excessive. So I feel like this debate has probably been a little bit more sensationalized, but Dan Pope you probably get asked this question a lot online and you probably are involved in these discussions probably more than any of us right here. What do you think? Do you want to give your two cents on this?
Dan Pope:
Yeah, for sure. I think it really just comes down to physics and the simplest way to explain it for me is; let’s say a squat, right? So if I’m going into a squat and I’ve had my knees traveling forward a lot over my toes, if you look at your center of mass and then you look at where the knees are, you’ll have a moment arm, right? And then if you look at your center mass to your hips, you have another moment arm. And if you sit your hips really far back, the moment arm grows for the hips. And if you have your knees really far forward, the stress is going to go more on the knees because you increase the moment arm there, right? So obviously in life, you need to have your knees go over your toes, but the more the knee forward from your center of a mass, the more your quad and your knee, right? And when you say knee, there’s multiple joints in there. So that’s even nuanced. There’s more stress on that knee, right?
Dan Pope:
And if you work in a population, let’s say of Olympic weightlifters, two things; one deep squats are important, and you’re going to have a ton of anterior knee translation. These going to come way far forward. And you also want to be very operate when you catch a snatch or a clean. And those two things are going to put a ton of stress on the knee. And if I never prepare my athlete for that, I’m going to run into some trouble, right? I think the issue occurs, and this happened to me as a strength coach or a personal trainer, when someone has knee pain, you figure out real quick, okay, if I had that knee travel forward, it hurts them. Right. And then if I just send their hips back, they feel phenomenal. Right?
Dan Pope:
So it’s kind of like, wow, I fixed my client’s pain by having them sit back. That must be the answer. When in reality and at least in physical therapy literature, if you have, let’s say patella tendinopathy. I’m sure if you’ve seen step downs are super, super effective for things like patella tendinopathy. So part of it is that if you avoid having the knee come forward when you have knee pain, it seems like a success. But at the end of the day, if you need to get back to deeper squats, then you probably want to have that knee come forward. At the end of the day, it comes down to the person. So if I have a regular person that just likes to work out in the gym and be able to play with their kids, I don’t know that I need to push that knee forward.
Dan Pope:
You know, I don’t have to, we were just talking about knees over toe guy. He has a lot of great exercises, but I think from the majority of regular folks with knee pain, you’d probably explode their kneecaps. If you tried that as a first movement, you know what I mean? So part of it is that you have to learn how to dose your exercises. And then exactly, as you said, you have to figure out the needs of the person in front of you and slowly work towards that, and allow pain to be a bit of your guide as they continue to progress over time.
Lenny Macrina:
Also Mike, you mentioned earlier that social media has influenced us a little. I see it the other way too, where early career professionals, newer grads, newer PTs are trying to force this on patients; to do the knees over toe thing because it’s safe and we got to do it because it’s safe without the person necessarily being trained or needing to have that in their life.
Lenny Macrina:
Now don’t get me wrong, going up and down steps, and basic things of life will require you need to go over your toes. It’s like that, but maybe not to the extent that dosing it and performing it weighted with like a sissy squat or things like that. And trying to basically force it on our patients. Again, I do it, I treat a lot of ACLs. We got to get their knees over their toes to be able to receive their weight and get their quads going and get them comfortable in that position. But I just think sometimes it’s going the other way, too, where we’re trying to push on people. Cause we know it’s safe, especially for everybody, it doesn’t feel good for some people. So you just kind of back off.
Mike Reinold:
Just the fact that this is a conversation about, is it good or bad or safe or unsafe is hilarious.
Lenny Macrina:
Right.
Mike Reinold:
I really think it’s a small, maybe like 20% of the people actually think this is safe or unsafe everybody else, in my mind. Maybe I’m taking this for granted. Everybody else just realizes that it’s not a safe or a good or a bad issue. It’s a spectrum. It’s just mechanics, people, it’s just biomechanics. Right? This isn’t about reconciling pain. This is about biomechanics, right? And the more your knee goes forward and the more you bend, the more stress it is, that’s it. Stress is good. Stress is bad. Stress can be good until it’s bad. Stress can be bad until it’s good. Right? Stress is stress, right? It’s just stress. And you have to put these variables together.
