Home » Chiropractic Blog » Page 2

Category: Chiropractic Blog

How to correct the knees going inward during the squat?

 How to correct the knees going inward the squat

In this follow up blog (see part 1 here) we are going to show you how to correct the knees going inward during the squat. Because finding the reason behind the problem is 50% of the solution

The main 2 reasons

There are two main reasons why the knee will move in throughout the squat movement:

#1 Mobility

Lack of mobility in the ankles will not allow for proper hip loading. Therefore, it will limit you on proper hip stabilization. The most common mobility fault, and quite honestly often overlooked, related to this problem of the knees going inward is ankle mobility. Lack of ankle mobility leads to improper load using mainly your quads or legs instead of the appropriate hip muscles:

ankle mobility knee cave inwards
knees cave in due to poor ankle mobility


#2 Poor Stabilization

Poor stabilization of the hips from weak glutes or a weak transfer of weight into the hips from the core. In other words, proper core stabilization will activate the gluteal muscles and provide stability in the hip. If there is poor transfer from the core, the gluteal muscles will not be cued to fire.

glutes stabilize the weight through proper core transfer
The hip muscles, specifically glutes stabilize the weight

Important clarification is the difference between knees collapsing and the “knee valgus twitch”

Here is an example of knees collapsing:

What is Knee Valgus Twitch?

Advanced lifters seem to briefly “twitch” by a slight knee “going in” when at the bottom of the squat. It is seen the most as they initiate the “coming up” part of the squat. However they usually revert back to having their knees out after they pass the sticking region.

On the other hand, just like in the video knee collapse happens throughout the movement.

What can be done?

If you already have pain in your knee, IT-band or in the side/front of the hip, the pain needs to be addressed. Exercise won’t fix the pain. The pain needs to be treated first before the poor movement pattern can be corrected.

Once the pain  has been treated we can move to correct the movement pattern. This is usually how we correct it (in order of importance):

  1. Correct the pelvic rotation.  Mobilizing or adjusting the hip will balance out the pelvis and lead to better loading into both legs.
  2. Improve Ankle mobility. If your ankle mobility is poor you will never be able to properly bear the weight in the hips since it limits the depth of the squat.
  3. Creating a stronger core by doing things like side planks, farmers carriers and counterbalance squats will lead to better weight transfer, banded push-pull.
  4. Stronger glutes or glutes that match the strength of the front of the legs (quadriceps) will create an ideal hip and knee stabilization.

How can squats cause pinching hip pain?

Causes of Hip tightness and pinching

It’s not so much that the squat in itself causes hip pinching pain. It comes from the less than ideal rotation of the hip and pelvis during the squat movement.

First of all let me state that there are actually two main types of hip pinching pain. Today we are going to address the less severe and more common.


Hip tightness that develops after squats

One thing that is very common among active populations is the sensation of bad tightness and even sometimes pain in the front and side of the hip. It is described as a “pinching” in the hip and travels up into the lower side of the torso.

There are different exercises (not just squats), that will cause this type of sensation, but a very common one is squats, especially barbell squats.

The body tends to show more imbalances when doing barbell movements. After some experience, many of us can tell that we have developed a “stronger side”. This sometimes is seen when only one knee deviates, or deviates more during a squat. Sometimes there is a clear hip shift either going down or up in the squat.

These side to side imbalances can be more subtle and go undetected for quite some time before they start causing any type of real signs or symptoms. But eventually, if not corrected it will lead to injuries of the hips, low back-spine and knees.

With enough stress this can develop into things like femoral acetabular impingement, MCL knee sprain or tear, or IT-band syndrome. When the pain or pinching is more intense these conditions need to be ruled out.

Core Stability

Even though the symptom is pinching in the hip, the actual cause of the problem comes from the core.

Many times what is seen is that one side is weaker than the other. One side of the core can stabilize better than the other side. This will lead to the body unequally “loading” the hip and legs.  In response the hip will fail to stabilize the knee and the knee will cave in. This ends up causing overstretching of the IT-band on the side of the leg.

After all, the job of pushing the weight up needs to get done, it will use the most efficient way to do it.

After many times of doing the same incorrect movement pattern the “most loaded” side will usually develop tightness and pinching in the hip that moves into tightness on the side of the waist.

Working on rolling the side of tightness with a foam roller or lacrosse ball sometimes will help release the pressure sensation; however, it will usually not be enough to truly address it.

There are 3 things that need to be considered to fix the problem and prevent it from becoming a more serious issue:


The side that presents with the tightness and pain needs to be addressed first, the unbalance between the hips and core and the constant loading on one side leaves the tight hip pretty beat up. The pelvis needs to be re-aligned into the correct rotation through a proper chiropractic adjustment.



