Stop if there is any pain, as this exercise should be pain free. When moving forward do not bring your knee in front of your foot.
Place your foot on a chair and then wrap a stretching strap around your ankle so that it will rotate your calf internally when you pull on it. With your knee relatively straight pull enough tension on the stretching strap to have your foot point straight forward.
While maintaining tension on the strap move forward so that your foot is above your ankle. Move back and forth 10 times.
When I would see a client's foot rotated externally I used to believe the cause was tight external rotators (piriformis and deep six muscles) in the hip. I have since learned that the problem can be at the knee joint instead of the hip. Tightness in the lateral muscles of the thigh (biceps femoris, vastus lateralis, tfl) can pull on the tibia and fibula and create a torsion stress at the knee.
Testing for tibial torsion can be done by having your client supine and flexing both the the hip and knee to 90 degrees. Gently dorsiflex the ankle and see which way the foot points. If the foot points laterally that implies tightness in the lateral thigh muscles (biceps femoris, vastus lateralis, tfl, etc.).
This torsion at the knee joint can put stress on the the ligaments and on the patellar tendon, and it can be a source of chronic knee pain. Treatment of tibial torsion can help to reduce stress on the knee and may help to relieve knee pain.
Assessment and treatment of tibial torsion is shown in a 23 minute video on knee pain which can be found here. Assessment of tibial torsion begins at 8 minutes 42 seconds, and treatment begins at 15 minutes 45 seconds.
Even with treatment the problem can sometimes recur, so I have found this self care exercise helps clients to stay aligned and pain-free.
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