How to fix your Knee Valgus

Got weird looking knees?

Do they cave inwards?

… Or do you lack a thigh gap?

Yes?… Then you may have KNEE VALGUS!


This post will cover:


// What is Knee Valgus?

knee valgus

Knee Valgus is a condition where the knees cave inwards towards the mid line of the body.

It is also referred to as being “knock knee” (… or having “no thigh gap”).

 

// How to determine if you have Knee Valgus:

Stand up straight. Bring your legs together.

Look down.

If your knees are touching and there’s a large distance between your ankles, then you may have those knock knees!

Note: I do realise this is probably not the most accurate test… BUT – it does give you the general idea.

 

// Why you need to fix it

With Knee Valgus, you lose the optimal alignment of your whole leg.

As a result, there is a much higher risk of developing issues such as:

  • Arthritis
  • Ligament damage
  • Meniscal tears
  • Knee cap tracking problems
  • (… and a whole lot of other issues involving the lower back, hip and ankle!)

// Characteristics

  • Hip Internal rotation + Adduction
    • “Hip rolls/moves inwards”
  • Tibia external rotation
    • “Lower leg turns outwards”
  • Foot pronation
    • “Foot arch collapses”

 

// The Causes

a) Postural:

If you have an Anterior Pelvic tilt, this can cause your hip to internally rotate and cause your knees to cave in.

Click here to see if this is your issue.

 

b) Issues with the Hip/Knee/Ankle:

Essentially – if your ankle, knee and/or hip joints aren’t doing their job properly, it can most definitely lead to Knee Valgus.

I have addressed of all these areas in the exercise section below.

 

c) Structural:

The following factors can lead to physical changes to the actual knee bone/joint formation.

  • Genetics
  • Osteoarthritis
  • Rickets
  • Scurvy

Unfortunately – there is no way we can undo these changes once they are established. 🙁

However… we can still improve your knee alignment (… as much as possible) with the right exercises. 🙂

 

// Avoid these positions!

a) ‘W’ sitting: 

This style of sitting is mainly seen in children. Don’t do it! (… Or don’t let your children do it)

b) Driving:

When driving, try to keep your knee and foot in the same alignment. Many people tend to have their knee facing the brake pedal and their foot on the accelerator.

c) Sitting with knees inwards:

Do you sit like this?… I know it probably looks better than sitting with a massive “leg spread”, but it’s not doing you any good if you have knee valgus.


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How to fix your Knee Valgus


Let’s break this section into 4 parts:


1. The Hip

The problem: Hip internal rotation + Adduction

(In other words… The hip joint turns and collapses inwards). This causes the  knee to collapse inwards.

// Releases:

We need to loosen up those tight muscles which are causing your Hip internal rotation and Adduction.


How to do a release:

  • Place the target area (see below) on top of a massage ball.
  • Apply your weight over the ball
  • Proceed to roll up/down/circle around the area.
  • Continue for 30 seconds.
  • Repeat on other side.

a) Adductor

Release point:

  • Inner part of your thigh

b) TFL

Release point:

 

// Stretches:

Next step!

Now that you’ve smashed these muscles, it’s important that you follow it up with some stretching!

a) Adductor

Instructions:

  • Lunge to the side. (see above)
  • Aim to feel a deep stretch along the inside of the leg.
  • Hold for 30 seconds.
  • Repeat on other side.

b) TFL

Instructions:

  • Assume the forward lunge position. (see above)
  • Keep your feet in line with each other.
  • Proceed to lunge forward.
  • Lean your hips to the side whilst using your arm on a support to keep your balance.
  • Aim to feel a stretch in the front/outer side of your hip.
  • Hold for 30 seconds.
  • Repeat on other side,

 

// Joint mobilisation:

If your hip joint is stiff, it may be biased to stay in the rolled in position.

External rotation:

Instructions:

  • Sit on the floor with your back to the wall.
  • Place your feet together.
  • Sit as straight as possible.
  • Push your knees down.
  • Hold for 60 seconds.
  • Repeat 3 times.

// Strengthening



*** READ THIS ***: It is vital that you understand how to activate the muscles that are responsible for Hip abduction and External rotation. You will need to activate them during the exercises as shown in Step 4 (down below).


a) Clam shell (External rotation)

Instructions:

  • Lie on your side with your knees bent at 90 degrees.
  • Whilst keeping your ankles together, lift up your upper leg as high as possible
  • Make sure that you do not move your pelvis.
    • Don’t cheat! Only the leg should be moving.
  • Feel your External rotator muscles (aka your butt) activating.
  • Hold for 3-5 seconds at end range.
  • Repeat 20 times.
  • Repeat on other side.

b) Wall slide (Abduction)

Instructions:

  • Lie on your side with your back 30cm from a wall.
  • Bend your bottom leg slightly as to support your body.
  • Plant your foot of the upper leg against the wall.
  • Apply a firm pressure on the wall through your heel.
  • Whilst maintaining this pressure, slide your upper leg up/down the wall.
  • Make sure you feel your Abductor muscles (aka your butt) activating.
  • Hold for 3-5 seconds at end range.
  • Repeat 20 times.
  • Repeat on other side.

