Neglecting the tibial rotation range of motion can damage your meniscus and ACL. Learn four tibial rotation exercises to restore strength in your knees.
Coach E from Precision Movement here. Today, I will discuss one of the topics I love to cover here: the neglected range of motion muscles and movements that we need to move freely and without pain.
I’m also going to back up what I will talk about with some science, and then we’re going to get into some unique and effective exercises you can do at home to fix this neglected range of motion. One of the phrases I often say is, “use it or lose it.” This applies to everything in life, so it applies to everything in our bodies.
When it comes to tibial rotation, use-it-or-lose-it applies to both tibial rotation and all of the connected mechanisms.
How Tibial Rotation Affects the Meniscus
The first thing I want to talk about here is the meniscus. If you lose tibial rotation, your meniscus will not experience as much movement as it usually should in everyday life. Because of this, it will not receive those forces, and those tissues will not adapt and stay strong and pliable.
In my research, I found a great study that explains exactly this.
The study’s title is “Assessment of tibial rotation and meniscal movement using kinematic magnetic resonance imaging.” [1]
Kinematic MRI is the ability to perform an MRI and record it live. During the MRI, you can see the movement of the structure.
The study found that “the tibia rotated internally about 11 degrees during knee flexion and externally around 11 degrees during knee extension.”
The important point here is that “…with regards to the meniscus is with knee flexion, the medial and lateral menisci moved backward, and the height of the meniscus increased. The movement range was greater in the anterior horn than in the posterior horn and greater in the lateral meniscus than in the medial meniscus.”
This study showed that as you flex and extend your knee, you have a natural internal and external rotation of the knee. The meniscus gets pressed, crushed, and deformed through that rotation in various ways. But if you lack the internal and external rotation of the knee, then you won’t get those same forces going through the meniscus, and use-it-or-lose-it will apply. And when you lose the pliability, tears more easily occur.
The second structure affected by tibial internal and external rotation is the ACL, or anterior cruciate ligament. The same use-it-or-lose-it phenomenon that applies to the meniscus can also apply here. If you’re not going through full tibial internal and external rotation, especially external rotation, then that ACL is not going to get the stress that it needs to stay pliable and strong.
Ligaments are very similar to muscles and tendons. They need force to maintain strength and pliability.
How Tibial Rotation Affects Your ACL
When it comes to the ACL, we know that it is most at risk in sports that involve high-speed cutting and changes of direction, like soccer or basketball.
A study titled “Revisiting the Role of Knee External Rotation in Non-Contact ACL Mechanism of Injury” created a model of the ACL and tried to see where it would be under the most stress and, thus, risk of injury. [2]
“The results demonstrated that the peak stress (11.00 MPa) and strain (0.048) occurred at the midportion of the anteriomedial bundle with the higher values being obtained under a combined knee valgus, flexion, tibial external rotation and high axial load.”
It’s clear that tibial external rotation puts stress on the ACL. When we use that external rotation in our normal daily lives and these exercises that you’re going to learn, we’re putting good stress on the ACL.
We need to stress these tissues to make them stronger and keep them strong. But if you lack this tibial rotation movement, then use-it-or-lose-it applies, and a couple of things will happen with the ACL.
Number one is if it’s not getting stressed, it’s getting weaker, and you’ll lose that pliability. Without pliability, it’ll be able to snap more easily. With pliability, your ACL will stretch more before giving way.
Number two, what will happen is if you’re lacking in range of motion through the knee joint, tibial internal and external rotation, when you’re using it, you’re going to hit a barrier. You’re going to hit a hard barrier where you no longer have that range of motion.
But if you break through that barrier, it will be a sudden stress, and that’s a high amount of force in a short amount of time. When you do that, it will break through the “bony barrier” of the joint, and then you’ll get quickly into the ACL, resulting in excessive stress on the ligament and a good chance of it popping.
Tibial Rotation Exercises
Enough fear-mongering. What can we do about it?
Well, we can do exercises. So now we’re going to use tibial internal and external rotation. That will help us use the meniscus and the ACL and keep those tissues healthy and pliable.
If you want to follow along with the video of these exercises, click here to watch How Your Poor Tibial Rotation TRASHES Your Knees on YouTube.
Exercise 1: Tib-Fib Mobilization
The first exercise is going to mobilize the tibiofibular joints.
There are two tibiofibular joints. The proximal one is up higher. The distal one is down lower.
Start with the proximal one.
- Grab the head of the fibula. (It can be really sensitive.) It’s the knobby part on the lateral (outside) of your leg just below the knee
- Stick your fingers just below the head of the fibula and just push it back and forth (anterior and posterior)
- Keep moving it back and forth for about 30 seconds
- Move your hand to grab the whole leg just above the ankle
- Wring it out for 30 seconds
- Repeat with your other leg
The area around the head of the fibula can be stiff and painful. But it’s good that we’re digging in there because keeping those muscles pliable is always a good thing. The area around the ankle can also be painful, but keep trying so the joint has at least a little movement.
Exercise 2: Seated Tibial Rotation
Now that we’ve done the joint mobilization, we’re going to activate the muscles so that any extra movement we get with the joint mobilization will stick. We can train the muscles with the brain to use and keep this new range of motion.
