Runners with weak hip stabilizers appear to have tendencies to rotate the thigh inward and to excessively adduct the hip (i.e. run knock-kneed) to create stability to compensate for the weakness of the hip stabilizers. These maladaptive movement patterns put strain on the knee, and over time an injury emerges.I took that from this article in “Competitor: Your Online Source for Running.” The author of the piece further simplifies the hip-knee relationship to:
Muscle weakness in hip --> bad form --> knee injury
Assuming you believe all that, you should also see a common sense solution:
Strengthen the weak hip muscles.
Easy enough, huh? Apparently not.
20 women (who weren’t injured yet who showed signs of abnormal adduction while running) participated in a study where half went through a six-week program of hip strengthening and instruction in single-leg squats. The other half (the control group) did their normal training.
And the results?
Nothing. Nada. Zilch.
The knock-kneed runners who strengthened their hips continued to run the same way as before.
So was lack of hip strength really causing them to run knock-kneed? Or was it something else?
And, more to the point if you’re a structuralist type (someone intent on tracing problems back to crookedness and muscle imbalances): How fixable anyway is what you think is wrong? (I’ll set aside the question of whether running knock-kneed predisposes you to injury -- let’s assume for now that it does).
This seems to be “the other problem” with structuralism. The number one problem, I think, is that the search for structural deficits is overused as a diagnostic tool. The “other problem” (the depressing one, really): It’s very hard/impossible to correct many structural “faults.”
A great example is leg length discrepancy. Having legs of different lengths, in the structuralist world view, sets you up for all sorts of problems. But what’s the remedy? Unfortunately, you can’t mail order an evenly matched set of limbs.
Have no fear though. In a long, fascinating essay on structuralism (subtitled “The Story of the Obsession With Crookedness in the Physical Therapies”), Paul Ingraham notes a 1984 study showing that leg length discrepancy doesn’t make any difference for back pain (within reason of course -- if a doctor saws six inches off your right leg after a car crash, yeah, that’s going to affect your walking and a whole bunch of other things).
And so it is with other bits of structuralist orthodoxy, Ingraham goes on to explain. Another study looked at imbalances of major muscles in elite players in the Australian Football League. Any structuralist worth his salt can tell you what that should lead to: higher rates of injuries. But researchers found that “asymmetry in muscle size was not related to number of injuries.”
Ingraham’s essay is a terrific read for its bountiful evidence and good insights. For instance, he says structuralists are masterful dot connectors. He gives this as an example of how they think:
A podiatrist might tell you that your fallen arches (dot!) cause greater strain in your knees (dot), which in turn force you to use your hips differently (dot!), which leads to hip weakness (dot), then muscle imbalance in the core (dot!), which finally results in back pain (dot!).What’s the first thing you notice there? I’ll tell you what I see: the potential for incredible, bewildering complexity. After all, almost everything in our lower extremities can be connected, somehow, to almost everything else. Treating chronic knee pain under such a belief system then becomes like solving some higher order math equation. This suggests your treatment will probably be long and frustrating, as your structuralist, dot-connecting physical therapist explores various hypotheses about what might be “truly” causing your knee pain.
My approach was much simpler. I operated on the assumption that my joints were just injured, or weak, and needed to be slowly strengthened and coaxed back to health.
This approach worked very well for me. I suspect it would work very well for many other people suffering from chronic knee pain too.