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Do My Knock Knees Need Correcting?

Hip Pain in a young Female Runner a Cautionary Tale

So when I am not working as the Clinical Director of Inside Edge Physiotherapy I am lucky enough to work as a Clinical Teaching Fellow in the National Health Service.

In this role I teach 4th year Medical Students how to diagnosis orthopaedic conditions.  I do this through formal lectures and bedside teaching in othopedic hospital clinics.  In these clinics we examine and interview patients awaiting surgery about the history of their symptoms.  

The Cautionary Tale :  

In one of these clinics we were lucky enough to examine and interview a 26 year old recreational  female runner awaiting (key hole ) hip surgery.  Now when I teach medical students and all students for that matter,  I go to great pains to emphasise the importance of listening to the patient and taking a through history.  This is something I have had to learn the hard way which is why at Inside Edge Physiotherapy we spend 1.5 hours with patients during their initial consultation .... but thats for another  blog.  

When we asked her how her symptoms had started and what she thought had got her to the stage where she needed surgery, she explained that her hip pain was keeping her awake at night and she had, had to stop running because of pain.  

Why did she have hip pain ?  

Well it turns out that she was born with a congenital hip condition called femoral hip anteversion. This is an anatomical or structural deviation in the angle of the femoral neck which causes the femoral bones to turn inwards.  In days gone by we would have referred to this as a pigeon toe walking pattern where the feet were turned inwards.  This in its self is does not often cause pain in most people providing they understand how to look after this anatomical variance. 


So why did her hip become painful?

Well after listening to her story about how the symptom begun and progressed.  It appears that for many years she was encouraged by personal trainers, running coaches and physiotherapists  to run with her legs in "normal alignment "  She was told that her running pattern would look better and this would reduce her injury risk because of poor biomechanical alignment.  


runner with poor femoral and pelvic alignment
runner with poor femoral and pelvic alignment

However,  what these well intentioned physios, coaches and personal trainers did not know, was that their advice was actually contributing to her hip symptoms by causing the femoral heads to ride forwards in the hip socket.  The safest place for her hip bones was in the socket in anteversion not in a normal neutral position.   So for several years she tried to maintain a " normal, neutral foot and femoral  alignment during running,  squatting  and  lunging until the pain became too much and she could no longer continue .

Why did she not stop when it was painful?

Well firstly,  the pain started as a low level ache which she just put down to the normal aches  and pains associated with training , not realising  that the change in her femoral position was probably irritating the front of her hip joint.   Also, she had professionals telling her that her new alignment was good for her and would improve her performance and reduce injury.  

The take home message!

If are concerned about your lower limb alignment during squatting , lunging , running or other weight bearing activities.  It is important to establish if the alignment is structural or non structural and therefore correctable.  If it is structural and not correctable there attempting  to change the alignment with postural correction is not recommended.  However, if it is correctable or functional then postural correction and targeted exercise therapy can make the world of difference. 


You must find a physiotherapist that understands the importance of differentiating between structural  and non structural variants.  

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