The quarterback throwing motion is a very complex motion where athletes can tend to have a lot of issues if they aren’t taught the right things. As quarterbacks are developing their skills as throwers, it’s important to identify common problem areas where issues can arise. One of these areas is the knee on the plant leg of the quarterback. Pain in the knee can persist for long periods of time for quarterbacks if some of these dysfunctions aren’t cleaned up. Guess what though? There’s a pretty good chance that the knee isn’t even the primary issue that is causing the problem for the quarterbacks. Better read the rest of this blog post to see what we mean!

Whenever we are evaluating quarterbacks, the first thing we try to do is distinguish if a quarterback falls more in line with being hyper mobile (overly flexible) or hypo mobile (stiff). This allows us to understand how the issues that they present are related to the pain or throwing restrictions that they have. For today’s topic on knee pain, these quarterbacks tend to be more hyper mobile. The extra range of motion/lack of stiffness or lack of mobility at certain areas tends to cause pain in the knee after repetitive movement in the throwing motion. We are going to hit 3 common problem areas that athletes tend to present with that cause knee pain. Here we go!

1. Hip External Rotation Strength

Weakness of the deep external rotators of the hip are super common for all quarterbacks, but we want to relate this to why this is causing knee pain today. During the loading phase of the throwing motion, the QB opens up the plant leg to the target. This would be considered external rotation of the hip. Problem number 1 happens when the foot doesn’t open up enough to the target to where the hips can be fully used when accelerating forward. This directly affects the knee position where the knee will go into a valgus fault when the foot hits the ground. This is a very vulnerable position for the knee as the patellar tendon is not loaded correctly, as well as the knee ligaments all being put on tensile force. You can see what I mean in the picture below.

You can see that this quarterback’s knee is in a very vulnerable position and in a position where it’s very challenging to use the body effectively. We would want to see the foot opened up all the way and pointing at the target while the knee is directly above the foot. The picture below depicts the proper position.

Quarterbacks will need to strengthen their external rotators both in an open chain fashion, as well as closed chain fashion to target external rotation during the loading and acceleration phases of throwing. An example of an open chained exercise that can be used is shown below!

2. Foot Supination Strength/Stability

The foot might be the most overlooked body part of the body. This is a shame because it is very important for quarterbacks, especially once the plant foot hits the ground during the throwing motion. For quarterbacks that lack some eccentric strength/control of their foot supinators, they can also present with this issue at the knee that is very similar to the picture that you see above. The arch of the foot will collapse causing a flat foot and loss of the arch of the foot. This flat foot position will cause a misalignment of the knee since there is now no stable platform to drive from. The valgus knee position can be caused from an issue at the hip or an issue at the knee, which will cause pain and loading problems for the quarterback. Below, you can see the picture of what a knee values position is.

Ankle range of motion and foot stability go hand in hand. In order to even have a shot at having good intrinsic foot strength, athletes need good ankle dorsiflexion range of motion as well. Below are two videos for ankle mobility and foot stability. Make sure you check these out and start performing them to clean up your knee pain!

3. Locking Out the Front Leg

The last issue that we often see is locking out of the front leg during the acceleration phase of throwing. We often call this “snapping leg syndrome.” This can be due to many reasons, but since we are talking about the hyper mobile QB, we will talk about why a hyper mobile QB will present this way. This QB propels his body forward through trunk flexion and knee extension, instead of true hip extension. This is because this QB lacks stability in his trunk and his hips. A lack of stability in these areas equals a lack of ability for the QB to use hip rotation and hip extension to produce the force. Below, you can see a video of what we mean.

Knee pain will come with this over time as the throws start to accumulate. Knee extension while loading the wrong way equals pain with a lot of reps. This can be cleaned up by becoming stronger and by also developing stability in areas where quarterbacks are weak. Please understand that not all quarterbacks with snapping leg syndrome will perform that dysfunction because they lack stability. That’s why it is SO IMPORTANT to have someone like us evaluate you before you start to clean up your motion so you can understand the proper path to success.

We hope that you learned a lot today by reading this blog post. Please understand that the human body is a system of systems. If you don’t understand the whole system, then you better find someone that can to reach your max potential. Reach out to us today! We can help for sure! You can email us at [email protected] or call at 812-343-4226.

-Drew Kiel PT, DPT, CSCS