Ben Patrick, better known as the knees over toes guy, has taken social media by storm. You've probably seen him doing some incredibly athletic feet that looks like it should be impossible to do, all while making it look effortless. He's turned the traditional rehabilitation world on its head, helped thousands of people, and upset quite a few rehab professionals on the way. Today, we're diving into what makes his program so effective for lots of people, and stick around to the end as I'll give you a practical checklist for what you need to look for when looking for your own knee rehab program. Welcome back team to the Building Lifelong Ethics podcast. Thanks for stopping by. My name is Jordan Rennicke. I'm a dual board certified physician in sports and family medicine, and the goal of this podcast, help you stay active and healthy for life through actionable evidence-informed education. Let's dive right in. First, we're gonna start off with his claim. So Ben Patrick is the brain behind knees over toes, right? And he tells the story of having a bunch of previous surgeries, knee issues, all that stuff, pretty much saying he was debilitated by having knee problems. So he was told he's never gonna do X, Y, and Z again, and pretty much had no outlook until he figured out this solution. So he figured out through this process of rehab something that worked for him, and now he's trying to change the world of fitness. And physical therapy and exercise science, traditionally these professionals recommend keeping your knee behind your toe. So when he's talking knees over toe, we're talking about your knee going up forward over your toe. And back in the day in the rehabilitation world, it was thought to be a big no-no to do that because there are studies that do indeed show that when your knee translates forward over your toe, it does increase the stress on your knee. So the idea was that, whoa, that stress is probably bad, we should keep our knees behind our toes. And that was like the old thing. And Ben has kind of come in and turned the world upside down saying, nope, that's actually not it at all. We were entirely wrong and we should get there and we should do that. We should get that movement. His whole idea is that the medical establishment was wrong and that getting your knee over your toe is actually the key to building knee resilience. And of a side note, he does like using the word bulletproof quite a bit, saying, hey, I'm gonna bulletproof your knees. As a physician, I can confirm your knees will not be bulletproof. If someone shoots your knee, it will indeed go through. It's not a good thing. So, I mean, I joke when saying I don't love the term bulletproof, but it's a great marketing, I understand that. But in reality, what he's trying to build is knee resilience and I'm all for that. But I think just a side note that bulletproof is never really truly bulletproof. It's just hopefully trying to build some knee resilience. Next, let's talk about why this works for so many people. And some of the things that he does, they may look insane, but the underlying principles are solid and honestly nothing new. The three main reasons his program succeed are because you have patient buy-in, progressive loading and auto-regulation. And I can pretty much just stop the podcast here as this describes every single quality rehab program in the world. These are the three underlying principles that for everyone in any program, those are gonna be the biggest things, right? So most people freak out about and really worry about this specific exercise or this specific exercise where in reality, the underlying principles are way more important than any specific exercise you put into a program. But those are the three main things that make this program tick. And we're gonna talk about those one by one here, go a little deeper on each individual one. All right, and so number one is patient buy-in. So this actually may be the most important point. And the point I like to make is you could have the best program on earth, right? Have a panel of professionals devise a perfect program that is down to the T, the best thing that science has ever shown us and experienced and it's perfect. But if you don't do it, it doesn't matter. And that's why patient buy-in matters so, so much. And I think he does a fantastic job of doing this in his programs, getting patient buy-in. He gives people hope, right? And hope is contagious and exceptional and improving outcomes. It's pretty standard that if you are optimistic, we have better routine outcomes for rehabilitation. Like you are optimistic and think this is gonna work, odds are it's going to work. And so Ben does an amazing job of fostering this environment. Hey, like you're not broken, we can get better. And I love that. That's one thing I do love. He's saying, hey, no matter how bad you are, we can get you better. Maybe not all the way. And he doesn't claim that at any time saying you have to do this, you're gonna get better a hundred percent. But he's saying wherever you are, we can get you better. Little by little, I love that. So he's contagious in his optimism, that's for sure. I think that's a huge reason. And he shows people that it's possible to come back from debilitating pain. And that is very motivating, right? When