How to fix Knee Valgus

What is Knee Valgus?

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!

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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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598 thoughts on “How to fix Knee Valgus”

  1. Hello

    My daughter is 13. She used to be pretty pigeon toed, however I noticed more recently that her feet are straighter but her knees look knocked. Today she was on stage for a play and I would have sworn she was clenching something between her thighs even while doing a box step dance move. Anyway, she tends to get some lower back pain, do you think that could be related? I would like to try these exercises with her however I’m not sure her attention span would allow for the whole workout. So would it be still beneficial to split it up I to two days? How long do you think it would take to see a difference to know if it was worth contiuing? What type of doctor/physio would I go to to diagnose whether it was structural?

    Reply
    • Hi Amy,

      Knee position can definitely be related to lower back pain.

      It is fine to split the exercises up between 2 days.

      In terms of how long it will take, it really depends on how committed the body is to the knee valgus position. Keep in mind, if this is a structural issue, there will likely be a limit as to how much your daughter can change with exercises.

      Most Physiotherapists should be able to help you out!

      Mark

      Reply
  2. Hi Mark,
    I had developed right knee valgus 4 years ago from being flat footed due to scar tissue in the plantar aspect of foot. With exercises and stretching it jas been under control, but now for the past 4-5 months it’s limiting my functionality due to pain in ankles, and starting to develop some back pain early in the morning to get out of bed. Do you think these exercises will improve the structure and functionality? It’s time consuming.

    Reply
    • Hi Esther,

      These exercises should help improve the position of the knee.

      If you developed knee valgus after a foot injury, you might actually need to spend more time addressing that. (See post: Flat feet)

      Mark

      Reply

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