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Knock Knees : fix it by boot alignment or by something else

 Poster: A snowHead
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Had an interesting chat with a a very good physio who lives in the mountains and works with all levels of skiers about body mechanics and alignment.

I am a big believer of boot alignment and assumed that this is the best way to compensate for knock knees or bow legs. The books all talk about it and it seems to be the received wisdom here. but the physio said that in 3/4 of the cases of knock knees she sees (even after the patient had their boots set up by a good fitter) that the overriding cause is imbalanced muscle development. I see A framing / knock knees fairly regularly and invariably when women with knock knees and are reasonably athletic are quizzed about what other sports they do they say they did loads of horse riding and ended up overdeveloped the "squeezy iny muscles" . The physio had a set of exercises to work on getting the leg musculature balanced and that fixed the problem more often than not. I would assume that most alignment issues are a range of muscle and skeletal issues but the muscle development gets overlooked..
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A framing is most often gotten rid of by improved technical ability, not a trip to the boot fitter. I suppose there are knocked kneed skiers out there who do need some adjustments to equipment but given that many straight legged skier A frame it can't be the whole story.
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A good way to fix muscle imbalance is to conciously not do it, and the imbalance is forced to correct itself too. This happens with posture pretty quickly and noticably. I've argued this before against the "but I can't ski centred because I need special ski boots/bindings/alignment/canting" complaint and had no success though...
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Accommodate the problems with cuff alignment and perhaps sole planing, and work on muscle groups to offset balance issues. Think a combination of these processes would be good.
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DaveC, not sure you can fix a muscle imbalance by "not doing it" you can compensate but your body will be working all the time and you will get tired. as SMALLZOOKEEPER, says i would agree a combination of alignment and balanced strengthening is a god way to tackle this. my main point was knock knees due to imbalanced muscle groups gets overlooked and rarely mentioned.
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skimottaret, and your muscles will then have to adapt, since they won't put up with being tired for long, and the problem will go away...
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skimottaret, I once heard a top football coach say that bow leggedness was something he liked in a player.
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jbob, might be good for football but sucks for skiing.... your earlier comment about technical ability is partly true and knock knee skiing can happen when the skier gets "defensive" and draws in the arms and folds at the waist.
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skimottaret wrote:
jbob, might be good for football but sucks for skiing....

...but have you ever seen an ISTD who's not at least slightly bow-legged? Phil S, PSG, Stuart B (and I can remove the slightly there Wink ), Charlotte, etc., etc., etc.. they all have a definite touch of the John Wayne about them.

(Maybe being bow-legged isn't great for goalkeepers though!)
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I'm assuming bow legggedness is the opposite of being knock kneed?
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GrahamN, not sure many top guys are truly bow legged but wide stance with parallel shins seems typical.
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Quote:

I've argued this before against the "but I can't ski centred because I need special ski boots/bindings/alignment/canting" complaint and had no success though...


Have you ever experienced what bad alignment feels like? Either too much heel lift or too much forward lean are easy to simulate. Try skiing something steep with a 10mm heel lift or a sizable shim down the back of the calves.

My A frame comes and goes depending on whether I'm in the backseat or not. Hips forward=parallel shins, hips backwards= A frame. This isn't just an alignment issue, it is also bad technique but dealing with the former is a prerequisite for dealing with the latter.

IANAI
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gorilla, I find it really hard to believe that the number of people claiming to be biomechanically different to the rest of the world is so high. I've experienced poorly fitting boots, yeah. I've also seen people ski much better than me in boots consisting mainly of duct tape. You might need alignment, you might find it makes your life easier, but there are lots of equipment crutches that could be used for any number of technique faults.
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skimottaret wrote:

I see A framing / knock knees fairly regularly and invariably when women with knock knees and are reasonably athletic are quizzed about what other sports they do they say they did loads of horse riding and ended up overdeveloped the "squeezy iny muscles" .


I find this interesting as people gripping with their knees (squeezing in) is one of the most common riding faults. I'd expect expert riders to make better skiers than less-expert riders.

Less-expert riders have the following riding faults that could carry over to their skiing - grip with knees(knock knee-ed), tense through the body, thinking backwards with regards to forwards speed(which often leads to leaning back/being defensive), and try to force things to happen. I'm sure there are others.

Expert riders should be more relaxed, let balance keep them on board, absorb un-expected/sudden movements easily, be happy 'flowing' forwards(and generally 'think forwards'), don't interfere/constantly check(brake) their speed, don't worry about falling, and have FEEL, which should all help their skiing.

P.s sorry to hi-jack the thread. I know you probably don't care!!
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Jumper, actually quite interesting and as you say very applicable to skiing. lots of sporty women/girls who ski also ride, or rode as children, and the sames problems are perhaps inherent in both sports. I do see a bolt upright stance in riders and that usually isnt good in skiing though.

