A pal of minewent to a bike ride , and after approximately an hour began to undergo acute knee pain. After assessing her lower extremity I discovered she’d “knock knees”. The clinical expression for “knock knees” is Genu Valgum. The reverse could be “bowlegged” or even Genu Varum. Because Genu Varum is not normally connected with problems or pain, we will focus on my buddy with all Genu Valgum. But, both these conditions will be the consequent of this Q-angle.
The Q-angle is decided from the frontal plane by drawing a line in the anterior superior spine of the ilium into the center of the patella, and another line in the center of the patella to the tibial tuberosity. A standard Q-angle for quadriceps femoris work is generally 10 -14 levels for men and 15 -17 levels for females.
Anyhow back to my buddy…
When appraising the lower extremity you’ve got to “escape the box” kind of talk, states Ruben Salinas PT, OCS. Ruben is currently the clinical manager of this Fortansce and Associates Physical Therapy clinic at Arcadia, CA. “Don’t just focus where the pain lies look at the entire picture. Bear in mind, the lower extremity is a closed chain, especially in cycling.”
Normally related to Genu Valgum you’ll locate pronation or flat feet, tight gastrocnemius and sometimes trochanteric bursitis. In gait you need to dorsiflex 1 ankle so as to swing through with the other leg.
If your clients gastroc is tight, they won’t be in a position to dorsiflex, which will get the foot to cave in. This will indeed alter the knee and then the hip. Take care to insure their foot doesn’t cave in while stretching. If necessary, support the inside of their foot with a wooden block so their foot won’t pronate. By strengthening the inverters, (see diagram) you’ll create the foot to supinate that’s the opposite of pronation. There are different methods of helping the foot out, but that’s a whole other article.
My friend was not complaining about her feet, however, the pain was on the lateral or outside portion of her knee.
So let’s examine the knee:
due to the excessive Q-angle there’ll be more compressive forces on the lateral side and more tensile or distraction forces on the medial side of the knee. So how can you fix that?
“This is topic a big grey area in the physical therapy world,” says Ruben Salinas. He’s a specialist on knees. VMO weakness or the inability to fire was suggested as the culprit for patella – femoral dysfunction. To raise VMO activity, try quad sets in all directions or have your client place a little ball or rolled up towel between their legs when the perform leg extensions. Have them squeeze tightly or adduct near the peak of the extension.
Through their fingers they ought to have the ability to feel which side contracts first.
It’s almost as though the head of the femur has rolled forward and inward. While this occurs, the greater trochanter starts to smash up against a bursa which eventually could lead to bursitis.
Concentrate on the gluteus maxims and not the gluteus medius. Bear in mind, the medius is an internal rotator. Don’t forget the deep external rotators either. By performing external rotation with a cable or tubing attached around the ankle, you will strengthen the piriformis, superior and inferior gemellus, obturator externus and internus in addition to the quadratus femoris. This will help stabilize the hip so that smashing of bone against bone doesn’t occur.
Be aware, some clients could have an aversion. This is the angle of the femoral neck in the frontal plane. (see diagram). Anteversion will turn the toe turn inwards, increase mechanical advantage of the gluteus maxims as an external rotator, increase the Q-angle and cause more pronation at the foot. Anteversion is structural, and that means you can’t repair that without a scalpel and a chain saw.
In summary, I hope you can see that in the instance of the lower extremity you must have a holistic strategy. Ask plenty of questions. How did they get this way? Is the condition acute or chronic? Is it congenital? Might it be structural or muscular? Examine their gait.
When there’s pain when performing these exercises, refer them out and receive a medical release.
It is my hope that this can assist you and your customers, and I sincerely hope you’ll assess their posture before you load anyone with a weight.
Learn how to fix bowed legs here