you are in pain a lot, that is it. To the idea of, hey, getting better, that is what we're looking for. Another aspect, he also offers coaching one-on-one in his programs and we've seen in previous studies that freaking check-ins for adherence is great for that. So when someone's there being accountable to you saying, hey, how are you doing? What's going on? That's great. Their program does have that when you pay for it. I've actually bought a program. I was curious because I've had so many people as a sports doctor, I had so many people come to me saying, hey, I tried knees over toes and they're still in my clinic. So I had to know, I had to know what's going on here. So I looked at it and I bought it just to kind of take a look at it. And they do kind of guide you through. And there's a coach, and not necessarily a rehab professional, there's a coach there saying, hey, coaching on the movements is kind of like treating like a strength routine is what essential it is. But there's a coach who's able to check in, see how you're doing. You can get feedback on your form and all that stuff. So that's another big reason why they have a lot of really good adherence. And so the first thing in a good program is that the patient believe that it could work for them. And then from there we have to go, and that's number one, right? If your patient doesn't believe at all, like, hey, this isn't, you know, it's not gonna work, then occasionally it does work still. And they are, wow, they're surprised. But a lot of times if they're not bought in, that's gonna be bad. And this is something that Knees Over Toes does fantastically. They get full buy-in and people are ready to go and they just, they love it and they're ready to go. So the second thing that's really important is progressive loading. So progressive loading, this is the bread and butter to any solid program. And I'm not just talking about rehab, right? So rehab, yes, it is important to have progressive loading, but this is strength and conditioning in general. If you're trying to get more fit from a cardiovascular perspective, you're gonna have progressive loading. From a strength perspective or a power perspective or flexibility, literally whatever, progressive loading is gonna be the ticket for all of these things. And so this is a core, core teaching for anything strength and conditioning that is incorporated into this Knees Over Toes program. And progressive loading is the idea that you incrementally over time increase how challenging your workout is or your rehab program to increase either your fitness, your strength, or your tolerance to an activity, right? So things you can change, let's think about weightlifting, right? So that's probably the easiest one to explain. If you're trying to get bigger or get stronger, you're gonna have to change some variables, whether that is the number of reps you do or the number of sets you do or the time in which you do them in terms of time and attention, how slowly are you lowering your eccentric versus concentric or how much volume are you doing in a total week? How many sessions are you doing per week? There's so many things you can tweak, but that progressive loading is changing and tweaking those variables for week after week or session after session trying to kind of gradually improve. And now I'm not to say you have to just keep throwing on weight, I don't agree with that. You know, there's different, that's a whole other podcast topic in terms of linear pureization versus whatever. So it's not like, hey, I'm gonna add five pounds every day and get stronger, no, 'cause eventually your body will stop it. But a lot of times what this whole process is is allowing your body to slowly accumulate fatigue, recover from that fatigue and then increase from there. So essentially you have a stress and then you recover from that stress and hopefully after that recovery, you're more fit. That's like the general goal and you do this little by little and slowly over time, you kind of just go, go, go and get more fit. That is the general idea of progressive loading. And you know, you don't have to necessarily, sometimes programs can get away with it if it's not well thought out. Occasionally you can throw some things together and people just need a little bit of break and they get better. Sometimes that happens, you know, you just pull back a little bit and you get better, but really quality programs are gonna have this built into it. And they're the ones that when you have lasting success, they have some sort of progressive loading into it. And some of his exercises may look crazy, atypical, but just absolutely crazy, but he still does a good job of gradually injuries movements. He talks about regressions and progressions of various movements and that's really important 'cause not everybody's gonna be able to do everything, right? So when I talk about progressions and regressions, let's say we're talking about a squat. Squat's an easy one to think about. A regression of a squat is maybe I have to go not as deep, or maybe I go to a box or I use less weight, something that makes it a little bit easier for you. And progression then would be, okay, maybe I go a little deeper in my squat or I add more weight or you change something up. So there's different