Knock Knees

Knock knees is a common phenomenon most of us have probably seen when walking around in public. Many people move with this strategy without issues, however sometimes it can cause a problem or two. Places like the feet, knees, hips and lower back are all areas that are commonly affected when folks walk around with this type of movement. Traditionally called knee valgus, there may be more to it than we think.

Conventional wisdom in the rehabilitation world attributes this type of knee position to muscle weakness in the hips. The theory is that the muscles surrounding the hips control position of the knees and if they are strengthened, they will prevent the valgus shape. Although there is evidence that this method of intervention can help with knee pain, there are also studies contradicting those findings.  We may need to rethink our approach and consider other factors that contribute to the knock knee presentation.

The hip is a long way from the knee, meaning your thigh bone can change its shape a number of ways on its way from hip to knee. It may be that the top of the thigh (femur) is in a different position from the bottom, and that if we altered this in such a way that they were more congruent with one another movement would clean up. There is a real possibility that the end of the femur which makes up part of your knee is twisted inward at the level of the joint, leaving your shin bone (the tibia) twisted in the opposite direction. This can lead to focal stresses being placed on select tissues and eventually pain or difficulty moving.

One area that is very often neglected is the abdomen, and specifically the guts. Every step we take, our abdominal contents are shifting and sliding, requiring guidance from connective tissues/bones/muscles. If the proper guidance is not afforded, they tend to go forward and down. An often-utilized strategy to prevent them from descending too far is by knocking the knees together. Knee valgus becomes a compensatory mechanism for a lack of movement elsewhere, and this may be a larger driving force than any other.

Knock knees are much more than a localized problem, if pain arises. They are a response to a more widespread strategy that can result in knee problems. Traditional descriptions may be too limited in their viewpoint to adequately explain the complexities that contribute to this circumstance. A more robust model of the scenario could provide better outcomes.

Austin Ulrich, Physical Therapist