If your knees cave inwards during squats, walking or standing, you likely have Knee Valgus. This can make the knees look misaligned, reduce force production and increase stress on the knees.

This blog post covers the exercises, stretches and strategies that will help to fix the position of the knees.

What is Knee Valgus?

The Knee Valgus deformity (Genu Valgum) is where the knee collapses inwards towards the mid line of the body.

(Knee Valgus is also referred to as being “knocked knee” or having “no thigh gap”.)

It may occur in one or both knees and can be observed in the static positions (standing) and/or dynamic movements (squatting, walking and using stairs).

In This Blog Post

• Characteristics
• Tests For Knee Valgus
• Causes
• Is It “Bad”?
• Exercises To Fix Knee Valgus

Characteristics

Hip Internal Rotation (Red Line)

This is where the upper leg bone (Femur) rotates inwards relative to the hip joint.

Hip Adduction (Orange Line)

This is where the knee collapses towards the midline.

Tibia External Rotation (Yellow Line)

This is where the lower leg bone (Tibia) twists outwards relative to the upper leg bone (Femur).

Ankle Pronation (Green Line)

This is where the ankle collapses towards the floor.

Duck Feet Posture

This is where the foot points outwards.

(Note: It is also possible for the feet to point inwards as seen with Pigeon Toe. However – this presentation is not as commonly seen.)

Knee Valgus test

Here are some quick tests to determine if you have Knee Valgus.

Standing Position (Static)

Instructions:

• Stand up right.
• March on the spot for 5 seconds.
• Assume a comfortably standing position.
• Assess the position of the knee.

Single Leg Squat (Dynamic)

Instructions:

• Stand on one leg.
• Perform a single leg squat.
• Observe the alignment of the knee during the movement.

(Keep in mind: It is possible to have normal alignment in the knees whilst standing, but have knee valgus when moving.)

causes

There are 2 main types of causes: Functional and Structural.

Functional Cause

This involves a combination of poor control and muscular imbalance in the leg resulting in the knee collapsing inwards.

Tight Muscles

Weak Muscles

This blog post is dedicated to showing you all of the Knee Valgus exercises that will help address this issue.

Structural Cause

The physical shape/position/angle of the bone and/or joints in the leg can result in Knee Valgus.

This may be related to:

Unfortunately – It is not likely that we can influence any significant changes in the structure through conservative means once they have been established.

However… with the appropriate exercises (as listed on this blog post), it is possible to prevent further deformation of the knees.

Is It bad?

This knee position is not inherently “bad” per se, however, the optimal alignment of the entire leg is lost.

As a result – This may place excessive amounts of stress on structures of the knee.

This can potentially lead to issues such as:

(Keep in mind – There are some situations where knee valgus is completely normal (e.g. sudden side stepping during sport). Ideally – You want to be strong in various positions of the knee.)

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How to Fix Knee Valgus

STEP 1: Releases
STEP 2: Stretches
STEP 3: Tibial Internal Rotation
STEP 4: Activation Exercises
STEP 5: Ideal Knee Alignment
STEP 6: Strengthening Exercises
STEP 7: Improve Walking Pattern
STEP 8: Address Pelvis Position
STEP 9: Knee Valgus On One Side
STEP 10: Avoid These Positions

Note: You may be required to address multiple areas of the body (such as the Pelvis, Hip, Knee and Ankle) to completely fix your knee valgus.

STEP 1: Releases

The first step is to release the tight muscles which are associated with the inward collapsed position of the knees.

(Note: If you are not sure of where these muscles are located, feel free to have a look on Google.)

Adductors

Tightness in the inner thigh region can cause the knee to be pulled towards the midline of the body.

Instructions:

• Lie down on your side.
  • (The side that will be targeted is the upper leg.)
• Place a foam roller underneath the inner thigh region of the upper leg.
• Keep this leg completely relaxed.
• Make sure to cover the entire inner thigh and groin region.
• Continue for 2 minutes on each side.

Hip Internal Rotators

(Muscles Targeted: Tensor Fasciae Latae/Anterior Gluteus Medius)

Tight hip internal rotators of the hip can cause the upper leg bone rotate inwards.

Instructions:

• Lie down on your side.
  • (The side that will be targeted is the lower leg.)
• Place a foam roller underneath the outer/front region of the hip.
• Keep this leg completely relaxed.
• Make sure to cover the entire outer/front region of the hip.
• Continue for 2 minutes on each side.

STEP 2: Stretches

Now that you’ve released the tight muscles associated with Knee Valgus, it’s important that you follow it up with stretches.

Adductors

Instructions:

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

… Is your groin really tight?

See Post: Adductor Stretches

Hip Internal Rotators

Instructions:

• Lie down on your back.
• Bring the bottom of your feet together.
• Bring both feet as close to your pelvis as possible.
• Tilt your pelvis backwards.
• Flatten your lower back to the floor.
• Allow your knees to drop to either side of your body.
• Relax your legs and allow gravity to gently push you further into the stretch.
• Hold for 30 seconds.

Tensor Fasciae Latae

Instructions:

• Assume the forward lunge position.
  • (The leg at the back will be the side being stretched)
• 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.

For more stretches:

See Post: TFL stretches

Outer Shin/Foot

As the position of the foot and knee are not in the ideal alignment with knee valgus, the muscles located on the outer shin (Peroneal, Extensor Digitorum) tend to be over worked.

Instructions:

• Whilst sitting, place your ankle on top of your other knee.
• Place one hand on top of the ankle and the other on the forefoot.
• Whilst anchoring the ankle joint down, pull the forefoot towards you.
• Aim to feel a stretch on the outer side of the ankle and shin.
• Hold for 30 seconds.

STEP 3: Improve Internal Rotation Of Tibia

With Knee Valgus – The Tibia (lower leg bone) tends to be in an externally rotated position relative to the Femur (upper leg bone).

To completely address this issue, restoring the normal amount of internal rotation of the Tibia is vital.

Lateral Hamstring Release

If the lateral hamstring (called your Biceps Femoris) is tight, it causes external rotation of the lower bone (Tibia).

Instructions:

• Sit on the floor.
• Place a massage ball underneath the outside part of the back of your knee.
• Proceed to apply pressure through the ball.
• Straighten and bend your knee.
• Continue for 1 minute.

Outer Thigh Release

The outer quadriceps (Vastus Lateralis) will generally be in a shortened position when the knee caves inwards.

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.

Popliteus

The Popliteus is a muscle that is located behind the knee. It is responsible for correcting the out turning of the lower leg bone (Tibial External Rotation).

Instructions:

• Sit down on a chair with your hip/knees bent at 90 degrees.
• Keep your knee pointing straight at all times.
• Turn your lower leg inwards.
  • (Internal rotation of the tibia bone)
• Make sure that your foot does not lift off the ground.
• Repeat 30 times.

STEP 4: Activation Exercises

It is vital that you understand how to activate the muscles that are responsible for hip Abduction and External Rotation.

(These 2 movements will correct the hip position into a more neutral position which can help guide the knees into a better alignment.)

Gluteus Maximus Strengthening Exercise

(Movement: Hip External Rotation)

Instructions:

• Lie on your side with your knees bent at 90 degrees.
• Whilst keeping your ankles together, lift the knee of your upper leg as high as possible.
• Make sure that you do not move your pelvis.
• Aim to feel a muscular contraction on the side/back of your hip.
• Hold for 3-5 seconds at end range.
• Repeat 20 times.

Gluteus Medius Strengthening Exercise

(Movement: Hip Abduction)

Instructions:

• Lie down on your side.
• Bend your bottom leg slightly as to support your body.
• Straighten your upper leg.
• Reach your leg away from you.
• Lift your leg up wards.
• Aim to feel a muscular contraction on the side of your hip.
• Hold for 3-5 seconds at end range.
• Repeat 10 times.

For more hip exercises: Exercises for Gluteus Medius

STEP 5: Ideal Knee Alignment

The ideal alignment of the knee is when the hip/knee/ankle are all in line with one another.

It is important to be aware of this when performing the exercises to fix the knee valgus.

STEP 6: Strengthening Exercises

Single Leg Balance

(This exercise will help with the neuromuscular control of the lower limb.)

Instructions:

• Stand on the leg you wish to address.
• Push your knee slightly outwards to maintain the ideal alignment of the leg.
• Make sure that your feet are pointing forwards.
• Maintain your balance for 30 seconds.
• DO NOT allow the knee to collapse inwards!
• (Note: If required – you can use your hand to provide some support.)

Wall Push

Instructions:

• Lift your knee up to hip height and place the side of that leg against a wall.
• Bend your planted leg slightly so that you are not locking your knee completely straight.
• Push this knee slightly outwards.
• Make sure that you are driving your heel into the ground.
  • This engages your hip muscles more and places less stress on your knee.
• Push the lifted leg firmly into the wall.
• Do not lean your body weight onto the wall.
• Aim to feel the outer hip muscles engage on both sides.
• Maintain the straight alignment of your knee.
• Hold this position for 30 seconds.
• Repeat on the other side.

Squat

Instructions:

• Sit upright on a chair with your knees bent to 90 degrees.
• Loop a resistance band around both of your knees.
• 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.
• Do not allow for the knee to collapse inwards throughout the entire exercise.
• Repeat 10-20 times.
• Progression:
  • Increase amount of tension on the resistance band.

Banded Reverse Lunge

Instructions:

• Anchor a resistance band to a stationary object at knee height.
• Loop the other end of the resistance band around your knee.
• Move away from the anchor point to increase the amount of tension on the resistance band.
• Make sure the band is pulling towards in the inside of the knee.
• Assume the lunge position.
• Perform reverse lunges without letting the knee collapse inwards.
• Aim to feel a muscular contraction on the side of your hip.
• Perform 20 repetitions.
• Repeat on the other side.
• Progression:
  • Increase amount of tension on the resistance band.

Step Up

Instructions:

• Place your foot onto the step. Keep it pointing straight.
• Push your knee slightly outwards to maintain neutral knee position.
• 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.

Single Leg Hinge

Instructions:

• Balance on one foot.
• Keep your balancing leg slightly bent.
• Maintain Hip/Knee/Foot alignment throughout the exercise.
• Proceed to hinge forwards without letting your knee deviate inwards.
• Perform 10-20 repetitions.
• Repeat on the other side.

Single-Leg Squat

Instructions:

• Stand on one leg.
• Maintain your balance.
• Make sure to keep your hip/knee/foot in alignment.
• Proceed to perform a single-leg squat to a depth that you are able to comfortably control.
• Do not allow your knee to collapse inwards throughout the exercise.
• Perform 10 repetitions.

STEP 7: Improve Walking Pattern

The Problem: If your ankle collapses inwards (pronates) whilst walking, it can lead to the knee collapsing inwards as well.

Addressing the following 3 factors will help minimize the amount of collapse in the foot whilst walking:

• Ankle Mobility
• Foot Arch Support
• Big Toe Extension

Improve Ankle Mobility

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

Without proper ankle mobility, the arch of your foot will likely collapse (Foot pronation) which can lead to the knees caving inwards.

Test For Ankle Mobility:

Instructions:

• Face a wall.
• Keep the front of knee in direct contact with the wall throughout this test.
• Slide your foot back with the aim of getting the front of your toes as far away from the wall.
• Keep your heel in contact with the floor.
• Maintain the arch in your foot.
• Observe the distance between the tip of your big toe and the wall.

If you are lacking ankle mobility and you have Knee Valgus, I strongly encourage you to check out my complete guide on how to fix this issue:

See Post: Increase Your Ankle Mobility

Here are some simple exercise to get you started:

Release The Calf Muscle

Instructions:

• Place your calf muscle on top of a foam roller or massage ball.
• Place your other leg on top and apply a downward pressure.
• Whilst keeping the leg at the bottom relaxed, roll your leg from side to side.
• Make sure to cover the calf region
• Do this for 2 minutes.

