Knock Knees – Can I reverse it? (Part 2)

August 19, 2010

In the previous entry for Knock Knees, we discuss about the different types of knock knees and the contributing factors of it. Now, we will talk about the problems of this condition and ways we could get rid of it.

The Problems of this condition

The alignment of the knee joint in someone with knock knees is such that there is an increased force on the medial (inner) part of the knee joint. This can predispose the knee joint to osteoarthritis because of the increased loading on the medial compartment.
Symptoms from this may not even present within the knee joint, you may have ankle problems or hip problems as a result of having knock knees.

How do I get rid of it?

External aids:

1. Orthotics

The knee joint may appear to be misaligned if the foot is not biomechanically sound. This means that someone with a very pronated/inverted/flat feet may be at risk of developing a symptoms similar to someone with knock knees. Placing an insole or orthotics device may help correct the foot position, and indirectly the alignment of the knee joint.

2. Knee braces

These can help prompt correct alignment of the knee joint, but may create a degree of dependency.

3. Strengthening

A physiotherapist can design an exercise program to help strengthen weak muscles. By focussing on the specific muscles that require strengthening, you will put your body is a safe healthy direction, and will be able to train for all types of sporting challenges and limit your risk of injury.

4. Stretching

Stretching is an important component of knock knee reversal. When a joint has spent all it’s time in a misaligned position, certain structures will shorten and become stiff. Stiffness in the joints and muscles will make it very difficult to train and strengthen the area. A physiotherapist can assess the position of your knee, ascertain which structures are tight, and give you an appropriate stretching program.

Written by Jessica Ellison · Filed Under Hip (NonSport), Injury Prevention, Knee (NonSport), Peripheral (NonSport), Treatment Option | View Comments

Knock Knees – Can I reverse it? (Part 1)

August 16, 2010

Knock knees is a phenomenon where it appears as though your knees are at an inwards angle in relation to your feet. Most kids under the age of 6 appear to have knock knees, but grow out of it as their body shape changes. An adult with knock knees may or may not have pain – mostly depending on the severity.

Source: Ecce Medicus
click for larger view

In this article, we would discuss on the different types of knock knees and the contributing factors that may develop with this condition.

When discussing the reasons for knock knees, structure of the bones and joints must be assessed. Structural reasons for knock knees are not normally reversible, unless surgery is indicated. When it comes to the strength, control and stiffness of muscles that control the alignment of the knee, a full assessment must take place so that a corrective program can be enforced.

Structural reasons:

Genu varum: … Not Reversible

A structural deformity of the knee joint, causing the lower leg to be angled inwards and the upper thigh to be angles outwards, causing a bowing effect.

Tibial valgus: … Not Reversible

This is a deformity of the tibia.The bone angles outward towards the end furthest from the knee joint.

Coxa Varum: … Not Reversible

A deformity of the femur; the angle between the head and shaft of the femur is more acute, making the shaft of the femur angle inwards.

Q angle: … Not Reversible

This is the angle between the line of the femur, and the line of the mid patella – tibial tuberosity. A larger Q angle will mean more biomechanical problems within the knee joint.

Poor strength of:

Hip external rotators: … Reversible

Gemellus inferior & superior
Obturator internus & externus
Quadratus femoris
Piriformis
Gluteus maximus
Gluteus medius posterior fibers
Sartorius

Weakness in these muscles will cause the femur to internally rotate causing an increased ‘knock knee’ effect.

Hip abductors: … Reversible

Gluteus medius
Gluteus minimus
Tensor fasciae latae
Sartorius

Without the strength of these muscles, the femur is more likely to adduct, increasing the knock knee appearance.

Quadriceps: … Reversible

Rectus femoris
Vastus medialis, lateralis & intermedius

Asymmetry in the strength of this muscle group may result in misalignment of the knee joint, giving the appearance of knock knees. Generally it will be the inner most compartment of this muscle that is weak.

Hamstrings: … Reversible

Biceps Femoris
Semitendinosis
Semimembranosis

Similar to the quadriceps, asymmetry in the strength of this muscle group i.e. inner most compartments (semitendinosis and semimembranosis) may lead to this appearance.

Poor control of:

Hip External rotators: … Reversible

Hip abductors: … Reversible

Lumbo/pelvic muscles: … Reversible

If these muscles are not controlled well because they have poor activation or endurance, they muscles will not be able to hold the knee joint in a correct alignment constantly. In other words, the muscles will get tired, and they will not be doing their job.

Stiffness in the:

Hip: … Reversible

Tight muscles in the hip region may limit the range of motion available. If the joint is not moving correctly, the required muscles will not be able to work to correctly align the knee joint.

Written by Jessica Ellison · Filed Under Hip (NonSport), Knee (NonSport), Peripheral (NonSport) | View Comments

Ankle Overpronation and Injuries video

July 18, 2010

Have you wondered why overpronation (rolling inward) of your ankles can cause injuries? Click on the video to find out more.

Written by lenia.teo · Filed Under Ankle & Foot (NonSport), Featured Video, Hip (NonSport), Knee (NonSport), Peripheral (NonSport), Video | View Comments

Total Knee Replacement Surgery video

June 24, 2010

What is exactly happening when you go through a total knee replacement surgery? Click on the following video to have a better understanding about the procedure.