 


2. The Knee:

Image courtesy of jk1991 at FreeDigitalPhotos.net

 

a) Releases of lateral hamstring

When the lateral hamstring (called your Biceps femoris) is tight, it causes external rotation of the lower bone (tibia). This causes the knee to cave in relative to the tibia.

Instructions:

  • Whilst sitting on the floor, place a massage ball underneath the outside part of the back of your knee. (see above)
  • Proceed to apply pressure through the ball.
  • Straighten and bend your knee.
  • Continue for 1 minute.
  • Repeat on other side.

 

b) Strengthening of the Quadriceps

Weak thigh muscles do not do a good job at controlling the alignment of the knee complex. This leaves the knee susceptible to Knee Valgus!

Instructions:

  • Lie down on your back.
  • Lock your knee by flattening it onto the floor.
  • Make sure you can feel your quadriceps muscles engaging.
  • Lift your locked leg up/down 30cm.
  • Repeat 30 times.

 

c) Strengthen the Popliteus

This muscle is responsible for aligning your knee joint complex.

Instructions:

  • Sit down with your hip/knees bent at 90 degrees.
  • Hold your knee straight with your hands.
  • Turn your lower leg inwards
    • (Internal rotation of the tibia bone)
  • Make sure your foot does not lift off the ground.
  • Repeat 30 times.
  • Repeat on other side.


3. The Ankle

Image courtesy of Flare at FreeDigitalPhotos.net

The problem: If your ankle collapses inwards (pronation), it can cause your knee to roll inwards.

 

// Improving Dorsiflexion of the ankle

Having full range of motion in your ankle is essential in any form of leg movement (running, squatting, jumping, walking etc).

Without proper movement and flexibility, the ankle will likely over pronate (… which is a fancy way of saying that your foot arch collapses), and thus can cause the knees to cave inwards.


How much ankle flexibility should you aim for?

Ideally – Aim to get your toe roughly 8cm from the wall with your knee still in contact with the wall. (This may take some time if you are very tight in your ankle.)


a) Release the Calf muscle

Instructions:

  • Place your calf muscle on top of a foam roller/ball. (see above)
  • Put your other leg on top and apply pressure down towards the foam roller. (if required)
  • Roll your leg from side to side.
  • Make sure you cover the whole muscle
  • Do this for 1-2 minutes each side.

 

b) Stretch the Calf muscle

Instructions:

  • Place the top of your foot against a wall (see above)
  • Keep your heel planted on the floor.
  • Learn forward into your ankle.
  • Aim to feel a deep stretch sensation at the back of the calf.
  • Hold for 1-2 minutes.

c) Ankle joint mobilisation

The plunge exercise:

Instructions:

  • Assume a lunge position with your hands on a wall for support.
  • Using your body weight, proceed to plunge forward as to place pressure on the front ankle.
  • Keep the heels of your front leg in contact with the floor throughout movement.
  • Repeat 30 times.

// Improving the arch support:

a) Strengthen the arch



*** READ THIS ***: It is vital that you understand how to do the Short Foot exercise properly. It will be required to be activated during the exercises as shown in Step 4 (down below).


Short foot:

Instructions:

  • Sit down on a chair with your feet on the ground.
  • Whilst keeping your toes relaxed, proceed to scrunch the under-surface of your foot.
  • If performed correctly, you should be able to feel the muscles under your foot tense up.
  • Hold this for 5 seconds.
  • Repeat 20 times.
  • Progress to a standing position once you understand how to do the exercise properly.


4. Combining it all together

This last part of this post is actually the most important!

Why?… It is where you will learn how to use your Hip, Knee and Ankle with each other to hold the ideal knee alignment.

Let’s go!

a) Wall push

  • Lift your hip to ~90 degrees and place the side of that leg against a wall. (see position above)
  • Activate short foot exercise on the foot that is planted on the floor. (see Short Foot exercise)
  • Bend your planted leg to ~15 degrees.
  • Try to put more of your weight on the heel of the foot.
    • This engages your hip muscles more and places less stress on your knee.
  • Push the lifted leg into the wall.
  • Hold this position for 5-10 seconds.
  • Repeat 5 times on alternate sides.

b) Step up

  • For this exercise you will need to use a step.
    • Start with a step ~10cm in height.
  • Place your leg onto the step.
  • Remember to engage your Short foot and Hip abductors
  • Step up and slowly lower yourself down.
    • Make sure that your knee and feet are aligned throughout the exercise.
  • Repeat 10-20 times.
  • Repeat on other side.

