Using Co-contraction Opportunities During The Day With Your Knee Pain Patients

Having an athlete leave your clinic pain free is an incredible feeling, but as I always say to anyone who attends the mentorship, the real art is getting those symptoms and the athlete to stay away.

In the previous knee joint article we delved into implementing a graded exposure change of direction process into your own rehab plan.

Today, I’ll share with you one more key to getting long-lasting results you deserve and your athlete needs.

Going Pain Free

Preparing your athlete for the real world is the final piece of the puzzle but we need to make sure that when at the gym or performing daily tasks, our patient is using and practicing good co-contraction strategy. We want the hamstring, the calf and the glutes to do their jobs.

There is one sure-fire way to get this all going. That’s with foot pressure. In order to keep all tissues happy we need to manipulate the direction of force through the foot.

Split Foot Squat

You can ask your patient to do a split foot squat. When doing this the patient has to generate a lot of torque to extend the knee.

When I ask an athlete to perform this exercise I see one of two things. Either they shift their weight right to the toe or to the heel. In either case the patient will be using more of certain tissues and less of others. What we need is all of them to do their job.

To counter this weight shift, ask your patient to keep the majority of their weight through the mid foot. This will give an ideal co-contraction with the hamstring, glutes, quads and gastroc all doing their job.


Another useful way to correct weight shift is by asking your patient to lunge. Again you’ll see most athletes coming in with the weight on their toes or their heels.

To get a positive co-contraction they need to put weight through the midfoot. Just as when we were doing a split foot squat, this pushing off through the midfoot allows the hamstring and quad to fire and the glutes and gastroc to chip in.

The midfoot is a part of the body that is so often underused. Some trainers are making athletes push through the heels or toes which will result in tissues being over or underused.

Final Thoughts

Pay close attention to weight distribution in the gym and through other activities. Do not go excessively through the heel or toe, putting weight on the midfoot will allow for an ideal co-contraction. This process is about allowing all of the tissues to work efficiently together and do their own job.

For more help on how to progress your athlete through a step-by-step rehab process click here.

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