Knee pain is a common condition that we see at Back to Function. After a thorough history of how and when your knee hurts, are next step to diagnose your condition is a posture evaluation. The posture evaluation can tell us quite a bit about the different stresses on the knee joint.

Typically, when the femur (thigh bone) and tibia (lower leg bone) are rotating in opposite directions with normal standing, there is a potential for a painful knee due to torque at the knee joint.

LEFT KNEE PAIN

The first knee posture that can cause pain is when the left femur is rotating inward (internal rotation) and the left tibia is rotating outward (external rotation). Often this knee posture will be associated with a high-arched left foot. This posture will typically cause joint pain on the outside (lateral) of the knee. Exam findings would include a positive left adduction and extension drop test. Treatment would focus on inhibition of the left lateral quadriceps muscle and facilitation of the left lateral hamstring to move the left femur into external rotation. Foot orthotics can be used to support the medial arch when a high-arched foot is present. At BTF, we can create custom foot orthotics that you wear in your shoes that will support that elevated arch. Here are exercises that we use at BTF to help correct this knee position:

The second postural issue with the left knee is to have the femur externally rotate while the tibia is internally rotated. Typically this will cause a bow-legged appearance (genu varum) of the knee and an overdeveloped left lateral quadriceps muscle. This posture will typically cause joint pain on the inside (medial) of the knee accompanied by medial infrapatellar tendonitis. Exam findings would include a positive left adduction drop test and decreased seated left hip internal rotation. Treatment would focus on inhibition of the left lateral quadriceps muscle and facilitation of the left medial hamstring to move the left femur into internal rotation. Here are exercises that we use at BTF to help correct this knee position:

Note: The most typical position of the knee is with femur and tibia in internal rotation, but due to the absence of torque, this posture is typically not painful.

RIGHT KNEE PAIN

Right knee pain can be caused when the right femur is rotating internally and the right tibia is rotating externally. Often this knee posture will be associated with overdeveloped right lateral quadriceps and a high-arched right foot. This posture will typically cause joint pain on the outside (lateral) of the knee and infrapatellar tendonitis. Exam findings would include a positive left adduction drop test, positive right passive abduction raise test, decreased seated right hip external rotation and increased right hip internal rotation. Other possible findings are an excessive gap between the 1st and 2nd toes, poor right toe extension mobility and a history of right ankle inversion sprains. Treatment would focus on inhibition of the right adductors and facilitation of the left medial hamstring to move the left femur into internal rotation and adduction. Here are exercises that we use at BTF to help correct this knee position:

Right knee pain can also be caused when the right femur is rotating externally and the right tibia is rotating internally. This posture will typically cause joint pain on the inside of the knee and a knock-kneed posture. Exam findings would include a positive right passive abduction raise test and decreased seated right hip internal rotation. Other possible findings are right sciatic irritation from increased right external rotation strength/tone or overuse. Treatment would focus on facilitation of the left lateral hamstring and right medial hamstring. Here are exercises that we use at BTF to help correct this knee position:

This article demonstrates a few exercises related to knee pain that can be caused by postural asymmetry. For a detailed evaluation of your knee pain and posture, please contact us at 310-534-1900 or by email at [email protected].

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