You may have noticed some people who appear to have both their knees caved in and pointing towards one another, almost as if they are slightly nervous about something. These same people will be the ones who have strange form when performing squats. Their knees will be pointing inwards rather than tracking neatly over their ankles.
I used to notice these people all the time. It was only until I started paying attention to my own form that I realised I also was one of these people. I looked in the mirror to do a double check. Yep, my knees were pointing towards one another. I had Knee Valgus, otherwise known as Knock Knees.
In this post, I will cover how I am attempting to tackle my own knee valgus through corrective techniques and exercises. Before moving on, note, that I am not an expert nor a medical professional. I’ll just share my thoughts and what I have found during my research on the topic.
What is Knee Valgus?
Knee Valgus, or knock knees, is when both knees are pointing towards one another in a standing position, rather than being pointed forward. Typically, someone with knee valgus will have their femurs pointed inwards with their hips being in constant internal rotation. These two factors work together to rotate the knees inwards.
Furthermore, flat feet or collapsed arches normally accompanies knee valgus. Some people may also have Tibia external rotation to compensate for the knock knees.
The Importance of Fixing Knee Valgus
There aren’t too many side-effects of having knee valgus, which I feel is one reason it took me so long to realise it was a problem. However, if you do have knee valgus it is something you will want to correct rather than ignore.
Firstly, it is preferable to have normal looking knees that are in alignment rather than the knees pointed towards one another. But more importantly, the compromised position of the knee makes it more prone to ligament injuries or the well-known ACL tear.
The other reason you should focus on correcting it is that it’s unlikely you are using your body to its full potential. There will be muscle imbalances and dysfunctions that currently exist that once fixed will leave your bottom half feeling much better than you have ever imagined.
Possible Causes of Knee Valgus
The causes of knee valgus are plentiful. Some of the cases of knee valgus are caused by bone deformities and complications such as Osteoarthritis, Rickets and Scurvy. Genetics has also been known to play a part with some people developing it early and some people developing it later in life.
How to fix knee valgus caused by these issues is beyond the scope of this post. If you feel your knee valgus could be caused by one of these issues, your best bet is to seek a medical professional.
Conversely, knee valgus caused by bad posture and muscle imbalances in most cases can be corrected by corrective exercises and stretching.
Much of the time knee valgus develops as a result of dysfunction in certain parts of the body:
- Tight Adductors – Adductors are the muscles which run down the inner thigh/groin area. If these are too tight, the tightness will pull the thighs inwards and the hip into internal rotation. The result of this is the knock-knee effect.
- Weak Abductors – The abductors are the muscles that help pull the legs away from the midline of the body. The sufferer of knee valgus is likely to have weak abductors, whilst the adductors are too overactive. Since the abductors are too weak, the inward pull is greater than the outward pull. The lack of balance between the two muscle groups results in the knees pointing inwards.
- Flat Feet – Flat feet or collapsed arches will cause the knee to become misaligned and pointed inwards.
- Naturally Wide Hips – This isn’t necessarily a cause, but people with wider hips are at a higher risk of developing knee valgus over time. Wider hips are more prone to internally rotating resulting in the knees caving inwards. This is one reason why women seem to suffer from knee valgus more than men.
- Anterior Pelvic Tilt – If the front of your pelvis tends to be tilted downwards in an anterior pelvic tilt, this can cause the hips to internally rotate forcing the knees to point inwards.
Finding the root cause of knee valgus is not a simple job. Since the knee is in the middle of the hip joint and the ankle, the problem can originate from either end. For example, most people with knee valgus have flat feet. Was it the flat feet that caused the knee valgus, or was it the internally rotated hip that caused the knee to buckle inwards which then caused the flat feet?
This complication in addressing the root cause can make it harder to find the best way to fix knee valgus. The next section discusses this fact.
How to Correct Knee Valgus
From my research on how to correct knee valgus, I have noticed that many sources will give a set of corrective exercises and routines for the user to accomplish, and then set that out as a definite fix for knee valgus. The problem with this approach is that as we have already witnessed, there are many things that can cause knee valgus and therefore there isn’t a one-fix solution that will fit all.
I am not an expert, nor a medical professional, but I can speak from my own experience of having acute knee valgus, that correcting the alignment of my knee had to be tackled from several angles. In other words, there were several muscles that were extremely weak or too tight from my hip all the way down to my feet. Certain muscles were ‘switched off’ over years of living a sedentary lifestyle. I had to make extra effort to make sure the right muscles were firing.
I will lay out the issues that I feel may be helpful for anyone looking to correct knee valgus. It is then up to the reader to assess which ones are applicable to them and seek to address them.
Issues to Consider in Fixing Knee Valgus
As I have already reiterated, if you’re knee valgus is a result of bone deformities or other similar issues, then it’s best to see a medical professional. However, if you are relatively healthy and are able to undergo some strengthening exercises and stretches, then you’ll find the next section helpful.
