Friday, September 13, 2019

My Patient Was Told Her Knee Alignment was "Off"

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My patient came in complaining of pain in both her knees after running. She had been to another physiotherapist who told her that her "kneecap alignment was off". He proceeded to give her some strengthening exercises for her quadriceps and asked to return for another session. He checked on her exercises and did some ultrasound and "electric current" therapy.

After the two sessions, she didn't get any better doing the quadriceps exercises and was referred by her friend to see me. I told her that all of us have highly variable alignment in our knees and she shouldn't worry too much about what the other physiotherapist told her.

Yes, just in case some other healthcare professional tells you the same, there is a very good article published on this topic. In fact the article is a systematic review, which means a search aided by computer for all randomized and clinically controlled trials. When it comes to quality, there is none higher than a systematic review or meta-analysis.

The systematic review concluded that healthy knees have a highly variable alignment, although this may be due to variables when doing x-rays/ MRI scans, measuring techniques and the people studied.

The exact role of knee joint alignment in development of knee pain/ symptoms remains unclear.

So we should not be telling patients that their knee joint alignment is in any way abnormal at all, not if we do not even know what normal alignment is.


Hochreiter B, Hess S et al (2019). Healthy Knees Have A Highly Variable Patellofemoral Alignment: A Systematic Review. Knee Surg Sp Trauma Arthr. pp 1-9. DOI: 10.1007/s00167-019-05587-z.

Is this knee's alignment abnormal?
I know some of you will be asking what did I do to make my patient better? After assessing the knee joint, I usually make sure there is no hip dysfunction or shortening in the calf muscles. In this particular patient's case I started with her Superficial Back Line (SBL) and her Spiral Line.

Superficial Back Line
Since she runs, I made sure I checked her running style/ technique too.
Spiral Line

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