Which knee has pain?


A.         B.   

     The answer is BOTH!  This is a picture of a woman in her sixties that came in with the complaint of right knee pain and swelling for the past year!  But, as the evaluation continued she admitted the left knee had pain as well.  It is easy to see from the pictures that her squat postion is extremely poor.  In both pictures her knee caves inward in relation to her hip, which indicates foot and hip weakness.  In photo A, her foot is turned out which also indicates a tight calf. 

     This knee position during a squat or landing from a jump is termed dynamic valgus.  I see this in 90% of my knee pain patients.  Dynamic valgus is also one of the leading causes of ACL tears.  As you can see from the pictures above, over time it causes uneven wear on the back of the patella (kneecap) and strain on the medial (inside) ligaments of the knee.  While the photo above demonstrates a woman in her sixties, I am seeing dynamic valgus in children as young as 6-8.

     How do we fix this?  While many people try and treat the problem with strengthening the thigh, the real answer lies above and below the knee in the foot and the hip.  Asssigning core, hip and foot strengthening exercises is key.  Teaching the proper squat position is also essential to decreasing stress on the joint.  

Subscribe to this blog and check out my post in 6 weeks for an updated picture and post of how this patient is doing.