Running With Bow Legs | Tips, Physical Therapy, and Correction

Last updated on April 13th, 2021 at 10:51 pm

Bowlegs and knock knees are a malalignment of the knees known as genu varum. If you are a runner with this condition you might be acutely aware of it already. While it is most commonly found in infants, some adults retain the condition which may result in knee alignment issues later in life. While running with bow legs may sound uncomfortable or painful, that is not always the case. In this post, we explore the ins and outs of running with this condition.

Having bow legs, or knock-knees does not exclude you from running. One of the most famous bow-legged runners, Steve Plasencia, actually competed in the Olympics and won many marathons. Understanding how the condition impacts your running, the type of discomfort you feel during runs (if any), and getting the advice of a physician may help you to find solutions to continue running and thriving with this malalignment.

Bowlegs do present some issues and challenges, but with the right direction and information, hopefully you can continue to run with some level of confidence.

Is It Possible To Run With Bow Legs?

Bowed legs do not automatically exclude you from running or other physical activity. Not by any means.

Keeping track of whether running causes pain for you will be a good indicator of whether running will be difficult for your specific body to handle long-term.

If you experience pain in the knees or lower limbs, you should strongly consider a visit to a physical therapist or physician.

With the above being said, taking proper care of yourself and following best practices for training regimes is typically enough for most bow-legged people to continue running without suffering pain or injury.

We will discuss long term effects or potential injuries later.

Two Types of Bow Leggedness With Different Impacts on Running

There are two main types of bow-leggedness people experience. We have alluded to them earlier in this post, but these two types are most commonly referred to as bow legs or knock knees.

The medical terms for these two variations are varus alignment (bow legs) and valgus alignment (knock knees).

Varus Alignment (Where Your Knees Bow Outward)

Varus alignment is where your legs curve outwards at the knees but your feet and ankles touch.

Bowlegs develop a gap on the outer joint that compresses the inner parts of the knee. Rather than spreading your downward force evenly across the knee, it is more concentrated on your medial meniscus.

It is often a result of natural development or occasionally Blount’s disease, which is more common in the growth of children or adolescent teens.

Here is a simple test to see if you have varus alignment:

Bring your feet together
Look down at your knees and feet
Take not of whether there is a gap between your knees.

If you have a noticeable gap between your knees when your feet are touching that is a good indication for possibly having varus alignment.

Unfortunately, bow legs have a higher risk of developing osteoarthritis due to the excess stress placed on different parts of the knee. Essentially, while running may not be inhibited in early or middle age, activity has shown to potentially damage the meniscus and cartilage.

The severity of your bow leggedness will typically determine how much your athletic preferences are impacted. There are a wide range of severity to any condition and bow leggedness is no different.

Valgus Alignment (Where Your Knees Cave In Toward Each Other)

Valgus alignment, more commonly referred to as knock knees, is virtually the exact opposite of bow leggedness.

Knock knees occur where the tibio-femoral angle is greater than 10°.

The at-home test for this condition is fairly simple. Bring your legs together, and take note of the gap between your feet (if there is one). If your knees touch each other, and you maintain a gap of 3 inches or more between your feet you might be experiencing valgus alignment.

Knock knees are relatively common, especially in children; genu valgum is more common in children with up to 75% of children between 3 and 5 having knock knees. It is much less common for the condition to persist in adults, however. For adults, it is typically caused by injury or infection, a severe lack of vitamin D, rickets, obesity or arthritis.

Running might be more of a challenge with the knock knees version of bow leggedness, just due to the type of pressure the condition creates for your joints. In valgus aligned knees, the load is shifted to the outside of the knee creating wear and tear on the lateral meniscus. The increased stress on the outer knees may increase the likelihood of a lateral meniscus tear, stressed ligaments, and muscles and may cause hip, ankle, or foot pain.

Similar to varus alignment, knock knees can be caused by or result in osteoarthritis later in life. This is true whether running is taken on as an activity or not.

