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

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.

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.

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