1. Tight Adductor Muscles
The adductors are a group of muscles that run the length of the inner thigh and groin area, if these muscles are too tight, they will cause the knees to buckle inwards. As a result, someone with knee valgus will find it helpful to begin a program of frequently stretching these muscles as well as doing some myofascial release to release the tension.
To hit the adductors, you will need something big to perform myofascial release. A standard massage ball is likely to be too small unless you can raise it up somehow. You can use a foam roller like in the video above, however, I have found the 5-inch Triggerpoint ball (which is larger than a regular ball) to be the most helpful in this situation.
Given the chronic tightness in the adductors, you may have to perform myofascial release several times.
The next important step after releasing the adductors is to regularly start stretching them. There are several ways to stretch the adductors, however, I have found the standing adductor stretch to be the best as you can always shift about until you feel the desired stretch.
Start a regular stretching routine and you should find it helpful.
2. Weak Abductors
This is not the same muscle group as we just talked about. These are the Abductors, not the Adductors. The role of these muscles is to pull your leg out to the side and away from the midline of the body. When these muscles are too weak, they allow the tight adductors to pull the leg inwards. By beginning to strengthen them, we can create a better balance on both sides of the legs.
From my experience, this was the main cause of my knee valgus. I had very weak glutes that weren’t firing properly paving way for my hamstrings and quads to become overactive and take over the work.
The abductors are primarily formed of the tensor fascia lata (TFL), the glute medius and the glute maximus. In my own case, my glute medius was weak, and my glute maximus were not firing. I suggest you read the following articles I have written on weak glute medius and glute imbalances. On there you will find help and pointers to consider.
In addition to those articles, here are some exercises you can start doing to help strengthen the abductors.
Side-Lying Leg Raises
This exercise is simple to perform. Lie on your side and abduct the leg away from your body and then back down. Repeat this motion doing 30 reps on each leg. Make sure to keep the toes pointed down to work all abductor muscles
Side Planks with Leg Raise
Side planks where the top leg is raised is a great strengthening exercise. If you have weak abductors this exercise will be quite tough, in which case it may be better to start off with a modified version shown below.
Someone with knee valgus will want to focus their attention on performing squats with proper form. If you place bands around your knees this will force you to push your knees against the bands activating the abductors.
If none of those abduction exercises appeals to you how about 19 more? Watch the video above and choose the ones that you like.
For further exercises, you may also like to see my page on the external rotators of the hip.
3. Flat Feet or Collapsed Arches
As stated already, flat feet can cause knee valgus and can also be the result of it. Either way, if you have flat feet you should look into fixing it. This can be done through corrective exercises or some form of orthotics such as special insoles for flat feet.
I cover how to do this in depth in my how to fix flat feet article. I recommend reading that article to get a full picture of how to correct knee valgus. However, if you want a quick overview of the type of exercises you will need to do to fix flat feet, then you can watch the video above.
4. Anterior Pelvic Tilt
The presence of an anterior pelvic tilt can contribute to knee valgus. An anterior pelvic tilt is where the front of your pelvis is tilted downwards and the back tilted upwards. A pelvis which is held in such a position may cause the femurs to internally rotate which forces the knees to turn inwards causing the knock knees.
To give yourself the best chance of fixing your knee valgus it’s a good idea to check if you do have an anterior pelvic tilt, and look to do corrective exercises to stabilise your pelvis.
See my anterior pelvic tilt page on symptoms, how to test for it and how to fix it.
Fixing Knee Valgus is Not Simple but Form Counts
Before I conclude this post, I want to remind you that I am not a health professional and am only speaking from my own experience and research. If your knee valgus is serious to the point where it is either causing you pain or severely inhibiting your movement, then go and see a physio or doctor.
If on the other hand, you are fairly fit and you feel that your knee valgus may be caused due to dysfunctions and muscle imbalances in the body from inactivity, then the exercises may prove helpful. This is the position I found myself in.
What I have learnt is that there isn’t a single, or a fixed set of ‘things’ to do that will correct knee valgus. In my own case, I had a lot of muscles that weren’t firing properly due to inactivity. I was doing things like squats and lunges, but rather than the glutes doing the work, most of the load was going to the hamstrings and quads.
If you have knee valgus and are already working out, you will need to become more aware of your form and particularly where your knees are, compared to where they should be. For example, if you are in a squat don’t let your knees cave in but keep them tracked over the toes. If you are in a lunge keep your knee stacked above the ankle. Doing simple things such as these will start to work the muscles that aren’t firing and over time you may start to notice that your knee alignment may start to improve.
The exercises here are a great place to start and something you can do in isolation. But as you go about your day keep in mind what you are doing with your knees. Look to correct the muscle imbalances from the hip all the way down to your knees because knee valgus isn’t just about the knees.