The soft tissue that is tight and the origin of tension need to be released. Active Release Technique, Graston, and other soft tissue techniques should release the tightness.  Also, not because it feels tight means you should stretch it; many times, stretching provides temporary relief just to come back with a nagging constant tight sensation.



If, what actually causes the problem is poor core stabilization, then the imbalances need to be corrected and the core activation under the barbell/load needs to be strengthened. Side planks are a great body weight movement to start rehabilitation; however, there should be a more personalized and targeted approach to fixing each patient’s weak sides. It’s not an individual muscle problem; the way someone moves must be corrected. Foot arches, glute recruitment and core activation need to be addressed on an individualized basis.

The Real Reasons why your Hamstrings feel Tight

No matter how much you stretch, your hamstrings are still tight. On this blog, we discuss the real reasons why your hamstrings feel tight, despite your stretching efforts.

Among the active population, it is extremely common to hear people complain about how sore and tight their hamstrings are. I don’t think I have ever walked into a gym where I did not see at least one person attempting to bring their leg to their forehead. Blog posts constantly pop up about new and improved ways to relieve hamstring tightness.  And yet, no matter how much you stretch, the feeling of tightness continues. Before we address the real reasons why your hamstrings feel tight, we want to address whether stretching your legs is a good idea.

Should you stretch your hamstrings?

Blog posts constantly pop up about new and improved ways to relieve hamstring tightness.  And yet, no matter how much you stretch, the feeling of tightness continues. Why?

Common sense would suggest that as you train the muscle, whether be running or lifting heavy things the muscle “shortens” or gets “tight” again and again from the contractions during exercise and therefore it needs to be stretched.  Well, this might not be the case.

Having the sensation of tight hamstrings is not due to the muscle working during exercise but from having to compensate for the poor function of Hip muscles. Hamstring tightness actually originates in the hips.

Here are the real reasons why your hamstrings feel tight

There are 3 reduced hip functions that lead to the sensation of your hamstring tightness:

  • You might have Poor Hip Stability

which in less fancy words means not so hot glute activation

Do your hamstrings always take over when performing movements like squats, lunges or other leg movements? Welcome to glute amnesia. Your body is not activating the glute muscles as it should be and it is using the hamstrings instead, this is quite common.

Here is a way test if your glutes have poor activation:

This means that when you start to perform a squat, a lunge, a deadlift, or when running you move your back/spine before you move or propel with the hip: “use your legs really actually means use your HIPS”

  • You might have poor control of hip movement

which means there is no core firing when the legs are moving

Think of core stability as the foundation of your house. Without core activation, your hamstrings are in a constant state of contraction in order to take up the slack where the core cannot properly stabilize the hips.

Poor core leads to initiating movements with your back instead of your hips. This causes the hamstrings to feel tight. Read our blog on Hip hinge to understand the importance of hip movement instead of low back movement.

  • You might have poor posture of your hip joint

If there is poor posture, rotation of the joint leads to an over-lengthened hamstring muscle.
When you have an anteriorly tilted pelvis, your “butt bone” or the origin of the hamstring muscle is shifted upwards thus leading to a stretched out muscle that always feels tight. It is in fact, “weak-tight” meaning it does not need to be stretched, but more importantly, must be strengthened.




When tight Hamstrings is not in the Hamstrings:

Disc related injuries of the low back and nerve irritation can  make you feel a sensation of tightness in the hamstrings

Here are some red flags that indicate that the tightness might be coming as a sign of something else:

  1. Bruising, usually after an injury
  2. Numbness
  3. Burning or tingling in lower leg
  4. Weakness in the lower leg or foot drop of involved side

The Best ways to release tight shoulders

As addressed on our previous blog there are three main reasons why shoulder tightness develops


How can we release tight shoulders?

1. If the problem is that the Chest muscles become overactive:

The pec minor muscles can become extremely tight when we spend countless hours sitting down. Habitually being in this position: sitting in cars, in front of computers, or the tv etc. leads to the muscle pulling the shoulder blade forward and eventually limiting full shoulder range of motion.

What to do?

                Activate the weak muscles that will limit chest compensation. It can be achieved through a sequence of posture Angel exercises:[if you are sitting constantly at your job try to put an alarm to do this sequence of exercises]

Start on the floor and week by week challenge your body to be able to do it seated against the wall:


2. Lat muscles become overactive:

Lats (lattisimus dorsi) tightness will limit shoulder mobility. Lats usually become tight when there are previous shoulder injuries, or the rotator cuff muscles are weak and the Lats have to compensate for this weakness.