For that, we’re going to do the Seated Tibial Rotation exercise. You can do both legs at a time if you like, but you don’t have to.
- Put your fists between your legs, and you’re going to keep that distance between your legs
- Pop your heels just off the ground, and rotate the heels out as you’re spinning on the balls of your feet
- Pulling the ground toward your butt
- Hold for 5 seconds
- Rotate the heels toward each other, pulling the ground toward you
- Hold for 5 seconds
Do two sets of 4 – 6 reps.
This exercise activates the hamstrings, which are the muscles that contribute to and form the movements of tibial rotation. Try to activate those muscles as much as you can at the end range of motion.
Go slow, back and forth, making sure the knees stay an equal distance apart, and feel the hamstrings work. When the heels are close together, you’ll work more of the lateral hamstrings. When the heels are further apart, you’ll work more on the medial hamstrings, so the inside.
You can also poke that area to wake up the muscles and teach them that they should be doing this movement.
Exercise 3: Supine Tibial Rotation
After the Seated Tibial Rotation, I like to do the Supine Tibial Rotation. This starts to train the knee locking and unlocking mechanism.
When you straighten your knee, it has to rotate a little bit, or when you straighten or bend it, it has to rotate a little bit to fully get out of the straightened position.
- Lie on your back and flex your hip to about 90 degrees.
- Starting by letting your knee relax, your heel drops toward your butt, and you go into tibial external rotation as far as you can
- Fully straighten the knee, keeping that rotation until the end, where it goes straight
- Come back fully flexed and then go into internal rotation
- Straighten it out. The knee will lock, and it will be straight
Again, just go back and forth – external and internal rotation – for 2 sets of 4 – 6 reps.
So here, we’re just ensuring that we have a sufficient range of motion through the flexed portion. Your knee doesn’t rotate when it’s perfectly straight. It’s locked. It’s nice and stable, and you want to keep it that way. But once you start getting into the flexed or bent knee position, you need to unlock the tibial internal and external rotation.
We’re just training that with this movement, which is also more quad-dominant than the previous exercise, which was more hamstring-dominant. We can train this knee rotation range of motion with these different patterns.
The more patterns we train this range of motion with, the better we can make it stick.
Exercise 4: 1-Leg Tibial Rotation Squat
The final exercise is the 1-Leg Tibial Rotation Squat.
A word of warning: if you have current meniscus or ACL injuries/pain, do NOT do this exercise. Or at least you can do it, but don’t push it into any painful range of motion.
Even if you don’t have any of these injuries, don’t push through a painful range of motion because this can irritate it. However, if your knees are good and you want to keep them that way, then working on this type of exercise is good because, again, you can use-it-or-lose-it.
You will need to know how to do the Short and Skinny foot activation for this exercise. (If you don’t know how to do the short and skinny foot, click here and go to Exercise 3.)
- Start with the short and skinny foot on your front leg
- With the front knee straight and locked, start with tibial external rotation (knee toward your center line)
- Drive your knee in a circle, come up the middle, and straighten it out
- Switch to internal rotation
- Drive the knee to the outside, circle forward, and then come right up the middle
Perform 2 – 3 sets of 4 – 6 reps per leg. You can switch legs between sets or do all reps on one side and then the other.
Keep most of your weight up on your front foot the entire time. Hold the short and skinny foot the whole time. That metatarsal pressure is important. Keep your foot balanced on the ground. Don’t roll to the inside of your foot. Keep balance evenly across your foot as you go inside and outside.
You may need to press down consciously with your foot. For example, you might need to press down more with the lateral aspect of your foot as your knee goes to the inside to maintain balance and even pressure.
What we’re doing here is integrating the movements and activation patterns from the first two exercises into a closed-chain, functional movement.
Just like we went through earlier, when does the ACL get injured? When you’re doing twisting motions, running, or planting, you’ve got the valgus knee combined with tibial external rotation, with the knee bent and high forces. That’s how you blow your ACL.
We’re training this exact range of motion, but we’re going slow, so we’ve got muscular control throughout the full range of motion. With that muscle control, we keep the ligaments safe and reduce the risk of injury.
Next Steps for Healthy, Pain-Free Knees
Now that you know about this neglected range of motion, you have these tibial rotation exercises to ensure it is there when needed.
You have another neglected range of motion that will no longer be neglected. I hope you enjoyed this article. We have a couple of other resources for you.
How to Improve Ankle Dorsiflexion to Eliminate Knee Pain – If you have knee pain, you may need to improve your ankle dorsiflexion. Learn to how to test your mobility and some unique exercises to quickly improve it.
5 Exercises for Bone-on-Bone Knee Arthritis Pain Relief – If you’ve been told that you have bone-on-bone knee pain and are wondering what you can do, join us to find out whether exercise is the help you need or if you should go under the knife.
But if you’ve got knee pain, the most important thing to do right now is to get started on our Knee Pain Solution, which includes concepts like you learned here on tibial rotation and many others that are similar and neglected and need to be worked for pain-free and healthy knees.
