Recently several new students have presented with subtle, and more pronounced, signs of valgus knee. It is especially noticeable when doing any form of squatting or a dancer’s plié, where the arch appears to collapse and the knees fall inward creating what is commonly known as ‘knock knees.’ Naturally, this topic has become an interesting part of current reading materials and an emphasis in class formats recently. Within the scientific journal articles, it appears that the ‘jury is still out’ on a specific cause of valgus knee. Trainers have long attributed this dysfunction to weak gluteal muscles, overactive adductor muscles of the hip, and/or pronation of the foot; but recently, imbalances in lower leg muscles have also been studied with interest.
In an effort to understand the basic knee pain that students have reported, this investigation began with general look at the powerful quadriceps muscles at the front of the thigh. The four muscles are formally known as the quadriceps femoris group. They include the rectus femoris superficial to the vastus intermedius, centered along the femur bone; with the vastus medialis running along the anterior, inner side of the femur, and the vastus lateralis along the outside of the femur. While three quadriceps muscles originate from high on the femur bone, the origin of the rectus femoris attaches on the anterior inferior iliac spine (AIIS), low on the hip bone where it assists in hip flexion. All four quadriceps work as the powerful extensors of knee. The distal portions of all four muscles join into one important tendon. The tendon attaches to the sides and top of the patella, which then becomes the patellar ligament and attaches to the tibia (lower leg bone). The forces of the quadriceps muscles pull at the patella (or kneecap) and it slides in its ‘groove’ or ‘track,’ during movement at the knee.
Researchers continue to speculate why this perfect balance is impacted and how muscles’ direction of movements, specifically affect the knee. In general, the scientific method to measure forces at the patella is by assessing the Q-angle. This is the angle at which the femur and quadriceps muscles come from the hip and meet at the tibia bone (and patellar ligament). Normal Q-angle for men is about 14 degrees and for women is 17 degrees. Women typically have a higher Q angle due to a frequently wider pelvis. In taller people, the principles of biomechanics teach us that longer levers (femurs) exert greater force at the fulcrum (knees in this case). The patellar ligament usually maintains normal ‘tracking’ because it is guided on the outside by a bony ‘wall’ formed by a raised area of the femur bone (lateral femoral condyle) and along the medial side, the distal fibers of the vastus medialis are angled to pull the patella medially. Any one of these players can cause the ‘tracking” of the patella to malfunction which is a significant risk factor for patellofemoral osteoarthritis, or worse. A high Q angle often results in repetitive microtrauma to the tissues causing patellofemoral pain syndrome (dysfunctional patellar tracking also called “runner’s knee”), another form of damage occurs to cartilage behind the patella causing anterior knee pain known as chondromalacia, or anterior cruciate ligament (ACL) injuries.
Like snowflakes, humans are unique in our various sizes, frames and shapes as a result of nature’s design. Some individuals’ physical assets, including Q-angle, may prove more challenging or injury prone than others. As fitness professionals, we seek to understand not only how to assist individuals to maximize their health and journey toward their goals, but also we must educate ourselves. As movement experts, it is our duty to help mitigate any impending negative results of dysfunctional patterns as we strive to help all to “live better in our bodies”. In Part 2 on Friday we’ll ‘Confront the Q-angle Quandary’ with Therapy Ball techniques to help address the tissues involved, and in the meantime, watch this video below for Prasarita Lunges to strengthen the quadriceps muscles, glutes and outer hip: