How to fix Knee Valgus

knee valgus

  • Do your knees cave inwards?
  • … Or do you lack a thigh gap?

Yes?… Then you may have KNEE VALGUS!


What is Knee Valgus?

The Knee Valgus deformity (Genu Valgum) is 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”).

Characteristics

knocked kneed

a) Hip Internal Rotation + Adduction

  • Hip rolls and collapses inwards.

b) Tibia External Rotation

  • Lower leg bone turns outwards relative to the upper leg bone.

c) Ankle Pronation

  • Foot arch collapses.

d) Duck feet posture

  • Feet point outwards.

The content presented on this blog post is not intended to be used as a substitute for professional advice, diagnosis or treatment. It exists for informational purposes only. Use of the content on this blog post is at your sole risk. For more information: Medical disclaimer.


Is Knee Valgus bad?

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

As a result, this can potentially increase the risk of developing:

  • Premature arthritis
  • Ligament damage
  • Meniscal tears
  • Knee cap tracking problems
  • Clicking in the knee

Knee Valgus test

knock knee

In the standing position: If your knees touch and there’s a large gap between your ankles, then you likely have knock knees!

Interested in fixing your posture? 

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Normal vs Knee Valgus

normal vs knee valgus

a) In the ideal alignment of the leg

The hip/knee/foot are in line with one another.

b) With a Knee Valgus deformity

The upper and lower leg bone are misaligned.

What causes Knee Valgus?

a) Functional cause

Tight and/or weak muscles in the leg can result in the Knee valgus appearance.

I have listed all of the knee valgus exercises in the sections below to address this issue.

b) Structural cause

Physical changes to the bone and/or joints can result in Knee Valgus.

This may be related to:

  • Genetic factors
  • Osteoarthritis
  • Rickets
  • Scurvy

Unfortunately – there is no way we can undo these structural changes once they have established.

However… with the appropriate exercises, there are usually other things that can still be improved upon.

How to fix Knee Valgus


Note: The following exercises are designed to show you how to fix knock knee (Knee Valgus) in the standing position. If your knees tend to collapse inwards when your knees are bent (eg. squat, landing from a jump, running etc), you will need do the exercises in the specific position and at the load in which your knee starts to collapse inwards.


1. The Pelvis

anterior pelvic tilt

The Anterior Pelvic Tilt is where the pelvis is in a forward rotated position.

This pelvis position can orientate the knees inwards.

For more information: How to fix Anterior Pelvic Tilt

2. The Hip

The problem: Hip internal rotation + Adduction

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


A. 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 foam roller.
  • Apply your weight over the foam roller.
  • Proceed to roll up/down/circle around the area.
  • Continue for 30 seconds.
  • Repeat on other side.

(Note: If you are unsure the location of these exercises, feel free to have a look on Google.)


a) Adductor

adductor release

Release point:

  • Inner part of your thigh
  • Groin region

b) Tensor Fascia Lata

tfl release

Release point:

  • Front of the outer hip.

b. Stretches

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


a) Adductors

adductor stretch

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) Groin

butterfly stretch

Instructions:

  • Sit on the floor with your back to the wall.
  • Place your feet together. (see above)
  • Sit as straight as possible.
  • Push your knees down.
  • Aim to feel stretch in the groin.
  • Hold for 30 seconds.

c) Tensor Fascia Lata

tfl stretch

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.
  • Check out this post for more stretches: Best TFL stretches.

C. Strengthening exercises

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: Combining it all together. (down below)


a) Clam shell (External rotation)

hip external rotation exercise

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)

hip abduction exercise

Instructions:

  • Lie on your side with your back to the 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.

 Want more Hip Exercises?

Check out this post: Gluteus Medius Exercises


2. The Knee

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 can cause 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. release the outer quadricep

The outer quadriceps (Vastus Lateralis) will generally be in a shortened position.


outer thigh release

Instructions:

  • Lie on the floor.
  • Place a foam roller under the FRONT/OUTSIDE of your thigh.
  • Apply an appropriate amount of your body weight onto the foam roller.
  • Keep the leg relaxed.
  • Continue for 1 minute.

C. Strengthening of the Quadriceps

Weak thigh muscles do a poor job at stabilizing the knee joint. This leaves the knee susceptible to Knee Valgus!


knee strengthening exercise

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.
  • Repeat 30 times.

d. Strengthen the Popliteus

This muscle is responsible for correcting the turning out of the lower leg bone. (Tibial external rotation)


exercises knee valgus

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

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

A. Improving Dorsiflexion of the ankle

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

Without proper movement, 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?ankle dorsiflexion mobility

At bare minimum – Aim to get your toe “a fist width” from the wall with your knee still in contact with the wall.


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.
  • 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

calf stretch

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 mobilization

ankle dorsiflexion mobilization

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.
  • Make sure that your knees do not collapse inwards.
  • Do not let your foot arch collapse.
  • Repeat 30 times.

B. Improving the arch support:

*** 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: Combining it all together. (down below)


a) Short foot exercise

short foot activation

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.


a) Single leg balance

single leg balance

  • Stand on the leg you wish to target.
  • Perform short foot activation.
  • Push your knee outwards.
  • Maintain your balance for 30 seconds.
  • Do not allow the knee to collapse inwards!
  • Make sure that your feet are pointing forwards.
  • If required – you can use your hand to provide some support.

b) Wall push

gluteus medius exercises

Instructions

  • 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.
  • 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.

c) Squat

knee valgus squat

Instructions:

  • Sit upright on a chair with your knees bent to 90 degrees.
  • Loop a resistance band around both of your knees. (see above)
  • Keep your feet pointing forwards and shoulder-width apart.
  • Push and maintain your knees in an outwards position.
  • Aim to feel a muscular contraction on the side of your hip.
  • Stand up and sit down.
  • Repeat 10 times.

d) Step up

Instructions:

  • For this exercise you will need to use a step.
    • Start with small step height to begin with.
  • Place your foot onto the step. Keep it pointing straight.
  • 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.

e) Single leg hinge

single hinge pelvis control

Instructions:

  • Balance on one foot.
  • Keep your balancing leg slightly bent.
  • Activate the short foot and hip abductors.
  • Maintain Hip/Knee/Foot alignment throughout the exercise.
  • Proceed to hinge forwards without letting your knee deviate inwards.
  • Repeat 10 times.
  • Repeat on the other side.

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

avoid these positions with knee valgus

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

bad sitting posture for knee valgus

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.

d) How to sleep with knock knees

how to sleep with knock knees

If you feel that your sleeping position may be contributing to your knock knees, consider allowing your knees to drop out wards whilst sleeping on your back.

Knee Valgus Brace

There are braces (called Knee Valgus Unloaders) that can be worn to help improve the alignment of the knee.

They are best used in conjunction with knee valgus exercises.

Bonus: Increase Big Toe Extension

In terms of walking, having limited Big Toe Extension can result in the out turning of the feet and the collapse of the knees.


a) Release The Big Toe Flexors

flexor hallucis longus release

Instructions

  • Locate the target muscles: (Use Google to find their location)
    • Flexor Hallucis Longus
    • Flexor Hallucis Brevis
  • Place your foot on top of a massage ball..
  • Apply an appropriate amount of your body weight.
  • Proceed to roll your foot on top of the ball.
  • Make sure to cover the entire big toe flexor.
  • Continue for 1-2 minutes.

b) Stretch The Big Toe Flexors

big toe stretch

Instructions

  • Sit down on a chair.
  • Place your ankle onto the other knee.
  • Hold the big toe with your fingers.
  • Pull it backwards.
  • Aim to feel a stretch underneath your foot.
  • Hold for 30 seconds.
  • Repeat 3 times.

c) Strengthen The Big Toe Extensorsbig toe extension

Instructions:

  • Keep your foot on the floor.
  • Lift up your big toe as high as you can.
  • Do not move the other toes as you do this.
  • Aim to feel a contraction of the muscles at the top of your big toe.
  • Hold for 5 seconds.
  • Repeat 20 times.
  • Progression: Apply additional resistance with your finger in this end range position.

What to do next…

1. Any questions?… (Leave me a comment down below.)

2. Come join me on the Facebook page. Let’s keep in touch!

3. Start doing the exercises!


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541 thoughts on “How to fix Knee Valgus”

  1. Mark,

    I want first to thank you for creating this website and putting so much of your time and effort into helping people on the road to a better posture!

    For the last six months, I’ve been trying to find the root cause of my back pain in the thoracic region (between my left shoulder blade and spine). When I take a deep breath and push the air into the area (think vacuum squeeze), I feel discomfort in the front of my ribcage as well as in the rear (left intercostal muscles).