Examples of Runners With Bow Legs

Many athletes across all types of sports are bow-legged or have knock knees including some elite runners through history. Below are some notable runners with the condition:

Steve Plasencia, who we mentioned earlier, is one such athlete. Despite being very obviously bow-legged, he succeeded in winning numerous marathons and even competing twice at the Olympics
Steve Prefontaine was another bow-legged Olympian. Prefontaine, of Oregon, competed at the Olympics setting American records in the 10,000 metres numerous times on his rise to glory.
Casey and Pat Moulton are twins from New Hampshire and share their bow leggedness. Both are extremely successful runners clocking 2 hours 15 minutes for Austin and Chicago marathons.
Zach Bitter currently holds the world record for running 100 miles. He is an American ultramarathon runner who has achieved incredible successes despite being a bow-legged runner.
Bernard Lagat is a Kenyan-American middle distance runner competing at 1500, 3000 and 5000 metre distances. He holds the second fastest time at 1500 metres in history and has competed at 5 Olympics and winning 13 medals from World and Olympic races. As a bow-legged running example, he may just be the best of all time.

Do I Need to Correct Bow Leggedness To Run?

Depending on the cause and severity of your bow-leggedness, there are a variety of options for improving your alignment.

Physical Therapies for Treating Bow-Leggedness

Depending on the cause and severity of your bow-leggedness, there are a variety of options for improving your alignment.

Much of the advice offered to those affected typically starts with neuromuscular training. Simply put, this is non-intrusive physical therapy to continuously keep your hips, knees, and feet aligned when running. This method is intended to lower your risk of injury and strengthen the muscles to handle additional stresses from the condition.

Neuromuscular training is aided by specific stretching and exercise routines. Hamstring, hip, thigh, groin, and glute stretches have shown positive results while strength exercises can be used to help control overall weight and correct any potential muscle imbalances. Single leg stands, pistol squats, and balance board exercises assist in correcting the imbalances noted in bow-legged runners.

Occasionally bow-leggedness may be caused by a difference in the length of your legs. In this event, a physician or physical therapist will prescribe an orthotic insole to equalize your legs.

Corrective Surgery Options for Bow Legs

Beyond non-intrusive physical therapies, there are surgical routes to correct bow-leggedness. It should be noted, however, that corrective surgeries for the condition can have mixed results.

Youths, whose limbs are still growing, will often have a corrective plate inserted known as guided growth surgery.

For adults who continue to experience pain or discomfort from their bow legs, an osteotomy is the most likely procedure. This may require reshaping some of the bone parts to force the load-bearing into correct alignment. The intent with this is to relieve overstretched muscles and reduce pain.

Finally, you have knee replacements. Knee replacement is typically reserved for over 40s who have exhausted their other options.

Potential Benefits, Issues, and Need to Consult Physician

As with any cause of pain or continued discomfort, it is recommended to consult a physical therapist and physician. Most will provide a solution catered specifically to the severity of genu varum that you are experiencing.

Before surgery is offered the corrective measures will likely include weight loss measures, knee braces, stretches and more.

For severe cases where the condition is causing big impacts for your everyday life, surgery is worth discussing with your doctor.

Both bow leggedness and knock knees have increased risks of osteoarthritis. By taking corrective measures against the malalignment, you may be able to mitigate this and the risks of increased pain, meniscus tears, ACL strains, or other stress caused strains to your ankles and knees.

With the above being said, osteotomy success in relieving pain can be difficult to predict. While reducing issues associated with genu varum are the desired benefits; some corrective measures come with unfortunate drawbacks. As you cannot put weight on your legs immediately after, it may take a lot longer to recover than with a partial knee replacement. Sometimes patients can spend up to 6 weeks in a cast and take 6 months for the full resumption of activities. Osteotomy is usually carried out on those below the age of 55 as knee replacements can tend to wear out quickly in active younger people.

Many surgeons nowadays prefer partial or full knee replacements. Although they aren’t as long-lasting, they are considered to be much more definitively successful. Relief from pain, improved mobility, and better quality of life are the most often reported outcomes of full knee replacement.

For runners experiencing negative impacts associated with pains caused by bow-leggedness, it is a good idea to have a serious and candid conversation with your doctor about your goals as a runner to see what courses of action are recommended.

There is Hope For Bow Legged Runners

While having bowed legs can be painful for some runners, it may be completely benign for others. For some, it may actually prove to be beneficial with regards to running form and potential for achieving fast speeds.

Many athletes with the conditions continue to run through the duration of their lives. Of course, where a bow legged runner experiences consistent pain and struggles, it is always wise to consult a physician.

Having a tailored solution, even if it is just a few stretches to include in your exercises, may go a long way in relieving any discomfort. This is the first step in continuing to successfully run for many years to come.

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