PT on the Net Research

Coxa Valgum and Exercises


Question

My client has a condition known as coxa valgum. If you could please advise me on what exercises are suitable for her and what she should avoid it would be greatly appreciated.

Answer

Coxa Valgum is a structural abnormality where the angle of the femoral neck is greater than approximately 125-degrees. This should be verified by x-ray as it is not overly common. This structural deviation will create abduction at the hip and adduction ("knocked-kneed" appearance) at the knees. Many times this is assumed to be in a client who simply has weak hip muscles that allows over pronation or adduction/internal rotation at the knees. Because it is a structural deviation, it cannot be "corrected," however, it can be strengthened to prevent further disruption.

When performing exercises with these clients, their patellar tracking will not be "normal" and should not be forced into a "normal" position. This is why it is so crucial to have an x-ray confirming true coxa valgum. Conversely, people who do not have true coxa valgum but who have weak hips should be lined up appropriately for all exercises.

Some simple exercises to avoid for coxa valgum would include leg extension machines as these traditional machines force the knee to track in a pre-determined manner that may not be suitable for this clientele. If this exercise must be performed (which it does not) use a standing cable extension such as a Free Motion Fitness machine. Also, leg presses, hack squats and hip abduction machine etc. should be avoided as they can put increased stress on the hip capsule, which is already altered due to the structural deficit. Free weight squats can be performed to a point prior to any compensation in their form (Please refer to the NASM's kinetic chain checkpoint). Flexibility should be used to maintain adequate extensibility of soft tissues as well as an appropriate core and balance program to functionally strengthen the lumbar spine, pelvis and hips (Lumbo-Pelvic-Hip Complex). This will include tube walking, Ball Bridges and progression into single leg exercises (Single-leg chest press, rows, shoulder presses, squats, etc.) Please refer to the NASM for appropriate exercises at www.nasm.org.