    Over the past couple months, I’ve seen my primary doctor for bloodwork and an EKG, referred to a PT for eighteen sessions, had three deep tissue massages, and I’m a little frustrated!

    My physical therapist thought my pain was nerve related because when she’d massage my neck I’d get temporary relief. We went through loads of exercises, but the pain lingered. I was referred to a deep tissue massage therapist and she mentioned I have a 1/2 inch discrepancy between legs, then acted out my posture and things started to click. For the first time in my life, I saw someone mimic how I’ve been carrying myself for all these years! I saw her three times and by the third time she told me, “I don’t want to continue taking your money, in good ethics, if I can’t get to the root of this” and referred me to a chiropractor who specializes in adrenal fatigue and applied kinesiology but I had had enough.

    That’s when I started my independent research and found this website and I have hope again! Here’s what I’ve noticed:

    1. My left leg appears to have a degree of knee valgus.
    2. My left arch is lower than my right
    3. My left hip is lower than my right.
    4. My hips are slightly twisted to the left
    5. Spine looks pretty good maybe a little curve left (not sure??)
    6. Belly button points toward right foot.
    7. Shoulder hike and rounded (left side)
    8. Shoulder drop (right side)
    9. Hip crease (right side)
    10. Knee pain after long walks (right side)

    My questions are:

    Does my left leg discrepancy sound structural to you?

    Do you think my rib/intercostal discomfort is related?

    Thanks again for your time,
    Andrew

    Reply
    • Hi Andrew,

      Pain only experienced on the left interscapular region makes me think that there is probably some degree of rotation in your body.

      Pain in that said area may be the body trying to counter rotate to compensate for the rotation occurring further down.

      It sounds like you have a Right hip hike (lateral pelvic tilt) which may be related to the left knee valgus (especially if you tend to stand on the right side more, Right rotated pelvis, Side bending of the torso to the right (scoliosis) which then would give you a high left shoulder (uneven shoulders).

      If the left interscapular region is hurting, I would think your torso is following the rotation to the right from the pelvis and the muscles between the spine and shoulder blade on that left side are trying to counter rotate.

      Do you sit down a lot for work? If so, check your sitting posture. This might be the key.

      Mark

      Reply
  2. Hi mark, great information. If I do these exercises will it improve the look?
    Have you worked with anyone with knee valgus and have you seen people with valgus improve?
    Also how often should I do these exercises?

    Reply
  3. I don’t know what mine is but I just know I have a walking abnormality same with my dad. please can it be corrected?
    Don’t know if it’s structural

    Reply
    • Hey Vincent,

      It is possible to correct it straight away, but maintaining it is definitely the challenge.

      As long as it is not structural in origin, you should be able to improve upon it.

      If there is absolutely no improvement within 6-12 weeks and you’re doing all the correct exercises at the right intensity, there may be a structural component to your knock knee.

      Mark

      Reply
  4. Thank you for the concise and instructive information here. Trying to help a friend resolve foot issues, but realize the problem doesn’t start with her shoes! Severely knock kneed with ankles more than 12″ apart, flat feet that turn way outward. Strangely she wears her shoes out on the outside of heel and ball of her foot & has thick callises on the outside ball of her right foot. She doesn’t have medical insurance but assume she needs a complete medical evaluation. She is only 32 yrs old. She works 40 hrs/week on her feet at Sonic. She complains always about her feet hurting and sometimes about back pain. This is a hard case–don’t know where to start!

    Reply
    • Hey Marg,

      Sounds like she is walking with Duck feet posture. I am not sure what her gait pattern looks like but sounds like she is weight bearing on the outside of her foot.

      I would usually start from the feet as this is the our contact with the ground (and it is a painful area of concern for your friend). Check for big toe extension, ankle dorsiflexion, strength of toes and the medial arch.

      If that is all good, I’d go straight to the hips. Make sure to check that she has adequate amount of hip internal rotation as limitations here can cause compensations during walking. Other things to check is single leg stance, single leg squat, balance, hip abduction/external rotation strength. Address any deficits.

      Pelvis could also be a factor as you have mentioned back pain. Anterior pelvic tilt could internal rotation the hips.

      Hope this helps.

      Mark

      Reply
  5. I’m shocked a health care professional would glorify a thigh gap. Baiting readers to aspire to a thigh gap sends a VERY unhealthy message.
    It’s a feature natural only for women with a certain type of body shape and bone structure (wide hips, thin legs) that most women do not have. Attempts to achieve this unattainable ideal result in problems of self-esteem that can lead to eating disorders.

