HipImportant ConceptsKnee



I’ve been promising to put this blog on my site for a long time. If you’ve read some of my responses to blog comments in the past several months, you would have read references to my Sit Like A Man (S.L.A.M.) program.

Now S.L.A.M. is not a feminist movement. It’s not a how-to formula for board room strategies. Nor is it a rejection of “lady-like” behaviors. It’s not a drive to encourage women to wear pants and shorts in the work place. However, all of the above might certainly be the result of it.

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It’s a women’s’ health movement. And I’m starting it! I’ve seen an occasional reference to the idea of sitting like a man in a different context, but S.L.A.M. is my Sit Like A Man acronym and I refer to it on a daily basis for my patients suffering from conditions such as patellar malalignment and chondromalacia, greater trochanteric bursitis, piriformis syndrome, and gluteal tendonitis. The concept even applies down the calf with iliotibial band syndrome, and all the way to the ankle with posterior tibialis tendonitis. I’m even throwing in some freebees with peroneal neuritis and plantar fascitis, since they’re not really due to biomechanical stresses, but are related to the way we sit. Some of these conditions are seen almost exclusively in women. Frankly it’s my “gut” feeling that they’re all seen more commonly in my female patients. And an orthopedic surgeon’s gut counts for something.

So over the course of my practice, I have tried to come up with treatment plans for my many female patients who suffer from these disorders. I apply the commonly used therapies such as various types of exercise: both strengthening and stretching. I use cortisone (pills and injections, and non-steroidal anti-inflammatories (NSAIDS). And depending on the condition, I might try braces or orthotics. And of course, in a few situations, surgery is an option. In most cases there are no surgical remedies, and patients are often counseled that these conditions are usually self-limited and will eventually get better on their own. Or they won’t. And we are frustrated…

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Let me tell you that it is almost as frustrating to give that counsel, as to receive it. And during almost 30 years of private practice, I have contemplated alternative remedies for these frustrating conditions, almost as much as I have concentrated on the learning, updating and evolution of traditional solutions to other conditions.

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But it was actually the gradual aging of my own body, which honed my theories on the treatment, and even the prevention of these conditions.  I’m a woman, and therefore am more likely to suffer the conditions of women: gynecological as well as musculoskeletal. And let me tell you that my patients love it when I suffer, not because they are cruel, but because they know I understand.

When I was about 32, I began to experience knee cap tracking problems (patellar malalignment). Way back in 1987, when many in the almost exclusively male orthopedic community, pooh-poohed patellar malalignment as some kind of female growing pain, or just one of those female aches and pains, I was actually suffering from it…and knew that it was not in my head. It was in my knees, which were crunching with stair climbing, and aching when I did any kind of squat, deep knee bend or lunge for exercise. It was then, early in my career, that I decided to stop any form of these exercises. The pain and swelling resolved completely. I then began a course of exercise to strengthen the muscles which stabilized my knee cap. The pain never came back, and to this day, I do these exercises and continue to avoid the activities which might aggravate this condition.

But a certain number of women did not respond to this program. So I added some additional exercises to encourage the femur to rotate outward. I began to recognize that the use of the knee/lower extremity, in a slightly externally rotated position, angled outward to the 11:00 position on the left, and the 1:00 position on the right, more closely looked like the way men sit. And if you get up out of a chair that way, it approximates the way a man gets out of a chair.

And Sit Like A Man was founded…in my head anyway.

vintage-beach-ladiesFor academia’s sake, let me also say that women start out a little behind the eight ball. The alignment of women’s lower extremities predisposes us to these disorders, and without going into the boring detail, suffice it to say that our hips and knees are mechanically aligned in a way which rotates our femur inward and our knees into a kind of knock-kneed position.

I applied it to my own lower extremities. Let me tell you that after decades of training my legs to slam shut, sitting like a man was not easy and certainly did not feel “natural.” I slipped back into my old lady-like habits.

Woman sitting on chaise longue, holding scarf, (B&W), portrait

Then in my 50s came greater trochanteric bursitis, that scourge of the feminine aging process. I probably see at least 2 women a day with this condition, and I began to suffer from it as well. But I quickly recognized that if I resumed sitting like a man (S.L.A.M.ing), the pain subsided. Of course, you will read on my blog that I also did some stretches and ultimately sold a car with smaller seats, preferring to drive my four-wheel drive Ford F-350 Super Duty pickup truck, with huge seats to accommodate my hu…never mind. Suffice it to say, that in my humble opinion, a smaller seat almost forces your hips and legs into that lady-like position. When we rotate the hip inward, our knees naturally fall into a knock-kneed position, which increases the stress across our iliotibial band (therefore our hip bursa) and incidentally, our knees. So the larger seat limits that pressure. I highly encourage the use of an F-350 Super Duty pick up as part of the solution to hip bursitis.

Okay, making the assumption that there will not be very many women going out to trade in their little cars for a one-ton pickup, and that there are no practical operations which we can use to realign our legs, let’s stick with one thing we can do…



How do you sit like a man? Well, first you have to spread your legs a little apart. When I was a teenager we called that shooting the beaver. I was a teen at the time when skirt lengths first started coming up. You HAD to slam your legs together. The boys would drop pens on the floor during study hall in order to bend over and look up our skirts! We were just little teenagers and sometimes we lost concentration on our untrained thighs while we were trying to STUDY in STUDY HALL. Boom, next thing you know, you got a reputation. “Bergin shot the beaver. Bergin shot the beaver.” Hey, it wasn’t just me showing off the whitey tighties. And as if that wasn’t enough. Then you were sent to the school nurse for indoctrination!  Like it was our fault. Well, it didn’t take long before you learned to slam them legs together…tight. Never to spread apart again…at least while sitting in class.

