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SQUINTING PATELLA A natural result of femoral anteversion is what is called the squinting (or winking ) patella. When the distal portion of the femur is medially twisted, the top surface of the patella no longer faces in a straight, anterior direction. Instead, it faces somewhat medially (Image 4, see page 97), and the forces on it are unequal, causing it to track improperly and toward the lateral side. A patellar-tracking problem is a common cause of anterior knee pain and there are numerous causes. However, in MMS it results from the described structural dysfunction of the femur and altered patellofemoral mechanics. GENU VALGUM Genu valgum, commonly known as "knock-knees," is frequently caused by a broad pelvis and a large Q angle. It is an easily observable biomechanical and structural condition. A valgus angulation is a postural malalignment in which the distal portion of a bony segment deviates in a lateral direction. In genu valgum, it is the distal portion of the tibia that deviates in a lateral direction (Image 5). In genu valgum, the distal femur and proximal tibia are both pushed in a more medial direction. Genu valgum causes additional tensile stress on the soft-tissue structures on the medial side of the knee, such as the medial patellar retinaculum, medial collateral ligament, and adductor muscle attachments. Proper weight distribution also becomes problematic because the weight is not fully transmitted down the long axis of the bones, placing greater compressive loads on the lateral meniscus. Genu valgum is assessed by looking at the client in a standing position. The long bones of the lower extremity (femur and tibia) should look like they are sitting almost directly on top of each other in a vertical line. In genu valgum, it will be evident that there is a bend in that vertical line as the knee appears to deviate more medially. EXCESSIVE PRONATION AND TIBIAL INTERNAL ROTATION Genu valgum can also lead to excessive pronation. Pronation is a diagonal plane movement that includes dorsifl exion, eversion, and abduction of the foot as it moves through the normal cycle of foot strike through push off. Alignment between the foot and the tibia is crucial for the weight of the body to be spread out evenly over the bones of the foot. Excessive pronation often leads to the tibialis posterior compensating for the improper alignment. Overuse of the tibialis posterior will then lead to the development of medial tibial stress syndrome, or if severe, stress fractures. 98 m a s s a g e & b o d y w o r k s e p t e m b e r / o c t o b e r 2 0 1 5 Work directly with Whitney Lowe Providing high-quality, science-based training in advanced clinical massage for over 2 decades. Fall SPECIALS Engaging & interactive online courses Orthopedic Massage Certification Workshops, books, video Earn Free CEs Announcing Whitney Lowe's ACADEMY OF CLINICAL MASSAGE New Free sample course 2015 FALL Workshops: OR, AZ, MA, FL Stay up on clinical news & research with Lowe's free newsletter Visit us today! "Lowe's program is the best I have taken in the last 30 years of CE." E. McCarron Free sample course

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