Written by lenia.teo · Filed Under Featured Video, Knee (NonSport), Video | View Comments

Knee anatomy and arthritis video

May 1, 2010

What is knee arthritis? Click on the following to find out more.

Written by lenia.teo · Filed Under Featured Video, Knee (NonSport), Peripheral (NonSport), Video | View Comments

Tendon Disorders: Inflammation and Degeneration

January 8, 2010

One common form of musculoskeletal injury is tendon-related disorders like tennis elbow and Achilles tendonitis. Your tendon is the connector that transfers power from your muscle generators to your skeletal structure to create movement. Under normal circumstances, healthy tendons glide easily and smoothly as the muscles contract. When tendons are injured, they cause pain, especially during movement. Read more

Written by Cindy Tan · Filed Under Ankle & Foot (NonSport), Elbow (NonSport), Knee (NonSport), Peripheral (NonSport) | View Comments

Osteoarthritis Knee

December 25, 2009

Osteoarthritis (OA) of the knee is a degenerative condition where the cartilages of the knee wear away. Pain, stiffness and swelling are common symptoms of an OA knee. In this article, we look at the three factors that lead to the development of OA knee – Aging, Physical Attributes and Muscular Causes. Of which two of these factors, Physical Attributes and Muscular Causes, can be addressed with physiotherapy management. We will focus more in detail on the exercises and treatment for OA knee in a follow-up article.

Aging

OA Knee

OA knee usually afflicts the older population as our cartilage thin naturally as we age. If you have a past history of knee injury or long history of activities that overloads the knee joint, degeneration may set in much earlier. Unfortunately, these events are irreversible, so it is important that we look after our knees during our early adult life.

Physical Attributes

The three key physical attributes are:

Obesity - A heavier person will load their knee joints more, wearing out their cartilages faster than a lighter person.
Knee alignment – A bow legged or knock-knee appearance will cause an uneven compression of the knee. Either the outer or inner compartment knee respectively will take up most of the load upon weight bearing and cause more wear and tear.
Foot type -
- People with flat feet or whose feet over pronate tend to roll their knee inwards upon weight bearing similar to a knock-knee above.
- A person with high foot arch or whose feet under-pronate absorbs less impact with each foot fall. More impact goes up through the leg and the knee will have to work harder to cushion the impact.

Muscular Causes

When the muscles around the knee do not contract strong and fast enough in a coordinated fashion to absorb the impact of walking or running, the knee joint takes up the remaining forces of the impact.

Tight muscles pull joints closer to each other.In an OA knee where the joint space is already reduced, tight muscles will increase the compression of the joint space. Muscles with reduced flexibility are also less coordinated and slower in reaction time. The muscles that tend to be tight are the quadriceps, hamstrings and calves.
Weak muscles. The quadriceps muscles is the main muscle group that help to support the weight of the body and off loads the knee joint. It is very common for this muscle to atrophy because of disuse. The knee pain deters the patient from loading the knee and this will gradually lead to weakness of the knee which will affect the ability to cushion the impact. This pain, disuse, weakness cycle will continue without treatment.
Weak gluteus medius muscle can aggravate the degeneration of knee cartilage because its function is to keep the hip joint stable, especially in walking. This is often seen as a waddling gait where the hip sway with big movements side to side. The thigh muscle have to work a lot harder to stabilise the wobbly hip and if they are unstable, the knee joints will have to bear the weight.

The management of these factors are summarised in the following table. In our upcoming article, we will further discuss the specific exercises and treatment for OA knee.

Physical Attributes	Management
Weight	Weight loss programme
knee alignment	- training of muscles – orthotics
foot type	- orthotics

Muscular Causes	Management
Tightness	Stretch Quadriceps, Hamstring and Calves
Weak	Strengthen Quadriceps and Gluteus Medius

Written by chyetuan.chng · Filed Under Knee, Knee (NonSport), Running | View Comments

Ladies! Stronger Thighs, Lesser Knee Pain

September 30, 2009

Knee pain is one of the most common, if not the most common complain of pain in the elderly. In the USA, nearly 4 million sufferers of knee pain above the age of 45 are ladies.

Why are females more prone?

There are quite a number of reasons why ladies are more pre-disposed to developing knee pain. The reasons range from wider hips to increased Q-angle, tighter ilio-tibial band (ITB) to weaker physique. However, what is the most common cause of knee pain? The answer lies in the weakness of the quadriceps or thigh muscles. Read more

Written by MCR · Filed Under Injury Prevention, Knee, Knee (NonSport), Treatment Option, Uncategorized | View Comments

Total Knee Replacement

March 31, 2009

Knee replacement is the resurfacing of the worn out surfaces of the knee and replacing the lost cartilage and diseased bone with metal and plastic. Knees wear out for a variety of reasons, including injury, simple wear and tear, and arthritis. The video shows the knee replacement procedure.

Written by MCR · Filed Under Injury Management, Knee, Knee (NonSport), Peripheral (NonSport), Sports Injury | View Comments