Mike Reinold:
Some people are ready for stress. Some people need to gradually load into stress. Some people want to avoid stress. Right? So the fact that this becomes a debate, and then what happens is just like everything else, like I said, it confuses the heck out of everybody is you have people saying they actually like looking at therapists that are avoiding deep knee positions and shaming them saying they’re “oh my God, they’re so old school in retro”. I’m having look at me, I get my total knee patient, she’s doing a pistol squad right now. Look at how good she’s doing. Right? That’s too far on that end. But then the person that’s like, “Oh, never let your knees because your knee will blow up.” That’s that’s too far on that end too.
Mike Reinold:
So like you just got to just take a step back and say, this isn’t about good or bad or safe or unsafe. It’s just a biomechanical principle that Dan talked about with the moment arms that says the deeper you go, the more stress you apply. And you have to determine does the person in front of you, are they ready for that stress? And do they need that stress in their life? And if they do, how do we build them up for that? Right? Is it really that simple? What do you think, Dave? I want to hear your mind on this.
Dave:
Yeah, I think, I mean, I think Dan said one of the most important things, threaded in there is like this really all comes down to understanding someone’s goals and what they want to get out of their fitness and their life. Right. Like I think the other one is kind of related to this is like Jefferson curl comes up a ton with like me and gymnastics and people are like, oh, like ever wants you to do Jefferson curls because gymnast like, maybe they’re doing them and not really actually it’s like not a super popular thing. But if you take someone, like you said, who just likes doing calisthenics and body weight type movements and they think it looks super awesome to do this extreme sissy squat, to like seven plates of depth and come back up. It’s like, if that’s their goal, then like, cool.
Dave:
Maybe it’s a two year goal for them. And maybe they do want to work on that stuff, but they have no goal of, of back squatting a super heavy weight or playing baseball or sprinting or cutting or pivoting or doing all sorts of other stuff that, that amount of mobility without a lot of good extra strength on top of it might be problematic. So, it’s really all back to like what people want. Like, is there a certain person who might really want that? Sure. Then maybe that’s a perfect progression of exercises over a couple years for someone else who, like Dan said, like I just want to pick my kids up and squat down and not have my knees hurt. It’s probably not a great option for them, because they have a long history of things that maybe don’t feel great.
Dave:
And I think it’s the situation where I think sometimes therapists or people on the internet just like get a little bit too dogmatic and say that it’s always black or white. And when in reality it’s really about what the person wants in front of you and you just got to listen to them and use the proper tool for them that you have.
Mike Reinold:
Yeah. I mean, I don’t think we could say that much better with like, it all just comes back to the person in front of you, but I would really, really, really love to just get out of this debate of like can you do it or not? Right. And like Lenny and I get this with like weighted baseball training in baseball, right? They’re like our baseballs bad, our weighted baseballs bad? I’m like, no, they’re not bad. They’re not good either. Right. They’re but they change the stress. So everything we do changes the stress applied and you just have to realize, do you want to change the stress applied? And when has that become too much or too little in the person in front of you. Right. And just like and stop getting in these conversations and these things about is something safe or unsafe. Everything has a spectrum of safety. Everything has a safe spectrum of load. Right. And we just have to like apply that and put that together. Right. Make sense. Awesome. But anybody else on that? I mean, I know this is kind of like such a popular thing on the internet. I want to make sure that we, we address it, but, Diwesh from the strength training perspective, like what, what are your thoughts?
Diwesh Poudyal:
Yeah. So I have two thoughts on this. One I do think this overall idea of principle definitely came from the physical therapy realm and then any fitness, professional strength, coach, personal trainer that wanted to keep an eye out on their clients to make sure that they’re doing stuff safe or they’re not hurting people. I think they, they’re probably the ones that took it really far, at least in the fitness community. Right.
Mike Reinold:
Right.