How to know if your  Lats are the problem? here

What to do?

                If you have shoulder pain, get it treated through chiropractic care and soft tissue therapy.  Follow a protocol to strengthen the rotator cuff; incorporate internal and external rotation exercises to create a more stable shoulder: Shoulder Strength


Poor Mobility of mid back: Thoracic extension

This is actually the most common cause of shoulder impingement and tightness. Many people have lost the ability to extend their mid-back. This is because A: we sit too much, and B: our head is so much more forward that our mid back becomes rounded


What to do?

                Correct your posture, sometimes taking care of yourself does not have to be limited to when you are in pain, getting a chiropractic adjustment and making it a goal to correct your posture will lead to longevity of your spine and joints.

What does chest pain imply when is not heart related?

Most of the time chest pain is not due to a heart attack

Having chest pain is not something that anyone takes lightly. Most people’s reaction to experiencing chest pain is that of a frightened response: a heart attack. However, most of the time the chest pain that is experienced does not come from having a heart problem. Instead, it is due to rib cage misalignment and muscular tension.

Today we are going to cover where this pain comes from and what we can do to not only heal it but prevent it from happening. Pain in the chest that comes from the rib cage usually presents in the front of the chest over the sternum, or on the back between the shoulder blades.

It can be scary to have these symptoms. One way to know if this pain is due to joints and muscles is that if you move in certain patterns the pain quality changes: it either makes it worse or better. If the pain is constant and no movement changes the quality of the pain then it can mean that is something more serious.

Important things to rule out with chest pain besides a heart attack are pulmonary embolism and aortic dissection. A heart attack needs to be ruled out when it comes to chest pain.

Many people end up in the emergency room but are told that they just have a muscle spasm. Patients with chest pain go home from the ER or hospital with no definite diagnosis. Although this is considered good news, the pain can persist and if not addressed it can become quite chronic.

Where does the pain come from?

Rib cage pain comes from poor breathing patterns most of the time. There are two primary ways we tend to breathe. One way is when we use our chest for breathing so we elevate the rib cage by using our chest muscles. This pattern of breathing is inefficient it results in minimum breath into the lungs because we use the small muscles between the ribs rather than the diaphragm.

Belly or stomach breathing is the most efficient way to breathe. It uses the diaphragm to expand space so that the lungs receive the maximum volume of air.  Learning how to breathe into the belly instead of shallow chest breathing has many benefits. It has been shown to reduce symptoms of asthma and bronchitis for example. It reduces the muscular tension between the ribs and therefore it prevents the rib cage from misalignment and therefore pain.

How can the pain be treated?

When the rib cage is misaligned it can be corrected through chiropractic adjustments so that the pain subsides. Many times soft tissue is used to release the diaphragm and therapeutic exercises are utilized to re-train breathing patterns.

In practice, we teach patients different drills so that their breathing becomes more effective.



The Actual Cause of Sciatica and why Sciatica is not a great diagnosis

Getting the right diagnosis for sciatica is the key to a proper and effective treatment.

What is Sciatica?

Pain traveling down the leg caused by nerve irritation is a condition that is commonly seen in chiropractic clinics. The sciatic nerve originates from the low back and it travels down the leg all the way into the heel. When people present with this type of pain the most likely “diagnosis” is sciatica.

However, sciatica is not a true diagnosis because it only describes the symptoms.  Pain from irritation along the path of the sciatic nerve.  The diagnosis does not address the actual reason why the sciatic nerve is irritated. Unless the cause is addressed, sciatic episodes are bound to continue

There are 3 mainstream accepted causes of sciatica:

  1. Disc Bulge and/or Herniation
  2. Bone Spurs and Disc degeneration
  3. Muscle spasm/contracture that pressed down on the nerve

Have you been told that your sciatica is due to a Disc Bulge or Disc Degeneration?

Disc degeneration is a common occurrence in our population. However, the majority of people with disc bulges and degeneration have no symptoms. Systematic reviews of imaging (MRI) of the lumbar spine in people with no low back pain or sciatica found that most people who had disc bulges had absolutely no symptoms.

The question then is…

Why if most people show some type of disc herniation do some have pain like sciatica and others do not?

The real reason that some people develop sciatica and others do not is that the nerve and disc are irritated by the way we move not by the fact that there is a bulging disc in the spine.

It is the position of the spine through movement that causes the irritation and sciatica to flare up. If people have the proper alignment and core engagement: when they are walking, running, bending forward or moving objects – the spine does not cause a compression on the disc, thus preventing it from irritation and pain.

In clinical practice, we use the McKenzie test to determine if the root of the pain is actually due to the nerve being irritated from the spine instead of the hips. This test allows us to observe the movement of the spine as the core is tested for engagement.

