The knee is a sophisticated design with three long leg bones (tibia, fibula, and femur), which join at the knee cap. Now add several connecting ligaments and muscles to make it move and to ensure joint stability.
The knee has many moving parts, but they all work together to function like a hinge that lets the leg bend and straighten repeatedly. The design allows for a variety of positions and movements, such as walking, sitting, squatting, and kneeling.
The design is solid, but with all those parts, a variety of malfunctions can occur over the life of a knee. One common issue is called knee valgus.
The opposite issue is called knee varus (bowlegged).
Knee valgus and varus are both common in toddlers. However, usually once kids start attending school, a straighter leg takes shape.
Many Possible Causes
There’s a wide range of potential causes of knee valgus. It can arise from a congenital abnormality, result from an injury, or begin with a nutritional deficiency.Most of the research on knee valgus centers on women, because they are more likely to suffer from it. One major factor is the shape of their bodies. Females have wider hips, which inevitably makes for a sharper angle as the line of the leg narrows to meet the knee.
“These findings confirm the need for training programs that increase neuromuscular control strategies,” researchers wrote.
Treatment Options
Causes for knee valgus may start early in life, or may develop later. For example, as arthritis in the knee progresses, it can wear down the cartilage of the joint, and the cave-in begins to take shape.Because of the wide range of causes, medical professionals typically recommend a variety of treatment options, such as orthotics, nutritional recommendations, a knee brace, or maybe a weight loss program, depending on what the contributing factors may be.
Surgery is reserved for the most extreme cases.
When considering treatment, Dave Candy, doctor of physical therapy and a board-certified specialist in orthopedic physical therapy divides knee valgus cases into two basic categories: structural and dynamic.
Knee valgus due primarily to wide hips, for example, falls in the structural category. This is just the shape some bodies take, and Candy says there’s not much that can be done to alter it.
The type of valgus with the greatest potential for change is called functional or dynamic valgus.
“That’s essentially when your knee moves inward while walking, running, squatting, or landing from a jump,” Candy said.
Candy approaches these cases with exercises, and orthotics to keep them under control. The forms the exercises take relate to where the issue originates.
“[It could be] a stiff ankle joint or calves causing your foot to overpronate (flatten). It could be weak hip abductors that prevent the knee from moving inwards. Or it could be weakness in the muscles in the foot and ankle that control foot pronation,” Candy said.
“The exercises that can help stability with knee valgus include strengthening the hip abductors and external rotators. The hip abductors are muscles that help you balance your body over your leg if you’re standing on your leg, or raise your leg out to the side if your foot isn’t touching the ground,” Candy said.
Focus on Strength, Above and Below
The ideal is straight, stable knees. However, the exercises that deliver this ideal don’t usually start with the knee. ACE certified personal trainer and powerlifter, Perry Mykleby, typically targets either end of the legs when helping people with knee valgus.“Work the muscles above and below the knee,” Mykleby said. “Isolation exercises for the glutes (maximus and medius), the tibialis anterior, foot arches, and calves can strengthen the tissues around the knee with favorable results.”
Researchers wrote that programs focused on strength (particularly gluteal muscles), improve balance, core stability, and short bursts of explosive movement. This approach can “reduce the angle of knee valgus and thus reduce the risk of lower limb injuries.”
Mykleby suffered valgus in his right knee as a result of a spinal cord injury. Surgery repaired his spine, but his time spent in recovery left him with a loss in muscle size and tone in his right leg. His right arch collapsed when he stood and he was always putting his weight on his left leg for balance. His right glute was also noticeably smaller and weaker than his left.
He addressed his valgus with the same principles he teaches his clients: work the muscles above and below the knee in order to pull the joint back into alignment.
“In other words, encourage the knee back toward the outside. I did toe crunches to build up my arches, calf raises, and tibialis anterior raises below, and glute maximus and glute medius exercises to work the hip above.
As with any strength training routine, consistency is crucial. To get his leg back into shape, Mykleby performed the exercises regularly for nine months.
Although specific and properly performed exercise is helpful, keep in mind that some movements can cause harm. Despite the “no pain/no gain” mantra common to some strength training circles, Mykleby says that stressing a dysfunctional joint can hurt rather than improve its function.
“Box jumps and exercises like these are a bad idea. The shock that travels up the leg does so off-axis, and will create undue stress at the knee,” Mykleby said. “Running should also be avoided. Opt for cycling or swimming for aerobic exercise if knee valgus is a problem”
Mykleby adds that footwear can also play a role in getting the knee back in proper alignment.
“Shoes with arch supports help, although they should not be considered substitutes for strengthening the arches,” he said.
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