The internet and social media are full of different alignment exercises for different joints and for the whole body. It seems that there is still quite a common belief out there that there is this one optimal and perfect way for joints to work and move – and any other way will lead to injuries and pain. However, my perspective on this topic is a bit different: I think that it’s not about one optimal & perfect alignment (or form), but rather how many variabilities and options the body has available.
The knee joint (as a part of the lower extremity) is probably one of the most mentioned areas when joint alignment is discussed, so we can use that as an example here as well. Couple of common beliefs that live strong regarding the knee alignment are that the knee shouldn’t go too much inside (valgus) or move too much in front (anteriorly). This is why people have heard the broken record of ”knee in aligned with the second toe” and ”don’t push the knee in front of the toes” over and over again. But to me it seems that there is too much attention on ’perfect’ alignment and form when in fact variability is the key: The knee should have the capacity to go and function in all different positions. At the same time, however, I want to emphasize that I don’t mean that form and technique wouldn’t matter at all. If the ’malaligned’ movement pattern is the only one there is for the individual to use we might be in trouble. But if there are other variabilities and options available and enough of capacity, then ’perfect’ form probably is not that big of a deal.
So what this means in rehab after knee injury or with knee pain is that instead of focusing on the perfect alignment and form, maybe we should build up the capacity progressively (which could mean quad and hammy strength, but also ab- and adductors as well as hip rotators or calf muscles – depending on the case) and focus on motor learning, introduce different movement variabilities and even some ’off-alignment’ exercises. Back in the day I experimented with these off-alignment exercises and all of the angles in a bit more isolated way (the idea was to introduce all possible angles to the joint, build up confidence for the client and in a way to ’strengthen’ all of the connective tissue, ligament structures etc. around the joint area). Nowadays my thinking has evolved in the direction where I see more value in creating variability in how the stress can be distributed, transmitted and absorbed from a single joint to larger kinetic chains (’earthquake architecture’) in a coordinated manner. Coordination & rhythm, interplay & orchestration of the whole body play a crucial role in joint health and injury prevention.