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I recently came across this post as I suffer from similar knee pain while hiking downhill or on a run.

Also be certain you aren't battling other imbalances of the hips and legs. When you lay down, do your toes turn way out to the side or point straight up? If they turn to the side(supination/external rotation of the knee), your hip abductors are too tight while your adductors are too weak.

I never paid attention to the way my feet rests while sleeping. I sleep on my back with my feet turned out. My feet make a 180 degree angle i.e. the outside of my feet completely rests on the bed. Is this normal? What problems could this give?

Should the feet be pointing straight up while sleeping?

  • I don't know your specific case, so I can't give you specific advice. A physical therapist or orthopedist may be better equipped to give a more thorough answer. But I can give some info. I changed my post to a comment as I do not have links to specific sources at this moment, but want to discuss the principles of biomechanics that I learned from lectures and conversations with physical therapists, anatomy lectures, orthopedic surgeons. The issue with lying with one's hips in external rotation for 8 hours a day is along the lines of what they said: – DoctorWhom Sep 15 '16 at 0:51
  • (1.) in extended external rotation position, the external rotators are shortened and over time/repeated can become tighter (2.) the internal rotators are stretched and can become more lax (3.) this can cause imbalance in hip/knee motion and gait (4.) ANY poorly aligned joint or gait abnormalities can cascade outwards to affect other joints and muscles (it's all connected!) – DoctorWhom Sep 15 '16 at 0:53
  • Experience: I personally have done physical therapy for tightened external/lax internal rotators that caused lower back pain from (among other issues) sitting cross-legged (external rotation) all the time. And asked 1,000s of questions of my PT for learning purposes. This is how I address it with patients as well. – DoctorWhom Sep 15 '16 at 0:57
  • Lastly, I have asked "what is the proper sleep position" of physical therapists and orthopedic surgeons. They all said whatever feels comfortable and neutral and doesn't cause pain/problems. But this isn't necessarily for everyone, depending on situation. Some people may need to change their sleep position to improve symptoms. Many back sleepers put a pillow beneath their knees to support the curve, keep more neutral, and relieve pressure in the lumbar back region. Again, not personalized advice. – DoctorWhom Sep 15 '16 at 0:58
  • @doctorwhom - please put this as an answer. Answering in comments sidesteps the voting process and is not allowed on SE sites. – JohnP May 27 '17 at 12:10

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