Piriformis Syndrome: It might be at the hips

Once spine involvement has been ruled out as the culprit of the pain we examine the hips. One of the hip muscles that will cause sciatica-type of pain is the piriformis muscle. The nerve travels below this muscle and if the piriformis is too spastic it will press on the nerve and cause a shooting type of sensation. Usually, carrying body weight on one side more than the other will cause the muscle to be spastic and therefore irritate the nerve. Alignment of the hips, as well as re-training of the hip muscles, will lead to positive outcomes when it comes to piriformis syndrome.

Finding the root cause is the first step towards an effective treatment.

The Often Missing Piece of Core Training

The ability to activate the core muscles during movement is perhaps the most vital factor in keeping a healthy spine. Countless of clinical studies have been done to determine what really causes low back pain and how it can be prevented, well it turns out that the main reason why people injure their backs has not so much to do with what they are doing but more importantly how they are doing it.

Sometimes due to the level of injuries on the low back, many practitioners advise against certain movements, specific exercises that are believed to be “high risk” like squats or deadlifts.  However, this really goes against what the studies show because it is not a particular movement that is to blame for injury to the low back. The injury is caused by the quality of the movement. In other words, it is how poorly we move that causes pain. Our body was designed to move, but if we do not know how to use it properly it will signal pain as a response.

That being said, it is our core activation that dictates the quality of movement, and therefore the health of our spine.  Now, most people think that a strong core is a solid visible set of 6-pack achieved by crunches, ab roll outs, and planks; however, this is a very common misconception. The visibility and definition of a muscle have nothing to do with how strong it is. A patient can have a very strong core and not show one single abdominal muscle.

Another common misconception about the core is that it can be trained effectively during isolation movements. However, it is important to keep in mind that we are not training our core to gain “strength” in those muscles per say.  We are training to learn how to active the core throughout a movement.

These are two completely different concepts. The use of core exercises like planks become valuable to the extent that we can develop an understanding of what it feels like to active the core,  how to do it, what it should feel like.  However, they have little to no purpose if we don’t have proper core activation.

The case of having great core contraction on isolation exercises like sit-ups and planks but poorly being translated into a healthy spine is far too common.  The reason is that the main function of the core is misunderstood and therefore ignored during training.  The main function of the core is not to help us sit up from a laying down position (like in a crunch), but it is actually breathing.

How we breathe is dependent on our ability to use our core, specifically the diaphragm.  If we breathe the correct way by engaging our belly muscle (the diaphragm) then we are using our core on a consistent basis, if on the other hand, we use our chest to breathe then our body hardly ever uses the core and therefore it forgets to use it. Especially, as we try to move whether that is through loaded exercises like squats or when we try to bend forward to pick up an object.

Activating a strong core has more to do with our breathing because that is its main function. As we have pressure built up in our belly from breathing, the spine is protected as a side effect.

Here is a common test we use in practice to test core activation:

We ask the patient to lay down face up, and we bring the legs up to 90 degrees, placing our hand beneath the low back we ask the patient to lower the legs in a controlled  manner, poor core activation will be noted as the patient tries to arch their back to control the movement losing contact/pressure over the testing hand.


Checkpoints for a Better Squat

I do not think there is another exercise as complete as a squat. We use it in practice every day to assess mobility, stability and core control from our athlete to our non-athlete patients; we see it as the most complete test of functional movement.

Progressing on strength and form takes focusing on the weakness or limitations that prevent someone from achieving good form.

We use a set of checkpoints to help improve form and prevent injury

Here are some of the common faults and what these typically mean when done improperly:

  1. Lack of Ankle Mobility

Do we have the mobility to approximate our shin to our toes?


This is where we typically start, without proper ankle mobility, the depth of the squat and torso control are compromised.

  1. Knee Mobility- How close can we approximate the calves to the thighs?

  1. Hip mobility- Can we flex our hip to approximate our chest to our thighs, without torso flexion

  1. Lack of Core Control, Engaging our core and having proper thoracic extension are the most important part of the squat, as these keep the spine from flexing and causing injury. If both of these areas are addressed and the patient still presents with a slight rounding of the low back and pelvis aka “butt wink”, we then delve further into the mobility of the hips in all ranges of motion.

  1. Engaging the glute medius to keep the knee joint and hip joint from rotating throughout the movement, the most telling sign that someone has lack of glute medius activation is the deviation of the knee throughout the squat.



There are different things that can be done to assess and correct the squat. We understand that although these are common patterns, it is important to evaluate each patient in an individual approach to design the best treatment and programming for ideal results.