Thursday, February 9, 2012

Effects of Excessive Pronation on the Knee

For an example of the interactions between the structures of the knee’s kinetic chain, let us take a look at a person whose foot is excessively pronated (rolled inwards). This pronation causes the person’s foot to flatten out during normal walking. This flattening then causes the tibia to rotate inwards (medially) and the femur to rotate outward (laterally).

These actions place a considerable amount of stress on the knee, eventually leading to friction, inflammation, altered motion patterns, and injury of the soft- tissues of the knee. Thus, a problem that started at the foot ends up causing abnormal hip and femur rotation, which in turn leads to knee problems.

From a therapy perspective, it is possible to achieve moderate success by treating just the immediate structures of the knee. However, in order to truly resolve the problem, we should also treat those structures that were the original cause of the excessive pronation – that is, the structures in the knee’s kinetic chain. For example, restriction in any of the following structures may be the actual cause of the excessive pronation:
  • Peroneus longus and peroneus brevis muscles help you to point your feet and aid in eversion (rolling inward) of the foot when walking or running.
  • Tibialis anterior lets you bend your foot upwards (dorsiflexion) and also helps to invert the foot (roll outwards) when you walk. Proper inversion of the foot is an important part of a normal gait pattern.
  • Abductor hallucis, this muscle is responsible for flexing the big toe and allows your big toe to move laterally (sideways). This is important since a normal walking/running stride requires us to push-off with our big toe.
  • Flexor hallucis brevis, this muscle is responsible for flexing the big toe and for supporting the medial arch of the foot.
  • Flexor hallucis longus, this muscle is responsible for flexing the big toe, supinating the ankle (turning inwards), and in pointing your foot (plantar flexion).
Restrictions in any of these structures can cause excessive pronation, which in turn leads to hip restrictions, and subsequent knee problems.

Obviously, in such situations, treating just the structures in the knee will not resolve the knee problem. Instead, the practitioner must treat the knee, and then, based on the biomechanical analysis, treat all other affected structures in the knee’s kinetic chain. The knee problem will only be resolved when restrictions in all these affected structures are removed.

For every restriction that occurs, an altered muscle-firing pattern is also created. These dysfunctional movement patterns will still remain after the restriction (adhesion/ scar-tissue) has been removed. Only a corrective program of exercises will re-establish a normal motion pattern by retraining these structures to properly work together. This is why it is essential to combine the removal of the adhesions with appropriate and specifically designed exercise protocols.

Bottom line, as good as any therapy is without rehabilitative exercises the problem will most likely return.

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