Back to the S.L.A.M. technique. Let those knees drop slightly apart, with the left leg pointing essentially to the 11:00 position on a clock, and the right knee to 1:00. Sure 10:30 or 1:30 would be fine too. But it’s not necessary to reach for 10 and 2. That would be manspreading. Manspreading is not necessary. This is what men in NYC do in the subways. They spread their legs wide apart to cover more than one seat so no one can crowd in next to them. I’m pretty sure they also do it to irritate women. No manspreading is necessary to S.L.A.M.SLAM PROPER

But while you allow those knees to comfortably drift apart, don’t keep your feet to the outside of your knees. That would still be encouraging the knock-kneed position of the lower extremities. Honestly, you have only to look at your husband, dad or brother to figure it out, because that’s how they always sit. For them there is nothing standing in the way of sitting naturally: no skirts, no culture, no desire to make themselves look smaller. They sit with their legs apart, they rarely cross their legs, and when they do, they certainly don’t noodle them up tight. They never hike their leg up under their rear end when they sit down on a couch. They just sit, in a natural relaxed way, with their knees apart and their feet flat on the ground.

Trust me, if they wore short skirts, they would be keeping their legs slammed shut and maybe even suffering from piriformis syndrome. Honestly, I don’t think I’ve ever diagnosed a guy with that disorder.

Now let’s take this one step further. You have to use this technique for getting in and out of chairs, because a lot of stress is placed on your knee cap when you sit down and stand up. So just keep those knees pointed at 11:00 and 1:00 when you get up and down. Don’t allow them to collapse into that knock-kneed position again. And keep your feet flat on the ground.

That’s it! That’s all there is to it! I propose this as an adjunct to traditional treatment methods for all of the conditions I mentioned above. I also propose it as a way of life. I want women to Sit Like A Man, unless they are wearing short skirts. I don’t advocate unladylikeness. I advocate health.

So why is this healthy?

Because this is the way women were meant to sit!

Think about it. Any of you who have read my blog know that I always go back to the cave person when contemplating the natural human. We are hunter gatherers, and the further we veer from that form, the more likely we are to be damaged. Picture the American football player. He’s come a long way from his cave-dwelling ancestors.

039_14209~Raquel-Welch-PostersThough not having been there in person, I can almost guarantee that the cavewoman sat around with her legs apart. First of all, she wasn’t ashamed. It took social and cultural progression to give us that shame. But more importantly, she wanted to show off her business. So how do I know what was in her head…that she wanted to show off her stuff? You have only to look at the animal kingdom to know that the female of each species tries all sorts of ways to show off her business. When my female horses are “in,” they raise their tails way up in the air and literally wink their private parts at the male horses. It’s ridiculous.

So once we got all prude, we were taken out of our little Rachel Welch miniskirts, and forced into long dresses. That lasted a LONG time…probably tens of thousands of years. Why would women slam their legs together under long dresses? What difference would it make? So not only was there no need to do it, it was hot up under there. We needed breathing room. Legs apart please. So how do I know what position women put their legs in for thousands of years? Well, you have only to look at old paintings of women in longs skirts to see that they did so.


It wasn’t until the 1920s when skirt lengths began creeping upward, that it was considered more pleasing and ladylike for women to have their ankles together. Then, when skirts got really short, slamming those legs together became a necessity. But Dr. B, how can you really know? 8362fb664b522b922b2e0aca10735950Because we have little daughters to watch.  Next time you’re around children, make some of your own observations. There’s no question that infants and toddlers S.L.A.M. And most girls S.L.A.M. until they get into junior high. I see them in my office, wearing pants and sitting like guys. And for each girl it’s different, but at some point, they start squeezing their knees together, tightly crossing their legs and noodling their legs, one coiled around the other.

And while it rarely contributes to painful conditions in the young, in my opinion, the long existence of this habit will contribute to problems as they age. I might go so far as to say that this sitting habit might even be related to the poor landing mechanics in females, which result in a higher rate of anterior cruciate ligament tears in this population. There has been a successful effort to teach young female athletes proper landing mechanics, in an effort to diminish the incidence of this devastating and life altering injury. So if an exercise program can modify the natural movement of women’s legs in a jump, why can’t a modification of sitting technique have a similar effect on some of the disorders from which we suffer throughout our lives?

So I’m here to tell you there is another way to sit. And that is to S.L.A.M. whenever possible: when you have pants on, when your legs are under a table or behind a desk, when you’re at home with those who do not care, or might prefer it. I believe you can S.L.A.M. 90% of the time.

grey t shirt girl SLAMMING

So go do it. And rather than teach your daughters to slam those legs together all the time, teach them to put them together when they wear dresses, or shorts, or when boys are around. And hopefully, for a while, that’s only 10% of the time.

So go S.L.A.M.! It’s the healthy thing to do.SLAM small image




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