 


All done!

Say farewell to your Knee Valgus once and for all!

Any questions? Leave me a question down below in the comments section!

About

I am a physiotherapist who has personally experienced the pain as a result of bad posture. I would like to offer you some of the solutions that I and my patients have greatly benefited from.

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25 thoughts on “How to fix your Knee Valgus

    1. Hey Jake,

      Both are very good exercises to engage the hip abductors.

      I like to do both!

      However – with the wall slides, I like it as it is engaging hip extension (via hamstring/glute max) whilst hitting glute medius at the same time.

      Since movement rarely occurs in isolation (esp. with walking, squatting, standing etc), it is a good one to do.

      Mark

  1. Hi Mark,

    I came across your website while looking up the Dowager hump, which I have. Since then, I have read several of your articles. You mention the use of a massage ball in most of them. However, I do not have one. In this case, what else can I do to release my muscles instead?

    1. Hi Vrinda,

      Any ball of similar size will do, But, a lacrosse massage ball seems to have the right amount of firmness to help release the muscles without hurting too much.

      Mark

  2. Hi Mark,
    I suspect that my son is suffering from Knee Valgus. We have visited many doctors but no one is able to see the abnormality in his gait. I am worried that he might end it up as a permanent issue. He is only 2 yrs old and I want to correct it asap. We are from India and would like your advice. Please suggest

    1. Hi Amrita,

      At what age did your son start to walk?

      Also – did he crawl before he walked?

      Many toddlers will grow out of their knee valgus/flat feet once their walking muscles are stronger (providing that it is not a structural abnormality).

      Thanks.

      Mark

  3. Hey mark,
    I came to your site before to see if I could correct ATP, and after a few months I did see a good result. I had no idea what knocked knees were until a few days ago when I noticed that I couldn’t tough my ankles together. My immediate response was to see if you made a page to correct it! I’m glad I found this, and I’m starting right now!

  4. Hi Mark. I have Knees Valgus and I want to fix it. Do I have to exercise everyday? How many days by week and how many times by day do I have to exercise?

    Thanks.

  5. Have had an operation on it for dislocation and it swells when I do squats and also have knee valgus so will these exercises make my knee better

    1. Hi Barbara,

      Providing that your bones are not structurally causing your knee valgus, then these exercises will definitely help you out.

      If you are squatting and it swelling up, you might want to cut back until you fix your underlying issues with your alignment first.

      Remember – try to keep your hip, knee and ankles aligned with each other.

      Mark

  6. I’ve been doing these exercises for only 4 weeks and I can ALREADY see the difference!

    Just wanted to let you know…. YOU ARE A LEGENDDDDD

    1. Hi Jack,

      Not that I am aware of!

      If anything, many of the exercises would help with an Anterior Pelvic tilt.

      Anterior pelvic tilt is one of the causes of knee valgus. So by correcting knee valgus, you may indirectly help correct the pelvic tilt.

      Mark

    1. Hi Joy,

      Very common question! But to truthfully give you an answer…. It really depends!

      There are some people who just need to be more aware of their body and activate certain muscles to correct it. These people will see results immediately.

      Whereas others may have very tight and/or weak muscles that need to be trained over time (eg. >6 weeks) to see results.

      Mark

  7. This is a great article! Please could you clarify whether these exercises apply to people who are not knock kneed when standing but whose knees only cave in on a squat? If anything, I am slightly bow legged but my knees naturally want to go together when I squat. Thank you!

    1. Hi Adele,

      Most definitely you can do these exercises if your knees cave inwards during a squat.

      I would try to do exercises that target the same muscles …. but in the exact position in your squat when your knees start to cave in.

      For example, you can do crab walks like this guy. But try to do it in a deeper squat position.

      Mark

  8. Hi Mark,
    Thank you very much for the article, I’m going to try this today at the gym. For me, one knee caves inward when I bend it…the other is straight. I even have trouble doing leg extensions with that knee, so in an effort to “stretch” my knee back into proper alignment, I have been using a stretch band around my ankle that pulls inward (while focusing on keeping my knee in line with my hip). It seems to help align my leg bones better. What are your thoughts on doing leg extensions this way. Should I use a foam roller (above and below the knee) on the outside or inside of my leg, or both, prior to doing this exercise?

    1. Hi Andre,

      Are you saying when you do a squat, you feel that one of your knees caves inwards? If so – I would first check to see if you are shifting to one side in that squat.

      Stretch band between the legs are great for cue the knees to drive out (via glute activation). You can do them with extensions , but try to combine it with some sort of weight bearing exercise (lunge, squat etc)

      You can focus on foam roller the groin/adductor group and see how that goes to begin with.

      Feel free to post a picture if it illustrates your problem clearer.

      Mark

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