DaveC, have a read of "the athletic skier" or skiing an art and technique (if you can find it) as an aside how often do you see guys in the gym who pump lots of iron and have big pecs etc but terrible gorrilla posture because they dont work on the opposing muscles in the back. no amount of saying to stand with a better posture will help them get better posture.. it isnt always technical faults..
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I'm so lost! What is knocked knees? I ride all the time and don't think I have them but then I'm not really sure what they are. Can someone enlighten me what it is and why it would be linked to horse riding. Puzzled
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skimottaret, Interesting. I suppose that the physio would work on the abductor muscles, to balance them up with strong adductors. There was a thread recently from someone who had muscle problems of some kind and turned out to be a rider - abc?

Loads of people (probably most of us) have muscle problems, often mistaken for all kinds of things, and solvable by the right physio. Just "thinking them away" is not likely to be too successful. You're right about the "gorilla postures" too, which can be caused by poor posture, not just pumping iron - those lengthened back muscles can also result from sitting in front of a computer screen for too long in the wrong position.

I get pains in and around my knees which are the result of trigger points in my leg muscles - which I can get rid of if I work on them (including in the abductors and calves).

And I am one of those A-framers with straight legs!
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skimottaret, this is a problem I have (as you're aware) and horse riding is something I used to do about 10 - 15 hours of per week as a teenager... I'm not a great rider - I was riding polo ponies and leading 2 or 3 whilst I rode one - hardly dressage!

For the past 6 mths I've been doing pilates and focusing on this problem, I really hope it's going to make a difference, but I suspect I'm not putting in the hours to really fix it and will probably need to get my boots alighend also.

Now I know what I do I'm very very aware of it. If I'm walking up steps I'll conciously think about trying to keep my knees pointing forward rather than collapsing in - that's what they wil naturally do. Even if I'm just sitting my thighs / knees will roll inwards.
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pam w, that was me!
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gorilla wrote:

My A frame comes and goes depending on whether I'm in the backseat or not. Hips forward=parallel shins, hips backwards= A frame. This isn't just an alignment issue, it is also bad technique but dealing with the former is a prerequisite for dealing with the latter.


Weird, I was totally the opposite. If I flex my ankles I will A-frame and both skis go onto their inside edge. If I force myself into the backseat I can get my skis flat.

Last year I had shims fitted in my boots by Andi McCann when I got new footbeds from CEM. No more A-Frame Very Happy

I guess we're all different, but this transformed my skiing.
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Over pronation is a major contributor to this 'A Frame', however there are also other symptoms that can cause it, femual rotation being one. IMO the Over pronation issue is the biggest and therefore an orthotic device, (which we should all be using when skiing) will help in most cases and in some remove it completely.
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I'm so fascinated by this. In riding (general riding, jumping, dressage) you are taught to have loose knees and thighs as this can tense up the horse and also allows you to balance through your seat and have your weight only in your seat or lower leg depending on what you are doing. Basically you ride all through your seat and leg aides of the lower leg (the top part of the leg is away from the horse). In jumping you are taught to ride in a slightly forward position so you are always with the horse. Being upright is ok as long as your back is not hollowed but you really don't want to get left behind so it's better to be slightly forward in the shoulder to reduce this happening. If I used my knees to hang on I would not have enough weight in my heels and would fall off a lot!

So I can't see how being a rider this would make you stand too straight or have a problem with your knees. I think I now might video myself next time I ski to see! I'm worried at what I could look like. Smile
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SMALLZOOKEEPER, that could be but even if the orthotic device statically realigns you into the correct position if you dont have the strength in your abductor (gluteus) muscles her point was during skiing your knees may still collapse in...
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skimottaret, bit off topic now but there's obviously a huge difference between muscle imbalance created by resistance training and muscle imbalance due to lifestyle... same dodgy logic that makes people think running/skiing will give you strong legs...
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chelseafc,

http://health-pictures.com/genu-valgum.htm

Horse riding is in my opinion a bit of a red herring, it would have to be a very skinny horse.

It does however seem to occur far more frequently in girls than boys so the shape of the pelvic girdle and growth can be a factor. It also appears to be more prevelant with those suffering from severe obesity.

Quote:

Over pronation is a major contributor to this 'A Frame', however there are also other symptoms that can cause it, femual rotation being one. IMO the Over pronation issue is the biggest and therefore an orthotic device

Which comes first pronation or 'knock knees' is one of those chicken and egg questions and it may very according to the underlying mechanics. I often feel it should be broken down into general catergories, those with pronation and mild intenal femoral rotation who respond well to orthoses and could ski, those with severe internal rotation who should play cards and those with pronation and little or no internal rotation who should snowboard Madeye-Smiley.
Quote:

I find it really hard to believe that the number of people claiming to be biomechanically different to the rest of the world is so high

Equally every now and then I come across a knock kneed supinator!
We're all different, even as individuals left and right are rarely exactely the same. This can be due to genetics, adaption, habit, injury, compensation etc.
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skimottaret, Stack the bones correctly first, they provide the structure, there after, muscles and tendon/ligaments will tune them selves over time, however nothing wrong with, if correctly advised by a sports physio.
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In my admittedly limited experience of 1 (me), I used to ski bow-legged until a trainer adjusted the cant(cuff alignment) of my boots. The result was a greater than 100% improvement in my skiing almost overnight. Since then, footbeds were invented and I find they obviate the need for canting.
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SMALLZOOKEEPER wrote:
skimottaret, Stack the bones correctly first, they provide the structure, there after, muscles and tendon/ligaments will tune them selves over time, however nothing wrong with, if correctly advised by a sports physio.


