Lower Body Workplace

by Mitch Hauschildt, MA, ATC, CSCS

Recently I spent 4 days with some of the smartest people anywhere in the field of movement science at the annual Rocktape Instructor Summit. It is a chance for the best Rocktape professionals from all over the world to assemble and work tirelessly for a few days to improve the understanding of movement throughout the world. When I say that, it feels that I might be overselling it a bit, but honestly, it is true. This year, we had brilliant minds from the UK, Australia, Mexico, Canada, and of course the US contributing and learning from each other.

One of the great things about this annual movement pilgrimage is that we literally spend16-18 hours together each day. Much of that time is structured with plans and goals going into it, but a lot of it is also just smart people hanging out together talking shop. Those are always my favorite parts of the weekend.

The last evening of the meeting, I was enjoying an adult beverage next to my good friend Stu Wilson. For those of you who don’t know Stu, he is one of the best PTs out there and I have learned a lot from him over the past couple of years. He motivates me to be better everyday thanks to his infectious knowledge and passion for life. He is not just a great PT, but he is an outstanding father, husband and man of faith. He’s the kind of guy I search to surround myself with everyday.

As we were talking about life in general, we started discussing the knee and it’s role in the lower extremity. We both agree with Gary Gray when he says that the knee is the “dumbest joint in the body.” At the end of the day, it is simply along for the ride, sandwiched between the hip and the ankle, doing whatever they tell it to do. The conversation rolled into a workplace analogy that I believe really illustrates how the lower extremity works in most people. Hopefully this analogy will shed some light on the importance of training the entire lower extremity when treating knee pain.

Being part of a team, either for a sport or a job, most people will agree that everyone involved plays an important role and everyone must step up and do their job in order for the business or team to be successful. But rarely is the case that it actually happens that way with everyone pulling their own weight to make the overall team successful. People tend to settle into several workplace roles:

The Blocker: They tend to be negative and stubborn, unwilling to contribute to team efforts, disagreeing and opposing without or beyond reason. They usually go against everyone else and are ultimately in it for themselves.
The Avoider: They try to do the least they can get away with, not becoming involved in team progress, being quiet or doing other work during meetings, not volunteering for assignments, presentations or never accepting any leadership responsibilities.
The Workhorse: They are the model employee, almost to a fault. They come in early, stay late and go above and beyond their call of duty. The downside to the workhorse is that they eventually become burnt out and broken down to the point that they become worthless. But, the team can’t run without them.
The Dominator: They try to use authority or long-service as a manipulator of others to their own agendas. This normally takes the form of asserting higher status, giving direction or down-casting the contribution of others.
The Joker: They adopt a nonchalant attitude and use an excessive amount of humor at inappropriate times. They rarely take things seriously, and want to be seen as the fun member of the team.
The Caretaker: They give constantly, but are often in relationships in which love and caring is not returned. They are drawn to people who take, but do not give. This is true of all their relationships whether it be their spouse, their children, their friends, their bosses or their coworkers. Ironically, because they are always giving, they tend to be the start of many of the issues within the workplace.

When you look at the lower extremity as a workplace, each area fills one of these roles. The ankle is the blocker. It is usually rigid and doesn’t play well with others. It is resistant to change and thus doesn’t get very much work done. The glutes are the avoider, only doing as much as it has to. It doesn’t play well with others, because it has a bad habit of pushing work onto others. The workhorse is the knee. It does everything that it is asked to do by the ankle and hip and goes and goes and goes until it can’t go any more. The dominator is the Psoas. It does whatever it wants, whenever it wants, regardless of who else is affected. It has a bad habit of being overactive, underactive, short and long, all at the same time, depending upon what it is being asked to do. The Joker is the core. Everyone likes to work with it, because they know that it is important, but rarely is it doing what it is supposed to be doing, but everyone allows it to continue working there because it looks good and puts on a good face for the business. Finally, the foot is the caretaker. It works hard to compensate for all of the other dysfunction, but because it is always giving, it isn’t strong or stable enough to stand up for itself, thus it actually creates an entire set of dysfunction within the group.

If the lower extremity were truly a workplace, we would look at things and make changes. We would tell the joker (core) to knock it off and get some real work done. We would ask the dominator (psoas) and the blocker (ankle) to take it down a notch and become a team player or they’re going to get replaced. We would love on the caretaker (foot) and the avoider (glutes) to encourage them to be more like the dominator at times. And, we would do all of this in an effort to protect the one person we are happiest with, the workhorse (knee).

While the knee only complains when it needs to, a good boss understands that if it doesn’t change things to protect the workhorse, they won’t be around long to continue the work they were hired to do. Unfortunately, we have a tendency to do just the opposite as clinicians. We ignore the true cause of the workplace dysfunction because it is a more complex problem and takes more energy get to root of the problem, so continuously put a band-aid on things to try to keep the peace.

When the workhorse is hurting, we hug it with a sleeve or a brace. Or, we inject it with a quick bonus or gift (i.e. corticosteroid) to make them happy in the short term to buy some more time before they get too mad or fired up. Sometimes we even go to the level of taking them to the spa for a massage (soft tissue work) or a nice haircut (arthorscopy) when things get really bad. But, at the end of the day, all the workhorse really wants, is for everyone else to just take their job seriously and do what they are paid to do so his or her life isn’t so stressful. He wants a little less work and a little more fun while at work, but he can’t, because he’s constantly under a ton of stress.

Think about the cause of the dysfunction the next time you look at a painful knee. Get the dominator and blocker to calm down, the joker to take things seriously, the caretaker to grow a backbone and the avoider to do some real work so that the knee can punch the clock and be happy for years and years to come.