ways to do, I mean, there's almost infinite ways to do every movement. And he does a good job of having these regressions and progressions. And the reason this is important, 'cause everyone's different, right? Maybe someone had a history of a surgery or an ankle surgery or something and they have really limited ankle mobility. Well, you're not gonna be able to do every single movement as prescribed the way it looks on their video examples if you physically can't get through that range of motion. Or maybe you have a lot of pain with a specific range of motion. Altering that is very reasonable as well. And so overall, I think they do a great job of having regressions and progressions, they can do that. And for every single good rehabilitation program, we have to find the correct entry point for the patient. So for someone who's in a crazy amount of pain, this may be a very little amount of exercise. So if you're having debilitating knee pain, when you were a, let's say you were a power lifter, right? Able to squat 700 pounds. If you're having debilitating knee pain, that may entry for you may be body weight squats, which would be crazy, right? You're incredibly strong, but the role of every good rehab program is finding an entry point, right? And to say do nothing is not rehab, that's just resting. And that's not ideal and that's not helping anything necessarily long-term. So we've got to find an entry point for activity and then progress from there. I think that's the biggest thing. And he does a good job with this. He talks about backwards walking, being the first step you have with the knee pain. And he says, "Hey, if you can't do anything else, just walk backwards." So it does give people that entry point where even if you can't do anything else, you can't bend your knee, you can't go forward with it, you can start with backwards walking. So he does do a good job of putting in a starting spot for them. And his whole philosophy is built upon building tolerance in the knee over toe position, right? So again, that knee over toe and backwards walking is the first and least aggressive way to do that. So he does find the entry point and he slowly progresses from there. And progress may be slow, but little by little, you can do more and more, and that will build up your tolerance and confidence. And at the end of the day, most injuries are a load tolerance issue. And so what I mean by that is the vast majority of times when I see an injured person, you can look on ultrasound or MRI and there's no actual damage to a tissue anywhere. They just have pain. And specifically the most common knee pain that I see is patella femoral type pain. There's no structural issue there. It's just a low tolerance, meaning for whatever reason, right now in your life, the amount you're doing or the things you're doing, your knee is just not ready for it. Pain is very complex. That's a whole nother podcast series in reality. It's so complex, but it's not as simple as, hey, there's damage to the structure, therefore I have pain. Are there times when it happens? Yeah, like when you break a bone, that equates pretty well. Like, yeah, bone's broken, you have pain. But for these chronic issues like jumper's knee, patella femoral pain, things like that, it is much more complex than that. And we just find all the time that it's usually a load mismatch, meaning, hey, I ramped up my activity too fast, or hey, I ended up doing too much and I'm not recovering well, I'm not eating well, I'm not sleeping well, all of these things. And then kind of, yeah, your body can only take so much stress, right? So when you train, you perform stress on your body and that's good, we want that, right? That's how you induce changes and improvements. But you have the stress, you have to be able to recover from it and so a lot of times, what I see is that we're just, your body is not ready to handle it. And it may be at a surprisingly low level for some people saying, hey, I used to do this, now I can't do this. Well, maybe things changed in life and circumstances and stress and all that stuff. Either way, if you're having an incredible amount of pain, usually what that tells me is we need to go below that pain threshold, right? Slowly increase workload till we get to that pain threshold and then our job is just to bump up against that threshold day by day by day, week by week, month by month, year by year to gradually increase our capabilities and tolerance and that's the main idea behind this whole thing with knees over toes is you're just slowly introducing it there and progressive loading and that's gonna be the biggest thing. And the last thing that they do is auto regulation. So auto regulation, this is the concept where you adjust what you're doing based on how you feel. This typically involves things like RPE or rating of perceived exertion or reps in reserves, RIR, meaning you're kind of gauging how you feel. So for example, let's say RIR, you're doing bench press. If you say, hey, I want you to do this set with an RIR of two, meaning, hey, you have two reps in reserve, so you do your bench press to get to the point where, ooh, I think I could have done two more but no more than that and that's like the level you're going for. RPE is where you're kind of grading on a scale