Do you have knee pain?
Do you have knee pain?
Your hip, knee, and ankle posture could affect this, making a “bad” problem worse. If your knees turn in or bow out, or if you stand with your knees hyperextended, you may already have degenerative changes—arthritis—occurring. If you already have arthritis, you can slow the progression of this by correcting your alignment, stretching muscles that are tight in your leg to take pressure off of your knee, and strengthening what’s weak to support the knee joint, much like a brace would. If you’re young enough, you can even prevent arthritis, given the absence of any trauma, by correcting your knee posture.

The reason that we need to correct deformities is that they result in compressing one side of the joint. If the joint isn’t straight, you can wear out that side of the joint and tear your meniscus (an important cushion in your knee) over time, so you ideally need to correct your knee alignment before this occurs. In this picture, taken from the front of the right knee, you can see one meniscus that is healthy, whereas the other one has been damaged.

Knock-kneed posture can be due to a combination of variables, generally stemming from misalignment of the foot and ankle and/or the hip, and it is easier to correct than a bow-legged posture is. If your ankle and foot roll in, or if you have a flat arch, then your knees will roll in. Looking at the hip, if the hip muscles (especially your gluteus medius) are weak, then your thigh bone, or femur, will roll in, making the knee also roll into a knock-kneed deformity. An imbalance of tight fascia on one side of the knee and weak muscles in the hip, knee, and ankle, combined with a knock-kneed and/or hyperextended knee posture, can not only predispose you to wearing out or tearing your meniscus, but it can also predispose you to other injuries such as dislocating your kneecap, or patella, or stretching or tearing a ligament in your knee such as your ACL.
Hip or ankle deformities can also cause knee deformities, as can deformities within the bones of your femur or tibia. However, alignment issues generally aren’t fixed deformities, so they are easily corrected with physical therapy, especially if caught early enough.
Chronic or old meniscal tears, as well as prior menisectomies, can also contribute to knock-kneed or bow-legged deformities. When you lose part of the cushion on either the inside or the outside of the knee, that side of the joint starts to collapse. If the outside (lateral) part of your knee starts to collapse, you will have a knock-kneed, or valgus, deformity. If the inside (medial) part of your knee starts to collapse, you will end up with a bow-legged, or varus, deformity.

Regardless of the deformity, it is extremely important to improve the alignment of that joint. Postural correction is key, as is regaining/maintaining the full range of motion of the affected joint(s) and normalizing the flexibility and strength of the surrounding musculature. Strengthening is important, but flexibility is one of the most important properties of muscle tissue. Muscles cross over joints in the form of tendons. You want to maintain as much space as you can in the joint so you aren’t crushing the bones together, making the arthritic bone ends and the menisci rub together more and wearing them down faster, which just accelerates the degenerative process within the knee. If the muscle is tight, then the joint gets compressed—increasing pressure on any meniscal tears or arthritis that you may already have and making the pain worse. By stretching appropriately, you can actually relieve some of those forces to give the structures inside the joint more space. In these photos, you can see a normal joint space on an xray as compared to a loss of joint space in the other—notice the nice space between the bones in the picture on the left as compared to the very thin line in the arthritic joint on the right.

It’s extremely important to catch and correct the deformity as early as possible. There’s a functional versus a fixed posture of knee deformity—if it’s functional, the deformity is fixable and you can correct it. If the deformity is fixed, however, it’s generally an older deformity so the joint ends up being fixed in that position, making it much harder (if not impossible) to correct, and often requiring a knee replacement to do so.

Even if there is no obvious deformity, you can still have muscle imbalances and faulty biomechanics that create undue stress on the knee (as well as on the hip, ankle, and spine), making the joint(s) wear out faster and resulting in pain. This is where a physical therapist can be especially helpful in identifying and correcting these imbalances, as well as in restoring good hip/knee/ankle mechanics. At Paradigm PT, we look at the foot and ankle first. If your ankle rolls in and your arch is flat, then your knees are going to turn in and start to wear down faster because they are no longer in a straight alignment. We can give you strategies to correct your foot and ankle posture, as well as make changes to your current footwear and help guide you in choosing appropriate footwear to support any collapsed structure and improve alignment up the lower extremity chain—i.e. your leg. Then we check your hip, knee, and ankle strength and flexibility, and give you exercises to stretch what’s tight and strengthen what’s weak to minimize any stressful forces on your knee joint, as well as educate you as to your hip/knee/ankle/foot posture so that you can correct this yourself. We can also check the alignment of your pelvis to make sure that malalignment here isn’t contributing to any dysfunction in your knee. And we won’t only look at your knee posture statically, while you’re just standing. We’ll do a comprehensive assessment of how your hip/knee/ankle/foot and trunk dynamically function together that could be contributing to your knee dysfunction with more active endeavors, from walking to going up and down stairs, running, cutting, jumping, and landing, depending on your lifestyle.