Stretch The Calf Muscle

Instructions:

• Stand in front of a wall.
• Place the under surface of the forefoot against a wall.
• Keep your heel planted on the floor.
• Aim to get the heel as close to the wall as possible.
• Keep your knee completely straight through this stretch.
• Learn forward into your ankle.
• Aim to feel a deep stretch sensation at the back of the calf.
• Hold for 1-2 minutes.

For more calf stretches: Gastrocnemius Stretches

Ankle Joint Mobilization

Instructions:

• Assume a lunge position.
• Using your body weight, proceed to lunge 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.

Improve Arch Support

Strong foot muscles can minimize the amount of collapse in the foot whilst walking.

Here is the best exercise to help improve the strength of your foot:

Short Foot Exercise

Instructions:

• Stand up.
• Keep the base of the big toe in contact with the floor throughout the exercise.
• Without gripping your toes, 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.
• Do not shift all of your weight onto the outer portion of your foot as this will make your ankle roll to the side (Inversion).
• Hold this for 5 seconds.
• Repeat 20 times.

Increase Big Toe Extension

In terms of walking, limited big toe extension will generally lead to the out turning of the foot and inward collapse of the knee as the trailing foot pushes off the floor.

(Due to the change in gait pattern, this is why a stiff big toe may also lead the development of a big toe bunion!)

Release The Big Toe Flexors

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.

Stretch The Big Toe Flexors

Instructions:

• Stand in front of an edge of a wall.
• Place the bottom of your big toe onto the wall.
• Keep the rest of the foot on the floor.
• Slide the foot closer to the wall to encourage the big toe to bend backwards.
• Lean your body forwards
• Aim to feel a stretch underneath your foot.
• Hold for 30 seconds.

Stepping

Instructions:

• Assume a split stance.
  • (The leg at the back will be targeted.)
• Lift the heel of the back leg to encourage more big toe extension.
• Aim to keep the knee and foot pointing forwards throughout this exercise.
• Repeat 20 times.

STEP 8: Address Pelvis Position

In some people – addressing the position of the pelvis may automatically improve the position of the knees.

Anterior Pelvic Tilt

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

This pelvis position can automatically orientate the knees into an inwards position.

Feel free to check out my comprehensive guide on fixing an Anterior Pelvic Tilt:

See Post: How to Fix Anterior Pelvic Tilt

STEP 9: Knee Valgus On One Side

If your knee collapses inwards on one side only, consider the following points.

Focus On The One Side

Perform the releases, stretches and strengthening exercises as mentioned on this blog post on one side only.

Assess For Rotation Pelvis

A rotated pelvis is where the pelvis is twisted towards the left or right side (… i.e. It is not centered).

This asymmetrical position of the pelvis may predispose someone to developing knee valgus on one side.

For a detailed blog post on how to address pelvis rotation:

See Post: Rotated Pelvis

STEP 10: Avoid these positions

In addition to the exercises, it is advisable to minimize your exposure to the following positions that may be encouraging the collapsed knee position.

‘W’ Sitting

This style of sitting is mainly seen in children.

Don’t do it! (… Or don’t let your children do it.)

It can encourage an excessive amount of internal rotation in the hip leading to the collapsed position of the knee.

Driving

When driving – keep your knee and foot pointing in the same direction.

(Many people tend to have their knee facing the brake pedal and their foot on the accelerator which can lead to malalignment of the leg.)

Sitting Position

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 favors if you are trying to address your Knee Valgus.

How To Sleep With Knock Knees

Honestly – I have doubt that the sleeping position has any significant influence on the position of your knee when standing.

However – 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.

This places the hip in a position of external rotation (… as opposed to internal rotation as seen with Knee Valgus).

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Conclusion

Knee Valgus is where the knee collapses towards the mid line of the body.

It may predispose you to certain issues in the knee such as poor balance, ACL tear, knee cap tracking issues etc.

The suggested exercises on this blog post can help improve the position of your knees.

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Disclaimer: The content presented on this blog post is not medical advice and should not be treated as such. It is not intended to be used as a substitute for professional advice, diagnosis or treatment. Use of the content provided on this blog post is at your sole risk. Seek guidance from a healthcare professional before starting any exercise and/or implementing any recommendation. For more information: Medical Disclaimer.