of, we've kind of used one to 10 to make it easier. Initially it was developed like eight to 26, like a random one, 'cause it corresponded with heart rate. Most of the times it's one to 10, but an RPE 10 is like, I just grinded through that, I have nothing left to give, hard as I can go. And one is like, oh, that was pretty much nothing, I'm just existing. And you can also base things off RPE saying, hey, I want you to take the set to RPE seven saying, hey, that was challenging but I probably had, maybe three or more in the tank kind of combining reps in reserve and RPE, but it's challenging but not like debilitating. And so those are general ideas that we think of for auto regulation that's become more common. You can use other things as well, like bar velocity. There's lots of ways you can actually do it, but you can also do other ways in terms of pain can be a way to auto regulate as well. In this program, Ben doesn't let you progress to more advanced exercises until you're able to do a certain amount of reps or certain range of motion completely pain-free. And this is this example of auto regulation. So it's not necessarily RPE, but you're not gonna progress it. If you're having pain with a certain range of motion, you're gonna scale it back, right? You're gonna regress and slowly try to build up on it as you're able to tolerate more and more. That's essentially auto regulation for this. Is it as good as RPE? I mean, at the end of the day, they're kind of, they're different things necessarily. Pain and RPE are gonna be different 'cause sometimes pain is a necessary part of improving. So I'm not saying you can't have completely pain-free, but either way, the concept is that there's some sort of regulation built in this program with his kind of pain guidelines. And that's why I wanna talk about it. And you're not progressing until you get past that there. And I think it's so important for two main reasons. Is one, you don't wanna progress too fast. If you go too fast, you're not gonna be ready for it. A classic example is, hey, someone hasn't done something for a while and they go back to where they were. Like, hey, I was a marathoner running 60 miles a week and then I took multiple, multiple months off. I wanna go back to 60 months. That's a bad idea. We want to slowly get there so your body can get used to it. The same thing in rehab. We don't wanna jump up. You're saying, hey, I'm feeling good today. I'm just gonna push it crazy. And then you have a setback and you're out for the next two weeks. That's not what we want. So auto regulation is great 'cause you can push it a little bit further, but it's never gonna be the point where you're completely unthrottled saying, hey, let's just go for it. So that's one main reason why auto regulation is so important 'cause it kind of helps prevent you from going too fast so you don't re-injure anything and makes you sure that you're ready for the load you're placing on your body, right? Time over time, your tissues need time. They need to accumulate. So the stress that you're going to give it, so you gotta give it time. That's really important thing with auto regulation. And another cool thing is what gives you permission to improve when you're ready. If you're feeling good, this typically allows you to push it a little bit, which is important to make improvements, right? But it should still be within a certain context, but progression is critical. So what I mean by this is if you're feeling good on a day that you're supposed to have an RP seven, let's just say we're squatting, for example, like, hey, I'm gonna do squats at 225. I want to do an RP seven. And normally that's for you, that's like five to eight reps or something like that, but you're feeling fantastic that day and you got more and you can get up to 10. Well, that's what like auto regulation is, is hey, I can go for it here within constraints, right? It's not saying, hey, I'm maxing out every single thing, but it's saying, hey, I got a little more juice today. I feel better objectively. There's no pain I'm doing well. We can go there. That's what auto regulations and lets you kind of prove. And this program does that not necessarily with the RPE scale, but saying, hey, my pain free movement, it's good now. Maybe I can progress to the next activity. So those are kind of the big things in that program as to what's going on. And next we're gonna talk about how to pick a program for you. So if you're trying to get any rehab program or really any program, this will work for anything. You're saying, hey, I want to find a program that works for me. Jordan, what do I need to look for? This is the guide I'm gonna give you to do that, to kind of help you assess programs or rehab professionals to find a good fit for you. So first and foremost, this is not an official endorsement of the Knees Over Toes program by any means. I was just explaining the underlying principles so you understood. And I wanted to do this 'cause this is probably the most controversial rehab program I've ever seen in terms of it's incredible the stuff he shows online, things he can do, what he's capable of. It just goes to show how robust and resilient the body is, which is amazing. But I chose this as an example to show you that he's doing some insane things, but