yogabook / pathologie / bowlegs

bowlegs (genu varum)

Definition

Newborns have an average varus angle of 15°, at 18 months 0° and from 2-4 years 12 valgus, later 6° +/- 1°. Bow legs are present at a minimum of 180° between femur and tibia, physiologically approx. 174°.

Studies now show that some sports with high loads on the lower extremities tend to develop bow legs. This has been observed in soccer for a long time, even though there were no studies on this for a long time. Even though soccer players generally have stronger gluteals than adductors – after all, they must have sprinter qualitiesto perform well in the game and the gluteus maximus, as the main force extender of the hip joint, contributes significantly to this – the adductors are often quite contracted, which is also due to the kicking technique with the inner foot, which allows the adductors to perform at high power in a short sarcomere length, which increasingly increases their tone. In the case of the monoarticular adductors, this is still quite uncritical and mainly results in a tendency to insertion tendinopathies at the pubic bone, whereas in the case of the gracilis, in addition to the tendency to pes anserinus syndrome, this mainly results in excessive traction at the pes anserinus, which has a varus effect on the knee joint. This is likely to contribute to the development of bow legs, especially before the end of the growth phase and closure of the epiphyseal joints.

ICD M21, E64, Q74

Cause

– Behavior

1. Sports that tone the adductors more than their antagonists, e.g. soccer

– Diseases

1. Tumors
2. Inflammations
3. Rickets (vitamin D-dependent or -resistant; renal)
4. Poliomyelitis epidemica
5. Hormone disorders
6. Tibia vara(M. Blount)
7. Osteogenesis imperfecta
8. Osteoporotic bone deformations
9. Paralysis during growth

– traumatic

1. Traumas
2. Fractures

– Other factors

1. Overload due to excess weight

Symptoms

1. Medial knee pain under load
2. Morning teething pains
3. Pain in the ankle joints

Complications

1. Varus gonarthrosis
2. Necessity of joint replacement
3. Ankle joint arthrosis
4. Articulated flat foot
5. With a one-sided bow leg: changes to the entire body statics, pelvic obliquity, scoliosis…

Therapy

1. infantile: conservative with night splint, otherwise tibial and fibular osteotomy
2. As early as possible, according to genesis, age, extent: from insoles and KG to osteotomy
3. Stretching orthosis to relieve the medial joint space
4. Practicing increased lower leg endotation and forefoot pronation and movement

Asana practice

Most experts do not consider movement therapy to have any influence on axial misalignments of the legs in adulthood. At a younger age, however, before growth is complete, it must be possible, as the pathomechanism in the case of the soccer player demonstrates. Presumably, the younger the patient, the better the prognosis for conservative, movement therapy intervention. The physiological alternation between bow legs and knock-knees as the patient grows up must be taken into account. In later years, the influence of exercise therapy may be considered very small, but it may have an influence on progression, if not a very slow but steady improvement. In cases where a corrective osteotomy is not indicated but an unfavorable influence on menisci and cartilage is generally to be feared, this approach should therefore be considered.

Staying with the example and following the above derivation, less tension must be applied to the inner knee. On the one hand, there is the gracilis, which plays a special role as a biarticular adductor, and on the other hand, a balanced relationship must be ensured between the inner and outer parts of the ischiocrural group, i.e. semimembranosus and semitendinosus on the one hand and biceps femoris on the other, which also form the pulley system on which the lower leg rotates. If the tension of the inner hamstrings were higher, this would again result in an excessive, varus pull on the inner knee. In this case, however, there should also be a tendency to turn in the lower leg as a flexed free leg during flexion in the knee joint. In practice, however, the opposite, an involuntary exorotation of the lower leg in the knee joint, is much more common. In the case of imbalances in the ligament system, the level at which they occur is sometimes important: the more mobile the hamstrings as a whole, the later the difference in tone and flexibility begins to have an effect in terms of increasing flexion in the hip joint. During sprinting in particular, however, the hip joints are flexed widely, so that in view of the usually rather shortened hamstrings of soccer players, the differences are likely to come into play even before sprinting speed. Since the balance between all valgus and varus forces in the knee joint must be considered, the muscles that transfer their force to the lower leg via the iliotibial tract also play a role: tensor fasciae latae and gluteus maximus. These must more than compensate for the pull of the muscles attached to the pes anserinus in order to produce a valgus force that counteracts the bow leg.