Exercise Tips for Bow-Legged and Knock-Kneed People

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If you have bow legs or knock knees, you may be at higher risk for injuries during high-impact exercise such as running or aerobics.

Knees that are significantly angled (either in or out) can put added strain on the joints of the hips, knees, lower legs, ankles, and feet. Typically, a runner who has knock knees will pronate (the ankles and feet roll inward too much). A bow-legged runner is more likely to supinate (the ankles and feet roll out).

How to Know If You Are Bow-Legged or Knock-Kneed

To check yourself, stand in front of a mirror with your feet hip-width apart.

  • If your kneecaps are not aligned with the center of your feet and turn inward, you have some degree of knock knee.
  • If they are not aligned with the center of your knee but turn outward, you may be bow-legged.

It is often true that we are not the best judge of our own body image. You may want to take a photo of your image in the mirror so you can get an accurate picture. Print it out and use a ruler to draw a line so you can determine if what you think you see is objectively true.

What Causes Bow Legs?

Bow legs are normal in infants, but most healthy children have their legs correct to being straight or slightly knock-kneed by age 2. This is not common in adults, but it is seen in Blount's disease. A major cause of bow legs is rickets due to malnutrition or deficiency in Vitamin D or calcium.

You may be familiar with the cowboy bow-legged posture, presumably from long days riding a horse, and this is seen in some jockeys today as an occupational cause.

Bow legs can accelerate developing arthritis in the knees due to the uneven stress. 

What Causes Knock Knees?

Being slightly knock-kneed is normal. Pronounced knock knees can be caused by rickets, and may also be caused by obesity. You may have collapsed inner arches of your feet, bringing the inner ankle bone lower than the outer ankle bones.

Excessive knock-knee can lead to chronic knee problems, including arthritis and chondromalacia.

How to Exercise With Bow Legs or Knock Knees

If you have knock knees or bow legs and do high-impact activities such as running, you might be a good candidate for an orthotic. 

Your orthopedic physician or a physical therapist may recommend special shoe inserts or a brace or knee support in addition to a modified exercise program.

For knock knees, the physical therapist might work on developing the arch of the foot, strengthening the abductor muscles, and correcting ankle imbalance. Yoga and Pilates may be recommended to work on overall body alignment and balance.

If you have lower leg pain, you could try cycling or ​swimming as an alternative form of exercise. Lower impact exercise will better preserve your knee health that is already at risk for developing osteoarthritis due to your leg alignment. Balance and flexibility exercise, such as yoga and Pilates, can be beneficial overall.

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