Diwesh Poudyal:
So, you kind of mentioned that, like,
Mike Reinold:
I feel like you’re right though. I feel like the fitness community almost like is the one that like, the PTs are like, whoa, we didn’t say like that for like everybody all the time, right. I feel like there’s a misconception somewhere here. Right. There’s someone miscommunicated, but yeah, you’re right. I think the, the fitness crowd heard it once. Right. And they were just like, man, what, and the medical professionals, they’re crazy all that they say, you can never do that. I don’t think that’s true, but yeah. Sorry, keep going.
Diwesh Poudyal:
Yeah. It’s like maddening to think how many strength coaches will try to push people to hit like a deep, like rock bottom squat without letting their knees go past their toes and like sitting way back. And they start cranking on hips and like giving people back pain and stuff. But it, like is definitely a big, big point in the fitness industry. And I know if there sure was when I was learning this stuff growing up, but that was kind of my first point. I, I do think in the fitness community, there’s a lot more education to be done. Like, I love that Dan talked about the biomechanics was just the lever arm and the moment arm from the knee to the hip compared to your center of mass. Like I think just knowing that for a lot of personal trainers and strength coach is super important.
Diwesh Poudyal:
Cause I am willing to bet you like, they’ve never really thought about it that way. Right. So that was kind of like my first point, the second point being, I kind of mentioned the needs analysis for our previous question, but Dave and Dan kind of mentioned like, what are the demands of support at the end of the day? Like a lot of athletic movements, like sprinting, especially in acceleration, even cut jumping, like it all requires quite a bit of forward knee travel. And I think the biggest thing for us to keep in mind is like, what, what does that person have access to? As far as their kinematics combined? Like, what does their ankle dorsal flection look like? Do they have a ton of dors selection? So they, they need to be able to control all that dors flection or they, don’t have a lot of dors flection.
Diwesh Poudyal:
Like, should we let people have their heels come up off the ground to perform that knee past toe squat? Probably not. But if you’re someone like me, for example, like me and Dan talk about this all the time, like bragging about my dors flection, but I have dors flection where I have six inches past my toes. Right. And like I have super long shins. Like I have to have my knees pretty far past my, to, to hit a rock bottom squat because I want to do Olympic weight lifting and, heavy back squats and front squats and stuff. So it definitely does come down to the needs of whatever activity or sport, but also what do they actually have access to for total movement? And then maybe let’s try to build some strength and active control there.
Mike Reinold:
I love it. I love it. Okay. And I think, the general kind of concept I think you can get from this episode is that like, there is no one answer for everything and there is no is something safe or unsafe. It’s all a spectrum. Right. And you have to keep that in mind. And most of these things like, knees over the toe is a great example. All it does is it just changes the stress and you have to determine for that person in front of you is the appropriate, is the stress worth it. Right? And then how do you slowly build a program to get you to that point where they can then control that stress? And I think that’s the real goal. Dan’s athletes, a lot of people that work with Diwesh in the gym, right. They, they want to get to depth in their squat.
Mike Reinold:
So we have to get them there. Right. But that doesn’t mean you jump right there, but we have to build a program to get them there because that’s their functional activity. Right. Not everybody needs that. So we don’t go that deep with that person. But I think it’s, it’s not so much the conversation of safe or unsafe. It’s more about stress. Right. And I think if we can take almost all of these debates about it, something good or bad, I think the answer is that everything can be good and everything and be bad. It just depends on how you apply it. Right. So hopefully that helps. Good question, Ryan. I like that one. You know, if you have questions like that, I mean, I understand how these things can be confusing for people that are just trying to learn these things, because you hear some very like, you hear opinions, right?
Mike Reinold:
You hear like these concepts and you wonder like, is this a bigger problem out there? I know there’s some people out there that hear a concept and think like the whole world is worried about this debate. When really it’s probably only 20% of the world that actually thinks this is a debate. The other 80% actually think it’s just a, that stress equation that we talked about. So I can see how that be daunting for somebody. So, thanks Ryan. If you have a question like that, head to mikereinold.com, click on that podcast link and keep asking away and please go to iTunes, Spotify, subscribe, and rate and review us. So we keep doing these episodes to answer your questions. Thanks so much.
