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Dr. Cathy A. Kim, MD, APC

Standing and Fascial Stiffening | Ep. 9

Standing and Fascial Stiffening

Standing and Fascial Stiffening | Ep. 9

In this video, learn how the mechanics of knee joint hypermobility affects your posture and stiffens your musculature.  Restore fascial elasticity and vitality by adopting my functional medicine approach to daily movement.  Watch the video or read the transcript below to learn more.


Hi, I’m doctor Cathy Kim and I’m a Body Function Specialist. In my practice, I help you understand how our modern lifestyle is causing structural imbalances and metabolic inflammation that sabotage our well-being.

In my last video, I explained how modern chair-sitting creates stiffening of our thigh muscles and demonstrated how we could promote elasticity by making a few key changes in the mechanics of how we sit. 

Fascial Forces While Standing

Today, I want to share my perspective on how the mechanics of standing can also contribute to progressive stiffening of our myofascial system. 

Different colors of physio tape represent the myofascial forces along the thigh.

As the knees bend, the tape reveals the stretching of muscles and fascia.  As they straighten, the left knee stops, but the right knee continues to move backwards. This “extra” flexibility is known as joint laxity or hypermobility and is extremely common, especially in the knees, elbows, and thumbs.   

Even though the right knee has only mild hypermobility, the tension created by the right knee mechanics is visible in the tape all the way to the muscle attachment at the pelvis.  

In conventional medical teaching, joint hypermobility is not considered pathological unless you meet criteria for syndromes such as Marfans or Ehlers-Danlos, but in my Body Function practice, I have found that even mild joint hypermobility disrupts healthy body mechanics.  

Via the body’s complex fascial network, these misaligned forces can disrupt function beyond the orthopedic realm, including: painful or heavy periods (dysmenorrhea or menorrhagia), TMJ dysfunction, vertigo, or even digestive and cardiac problems. Yes, these problems could be originating from your legs! 

Excellent reference books to describe the anatomic and functional layout of fascia in our bodies are: 

Functional Atlas of the Human Fascial System by Dr. Carla Stecco, MD and Anatomy Trains by Thomas Myers.

You may also be interested in reading my case-based articles that discuss the clinical application of approaching our fascial network as a single, unified organ: 

TMJ Pain & Plantar Fasciitis: How They May Share the Same Root Cause and 

Could Vertigo Be A Myofascial Problem? (Part 2)

The crucial problem caused by knee hyperextension is that it immediately throws off the balance of our pelvis and torso, and the rest of the body is forced to compensate. Let’s look at a more dramatic way to illustrate the disruptive power of knee hyperextension, using a yoga posture called Warrior I.

In Warrior I, the front knee is bent at 90 degrees while the other leg reaches back to open the groin and stretch the hip flexor.  When the back knee is straight, the pelvis can remain more level and the torso stays vertical.

With knee hyperextension, however, the thigh muscles drag on the pelvis and the PINK back muscles activate to keep the trunk upright, resulting in arching of the low back and a slight shift forward.

Comparison of  the final images makes it easier to see the impact of the thigh on the pelvis and back.   

Now that we can visualize the effect of knee hyperextension on the pelvis and the back, let us take a step back and analyze how it affects our daily movement.  

Postural Consequences of Knee Hypermobility

Anteriorly Rotated Pelvis

Here are typical mechanics for standing up and favoring an anteriorly rotated pelvis: the knees push back, the front of the pelvis tips down, and the PINK back muscles activate to keep the trunk upright, causing the back to arch, a shape known as lordosis.

By softening the knees, the pelvis and torso can find balance over the heels and allow the pink back muscles to relax.

If the knee mechanics don’t change, fascia adapts to this movement pattern:  lordosis worsens as the disc spaces are compressed over time. 

Postural Consequences of Knee Hypermobility

Posteriorly Rotated Pelvis

Others resort to a posteriorly rotated pelvis for standing.  As the knees push back, the back of the pelvis tilts down and the green muscle group shortens. The pink muscles pull the upper back down and back to follow the posterior pelvic tilt.

In this sequence of clips, notice the effect of a posterior pelvis rotation on the thoracic spine, shoulders and head position.

Over time, the thoracic spine can end up markedly out of alignment from the lower half of the body.

Hypermobile Joints Creates Immobile Muscles

Remember, the muscles and fascia require Strength-Stretch forces to maintain overall elasticity, but when hypermobile knees substitute for “stretch”, this means that muscles become less flexible because they are only used to provide “strength”  Over time, stiffening of the muscles and fascia dominate and the joints break down because they cannot compensate any more.  

In traditional squatting, our influential thigh and pelvis muscles have to execute Strength-Stretch dynamics multiple times a day STRETCH >> STRENGTH in order to lower, and STRENGTH >> STRETCH in order to get up.  Muscles must handle both stretch and strength duties, leaving little opportunity for knee hypermobility to intervene.

The transition to chair culture has replaced this elastic, fluid movement of the thigh, with a series of short “adjustments” that exploits our joints — from the ankles to the back, and even beyond.  For  individuals with moderate and severe knee hyperextension, the fascial forces are even greater.  

Fortunately, we can incorporate the 3 Rules of Movement from the last video into our standing mechanics and revive dormant elasticity.  

  • Rule #1:  HEELS. As you stand up, use your heels to activate more muscles.  
  • Rule #2: KNEES. Don’t move your knees. Challenge your thigh muscles to stabilize your knees over your heels.
  • Rule #3:  HOLD YOUR PEE! (aka kegel). Instead of locking your knees backwards to stabilize yourself, kegel for balance as you get up and remain standing.   

Fascial Tension Is Fueled By The Thigh

Thigh mechanics are considered so important that athletic trainers, yoga teachers, and physical therapists emphasize perfect form for squats and Warrior poses; yet right afterwards, everyone, including the instructors, reverts to the stiffening patterns of modern living.

Take a day to pay attention to your knees and you will notice that you lock your knees when you sit or stand, push or pull a heavy door, put on pants, wash dishes, or work at your standing desk.   

Day by day, the tension you generate in your thigh gradually ratchets into your whole body’s fascial network, influencing distant anatomy via what I call, Fascial Histodynamics. But, thanks to fascial plasticity, changing our movement can improve our Histodynamic patterns and restore health.  

I hope this video helps you see how knee joint hypermobility can affect your mechanics for standing and motivates you to adopt the 3 Rules to help promote and preserve fascial elasticity in your body.  

Please leave any questions or suggestions for future topics in the Comments section.  As always, thank you for watching.

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Dr. Cathy Kim

Dr. Cathy Kim is a Board-Certified Family Medicine physician and Body Function Specialist. She practices in Camarillo, CA and specializes in complex cases.

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