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The quest for Pre-Hab vs. Rehab

The Knee

The knee is a “victim joint.” That is, the knee is rarely the source of dysfunction, but rather the unfortunate victim (often painfully so) of alterations in hip and/or ankle motion. The knee has a propensity toward a “COMPENSATION PATTERN” described as a “functional valgus.” Knee valgus is also referred to as knock knee, valgus collapse and medial knee displacement. It is characterized by hip adduction and hip internal rotation, usually when in a hips-flexed position. 

Knee-Valgus

It can also be thought of as knee caving (see image above.) In the past (VMO) strengthening has been the “go-to” intervention for improving knee pain, dysfunction and pathology. There is now a bounty of research that supports the statement “improving gluteal neuromuscular control as part of a comprehensive injury prevention program or following an injury is imperative for knee health.”
Studies examining individuals with patellofemoral pain syndrome, iliotibial band syndrome, ligament rupture, and even achilles tendinopathy, most often present with what is commonly observed as knees bow in (a.k.a. Functional Knee Valgus) during  movements that include squattting, running, walking, walking up or down stairs, standing on 1 leg to reach for something etc. Based on this research, there are multiple factors contributing to this ( Valgus Knee) and MULTIPLE FACTORS IS A GOOD THING. Anytime you see multiple factors contributing to a dysfunction do not think “WOW that’s complicated”, instead think “look at all the potential issues I could address”. More factors could mean more potential interventions, which could mean more opportunities for success! Woohoo!
As to what’s causing the valgus collapse, in the research it has been suggested that knee valgus can be caused by four primary factors.  
 
1. Weak Hips
Inadequate gluteal/hip strength (gluteus minimus, glute medius, gluteus maximus, hip external rotators), possibly in conjunction with overactive hip adductors, prevents proper stabilization of the femur. The hips then move into adduction and internal rotation. And when the adductors are overactive in comparison to the glutes/hip external rotators, the knee is similarly pulled into valgus collapse.
 
Glutes
 
2. Tight Ankles
Inadequate ankle dorsiflexion mobility along with tight lower leg musculature (gastrocnemius, soleus, and anterior tibialis) prevents the tibia/knee from migrating forward sufficiently. This causes the foot to compensate by pronating (allowing for more forward knee migration), forcing the tibia to internally rotate, which leads to hip internal rotation and hip adduction, and therefore knee valgus.
 
lunge-test4
 
3. Impaired Quad Function
Inadequate VMO (vastus medialis obliquus) strength will fail to allow for proper knee stabilization, which will cause the knee to track inward.
 
VMO
 
4. Impaired Hamstring Function
Inadequate medial hamstrings (semimembranosus and semitendinosus) strength will prevent proper stabilization of the knee which will lead to some medial knee displacement, similar to what happens with impaired VMO function but on the opposite side of the thigh.
 
Medial Hams
 

What’s the First Step in Correcting Knee Valgus?

First, It is vital to solicit the help from a skilled trainer, movement specialist or conditioning coach who can give you an evidence based assessment to help you determine what is contributing to knee pain. 
1. Lack of Ankle Dorsiflexion Mobility
2. Lack of Hip Stability
3. Coordination
4. Non Optimal core strategy/weak Intrinsic stabilization system
5. A combination of all three
 

Reassessment is important to determine whether the initial treatment plan/program/treatment is working and will also help to determine when it is time to Progress.


This Blog was written by Debbie Abell, Interdisciplinary Movement Specialist and Educator at Movement U Department of Body Kinetics

For a limited time Debbie Abell is offering a complimentary assessment and a 3 pack special of one-on-one sessions for only $199 to help get you going. Call 415-895-5965 to schedule your free assessment today! Offer valid for first time clients of Debbie only.

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