the underlying principles are like universal and the same, and they're not anything new. And that's what I wanted to show you. That's why I chose this specifically to look at it. And I also wanted to show you, this is not a magic program, right? It's certainly not the only program that can help you with the knee pain. But what it has done is massively market on social media with success stories and the story that somehow, it's somehow drastically different than traditional rehabilitation. And are the movements traditionally different than traditional medicine? Again, they are. But I've seen countless people get better with, quote, unquote, traditional physical therapy, as I've seen lots of people get better with knees over toes and well, and vice versa, right? So once again, I'm not endorsing any specific thing, but I just wanted to talk about it. And I've seen countless people in my sports clinic who've tried this program and did not fix their knee pain. And it's definitely not a one size fits all approach. And that's crucial, right? I'm not ripping on this program by any means, because any program that is given to someone, a generic program, I don't expect it to work for everyone. It's just like lifting in general. Someone does squats for the first time in their life, and they all of a sudden they get it and like, wow, I react fast and they're squatting 600 in a year and a half. Like something like that can happen. So people respond differently to different things. They have, yeah, just different responses. And so I would never expect anybody to respond the same way to someone else. And so a generic blanketed program, I wouldn't expect to work for everybody. And I don't think he claims that either. He's not saying it's gonna work for everybody, but I just wanna say, this is not like a be all end all, catch all. And so whether it's a traditional program or this program, I wouldn't expect everybody to get benefits from it. And that's kind of unfortunate, but a lot of times this game is a little bit of trial and error finding the right fit for you. And yeah, like I said, that's what we're looking for specifically is someone who talks with humility, which he does saying, hey, you can try this. And so what are we looking for first in a program that has no crazy promise, right? If it sounds too good to be true, it probably is. If someone says, hey, I'm gonna fix your chronic back pain that you've had for 15 years overnight, I'd be cautious. That's probably not gonna happen. So just understanding crazy claims require insane amount of evidence. And most people don't have that. So if it sounds too good to be true, probably is. Next thing though is a well thought out structure, right? So it's crucial to have an overarching goal of where you wanna go with your program. If you just sprinkle together a bunch of exercises that you found on social media, that's probably not gonna be ideal. We wanna get you to a goal. We wanna reverse engineer. Is it a certain thing you wanna do? You wanna train for a obstacle race or a powerlifting meet or a bodybuilding show or get back to your sport, whatever it is, having it in goal is very helpful. And that's one of the reasons this program was so fantastic because it has a structured program for people. I think a lot of times people fail in rehab is 'cause they just see a Instagram reel or YouTube short or something saying, "Oh, I'm gonna try these exercises." And they try them for a week or two and they don't progress them at all. And they just do them and they say, "Oh, it didn't work." Well, it didn't have the key components that we've already talked about. I'm gonna talk about more. So having a goal and a structured program is crucial. I would highly, highly, highly recommend that. And it also has to have an approach you can get behind, right? So adherence is everything. And if you're, let's say you're a weightlifter, right? Big powerlifter putting up huge numbers. And all of a sudden you go with a rehab professional and they say, "Hey, we're just gonna do some little bands and we're not gonna actually do that. We're just doing more cardio. We're not gonna do lifting." You're gonna be like, "This is not my person." And that's why it's super important to find your person. I almost joke when I talk to patients about finding a physical therapist, it's almost like dating. You gotta find one that fits for you, right? So you gotta find that person who understands you. It's your people, right? Someone who has experience with lifters or runners or whatever it is, find that person who understands you, the demands of your sports and your desire to get back there, right? If I, the running joke is in my clinic, if I tell a runner that they should stop running, they're gonna immediately be like, "Wow, no, I'm not trusting this dude." So I never wanna do that, right? Athletes are gonna do what they wanna do. Our job is to throttle them a little bit to get them better. So finding someone on your side and a program that you can get behind, super important. And as we mentioned, progressive loading, the bedrock of every good program. There should be a planned way to push you and advance you and just make you more robust and more capable. That's the big thing. And also with that, we want auto-regulation. So a way that you can adjust what you're doing based on how you feel and making sure we're progressing things. So notice I did not include specific exercises saying you have to do this knees over toe squat, or you have to do these Spanish squats or these whatever. There is no special movement. There's no specific movement that's gonna magically make your knee pain better. It's this whole amalgamation of all of these principles that's really gonna get you there. So that's why I wanna say that. But you may do all these things and say, "Hey, I'm feeling not quite there yet." And I'm really discouraged. It might be time to talk to a rehab professional. Whether it's a physical therapist or a sport chiropractor or a sports medicine doctor, talking to someone can be very helpful. 