    Reply
    • Hi Cynthia,

      The goal of this blog post is to help those who are having functional issues with their knee due to the inwards collapsing of the knees. By no means do I intend for this blog post to judge the appearance of one’s knee. If a knee valgus can be corrected and reduces knee pain, I feel like this would be beneficial to people?

      As mentioned in the article, I agree with you that the knee valgus can not be significantly altered if it is due to structural means (and honestly it’s really not an issue if there is nil effect on function and/or the musculoskeletal system). However, there are also many people that may have developed hip, knee and foot issues due to the poor control of the knee.

      Mark

      Reply
  6. Hi there,
    Thank you for this informative article – I look forward to implementing this into my life! I have terrible knee valgus which was inherited but made worse by long standing laziness.

    I was wondering – I’ve looked online at hip abduction pillows and braces and think they could help the internal rotation of my hips and generally help improve hip strength/alignment – do you think this would help?

    Also, my 55 year old mum and 80 year old grandma have knee valgus (gma now how bad arthiritis in her knees which I assume was encouraged by the valgus) – would it be worth trying these excercises with them?

    Thanks In advance,

    Jasmine

    Reply
    • Hey Jasmine,

      The pillows and braces can help. But only if followed up with an exercise program.

      Mum and Grandma could benefit from these exercises too! (but probably best to get clearance from the doctor to be on the safe side)

      Mark

      Reply
  7. Hi Mark,

    If you have like 7 of these issues you have exercises for, how often do you recommend doing the exercises? I have mild knock knees, anterior pelvic tilt, kyhposis, forward neck, rounded shoulders, flared rib, and winged scapula. You had said to another person to do the knock knee exercises 3 times a week. How often should I do each of these groupings? Or should I pick 3 and do like twice a week each? And if so which do I pick? They are all equally bad🤣.

    Reply
  8. I cannot thank you enough for all this information. I am a 28 year old female that has had knee valgus for years. I have been to my doctor many times concerned about it, as I am a nurse and it has really affected me being on my feet for long periods of time. I wear orthotics and go to a yoga class 3 times a week. It is at the point where I have bad knee pain intermittently that keeps me awake. Although yoga incorporate many of these stretches/ exercises, I am going to start this routine religiously. Through my own assessment; I have bilateral collapsed foot arch (to the point where my pinky toes do not touch the floor at all), tibial external rotation, hip internal rotation /knee adduction, and anterior pelvic tilt. I am so desperate to find a solution. Do you have any other suggestions for sleep positions?

    Reply
    • Hi Meghan,

      Hope the exercises help !

      In terms of sleeping with knee valgus, just try to avoid adducting the legs. If you sleep on the side, best way to address this is by placing a pillow in between the legs.

      Mark

      Reply
  9. Hi Mark,

    You mention that you should not let your arch collapse when doing the dorsiflexion exercise. Is there a correlation between the two?

    Reply
    • Hey Ryan,

      If your arch completely collapses as your ankle goes through dorsiflexion, then you will not be getting a pure movement in the ankle joint.

      As a result of the collapse, the knee will tend to follow and collapse towards the mid line.

      Mark

      Reply
  10. Hi mark I was wondering how do you make sure you have good stability and strength in your knee and what are some good knee strengthening exercises and tests to test knee strength and mobility

    And also can unstable knee lead to further problems up the body ie back pain?

    Reply
  11. Hi, Mark. First off, thanks for all the helpful information you provide, it’s very much appreciated. I have knock knees and I’m trying to see if it’s structural or not without having to go to a doctor. This may be silly or futile relative to finding out but I noticed when I stand upright, my knees touch before my ankles do but when I start to bend at the waist my knees start to separate and my ankles still touch and it displays a more traditional leg stance. It stays this way if I walk in that waist bent position as well. Is this telling at all?

    Also, if you have the time, do you find that one of those knee unloader braces could work?

    Thanks again for all your help to the community.

    Reply
    • Hey James,

      It sounds like when you are bending forwards, the hip is going into hip external rotation which would then push the knees out.

      If you can correct the knee alignment (that is, it is not fixed), then it is likely not structural.

      Unloader braces can help in conjunction with a strengthening program.

      Mark

      Reply

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