+1 - HELP ME, I'm agreeing with SMALLZOOKEEPER

Otherwise the muscles are woring harder to try and compensate and are very inefficient.


Last edited by So if you're just off somewhere snowy come back and post a snow report of your own and we'll all love you very much on Thu 25-11-10 17:10; edited 2 times in total
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I think internet based hypochondria is a big issue for Snowheads though - I think maybe 10% of the instructors I've worked with have even had correctly fitted boots, and they seem to ski pretty well. If you spend a lot of time on a forum with people educated in the benefits of it, and lots of expert knowledge bandied around, it's easy to decide you definitely must have x y and z to ski well. What most people actually need to do is learn to ski well...
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There are benefits of being knock kneed though, easier to snowplough rolling eyes
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DaveC, Those with significant biomechanical anomolies which effect performance rarely take up highly active hobbies, jobs, sports (there are exceptions though). On the otherhand some biomechanical anomolies can be a benefit for some sports or activities, build of swimmers being one where most of the top level ones look like clones Shocked
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GrahamN wrote:

...but have you ever seen an ISTD who's not at least slightly bow-legged? Phil S, PSG, Stuart B (and I can remove the slightly there Wink ), Charlotte, etc., etc., etc.. they all have a definite touch of the John Wayne about them.


Never thought I could be in the same group as these guys even if it is only on account of my bandy legs!!! There is hope for my skiing yet Toofy Grin
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anarchicsaltire wrote:
SMALLZOOKEEPER wrote:
skimottaret, Stack the bones correctly first, they provide the structure, there after, muscles and tendon/ligaments will tune them selves over time, however nothing wrong with, if correctly advised by a sports physio.


+1 - HELP ME, I'm agreeing with SMALLZOOKEEPER

Otherwise the muscles are woring harder to try and compensate and are very inefficient.


couldnt agree more but it was her comment that in patients who HAD footbeds and alignment done and were fine "in the shop" but when actually out skiing still pronated and had knock knees awas mainly down to a very noticable (to her) weakness in the abductors....
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DaveC wrote:
I think internet based hypochondria is a big issue for Snowheads though .............. What most people actually need to do is learn to ski well...


You may be right, but not in all cases. The first time I skiied with shims fitted was a Eureka moment.
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skimottaret, Agreed, building up muscle strength and balance is very important but it takes time and or effort, it doesn't occur immediately just because you've improved the mechanics. However you need to get the underlying structure optimised to make this easier. You can't completely 'remove' pronation it's needed for ankle flex, so limiting it entirely causes other issues. Nor can you always eliminate knock knees, it depends on the severity and the underlying cause.
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FECK, i've posted in BZK, back bottom.
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I had knock knees as a child. They were corrected (according to before and after photos) by wearing hard-soled shoes with heels filed down at an angle, for a couple of years or so. Presumably that was like wearing footbeds to correct pronation, except that my muscles adapted in some way. ??
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Hurtle wrote:
I had knock knees as a child. They were corrected (according to before and after photos) by wearing hard-soled shoes with heels filed down at an angle, for a couple of years or so. Presumably that was like wearing footbeds to correct pronation, except that my muscles adapted in some way. ??


Correct, the boot acts as an orthotic, get the alignment right (for the right problem) and things line up, muscles work better and ligaments slowly adapt. Time, effort and persistance are often the answer.
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chelseafc wrote:

So I can't see how being a rider this would make you stand too straight or have a problem with your knees. I think I now might video myself next time I ski to see! I'm worried at what I could look like. Smile


I wouldn't get too hung up on this. I suspect that most of the riders that are too straight or whatever are infrequent, and not very accomplished, riders. And as most riders probably fall into this group, then these are the ones that SKIMOTTARET is most likely to come across.

One thing about forum based discussions is that the instructors here aren't able to say 'just go and try it', so things can be discussed in far too much detail for most of us. Paralysis by Analysis, anyone?

And as I have mentioned elsewhere, I believe that 'FEEL' is vastly undermentioned (is this a word?!) in this forum, and is a huge part of both skiing and riding.


Last edited by You'll get to see more forums and be part of the best ski club on the net. on Thu 25-11-10 19:07; edited 1 time in total
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skimottaret, Yup you're on the button. Regrettably 'form follows function' and the activities or lack of in our early years has a physiological effect on our bone structure with a concomitant change to our muscular development. Where it all goes tit's-up is when we use orthotics to compensate for BOTH structure and muscular imbalances. They are separate issues, one usually fixed and immutable, the other is very malleable. An orthotic should attempt to correct the structural issue and help to develop a balanced musculature. Otherwise even more stress and long term damage may occur. It's like doing 'crunches' incorrectly can give you a great and huge 'pot belly'.

I must get back to that comment I made a few months ago about that video, I was trite and I can understand your issue with it but there is real subject behind them.
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