'Cause sometimes we can do things that just general programs can't do. And that's more like hands-on work specifically for like physical therapy or chiropractor. Maybe that's more soft tissue work. For me as a doctor, it's more injections. And once again, I'm not gonna be the person, I'm like the most anti, unlike the most anti-injection physician ever. I do them all the time. I get part of my job. But I really, really want you to like qualify for injection. So that's not me saying, "Oh, like this." And I know there's a whole crowd of the evidence-based medicine, physical therapy world and sports medicine world that say like manual manipulative techniques are like worthless and soft tissues where they... Once again, like most things in this world, it's probably a little grayer. Some people respond fantastically well to some passive modalities or hands-on soft tissue, whatever it is, and other people don't necessarily need that. But for me, I'm always gonna try to start with the things that are able to be done at home. So home exercises, things that patients need on their own. And the reason I don't love injections or hands-on stuff is because it relies on someone else. If I can have someone be more independent, just handle themselves, I will always choose that. But every once in a while, we kind of run into things where we need a little bit of help. And as I explained before, the bedrock of the program is gonna be the auto-regulation, the buy-in and the progressive loading, and injections or hands-on work, stuff like that. All that's doing is allowing you to progress more. And so you're getting over a hurdle and then being able to continue to progress. So that's the general idea is I'm not saying that. And if you follow these principles though, you should be able to follow on a solid program. It also works for finding a rehab professional saying, "Hey, do you follow these principles? Do you have a progressive loading? Do you have a plan? Do you have auto-regulation?" All those things. So that's how you can find someone as well. And if you're curious, like who the good guys in the industry are, please just feel free to send a message or leave a comment on this video. And I'll point you in the direction of some people I've worked with who've been fantastic as well. But overall, those are the main things when we're trying to find a program is that there's lots of ways to do it right. There's not one specific way. There's lots of different ways we can do it, but I wanted to at least cue you into how I think about it when looking at building a rehab program, finding a rehab program or finding a rehab professional. And so to kind of sum up this entire podcast here, the program we talked about today, it's succeeding because of its structure, ability to motivate individuals and the progressive nature of the exercises and with auto-regulation built in. And once again, I'm neither pro nor against this. I think it's a very well thought out program. And so there's a lot worse programs you can have, but it's not like this magical thing. So I'm not pro or anti. I'm just saying this is what it is. But if anybody does know the needle-over-toe guy, Ben Patrick, I'd love to work with him. And I'd love to develop a research study with my clinical athletes to kind of see, hey, is this something we can get to and we can improve things and get better rehab at home? So if anybody knows him or just wants to spam him with tags pointing to this podcast or this specific clip, that'd be great. But in reality, this is it for the day. I really appreciate you. Thanks so much for stopping by. If you liked it though, it'd mean the world. If you liked the video on YouTube or subscribe to the podcast or YouTube channel, or if you share it with a friend, that's like the highest compliment and the best way to get the word out. But either way, I appreciate you stopping by. Now get off your phone and get outside. Have a great rest of your day. We'll see you next time. Disclaimer, this podcast is for entertainment, education and informational purposes only. The topics discussed should not solely be used to diagnose, treat or prevent any condition. The information presented here was created with an evidence-based approach, but please keep in mind that science is always changing and at the time of listing this, there may be some new data that makes this information incomplete or inaccurate. Always seek the advice of your personal physician or qualified healthcare provider for questions regarding any medical condition.
