Two words no coach or athlete wants to hear, see or experience with regularity. Unfortunately, those two dreadful words are insanely common in today’s weight rooms and athletic fields. A wide range of athletes, from Pop Warner to pros, have to deal with this lower extremity dysfunction during training, competition and everyday life.
What is Knee Valgus?
The term is sort of a blanket statement for a broad variety of compensations that cause an inward collapse, or medial displacement, of the knee joint. In simple terms, it’s having “knock knees” during athletic movements, or both dynamic and static positions.
As I mentioned before, this is a very common event, but one that’s also very problematic Why is it so bad? Knee valgus is an interruption of proper ankle, knee and hip function. It’s not just the knee or knees being altered, but also other joints, tendons, muscles and functionality.
Consequently, the knee—located between the hip and ankle joints—gets hammered with the repercussions. This medial collapse puts an enormous amount of undue force and stress on the Anterior Cruciate Ligament (ACL) and other ligaments in the area. Valgus can also cause pain in the Patella or surrounding structures. Lastly, this inward collapse makes your squat pattern less effective, lessening your ability to build strength in this position and making it more dysfunctional in sports/everyday life.
Bottom line: For the vast majority of humans, a valgus collapse of the knees is going to cause pain or movement issues, either immediately, chronically, or both.
What Causes Knee Valgus?
This is the million dollar question. A lot of things can cause knee valgus. To be quite honest, it would require an individual movement assessment to determine the exact cause on a case by case basis, but there are some definite common denominators at play. Here are the main culprits.
Poor Ankle Mobility. If an athlete has limited ankle dorsiflexion caused by tight lower leg muscles or weak muscles in the foot arches, this can lead to the knees caving in.
For example, in a squat, an athlete may lose the arch in their feet or allow their knees to drift forward. If the ankles can’t support those movements with dorsiflexion, the feet will pronate, allowing the heels to elevate from the floor and knees and/or hips to a internally rotate. Then, boom…knee valgus.
Weak Hips and Posterior Chain. Another common culprit that may lead to valgus would be weakness in the hips, glutes and/or hamstrings. All of these muscle groups play some role in external rotation of the femurs and/or stabilization of the pelvis.
Chances are, if you have a weakness at the abductor group, then you may also have some overactivity opposite them in the adductors. Or, you may have weak hamstrings and very overactive quads. Whatever it may be, the posterior chain is losing the battle against the anterior musculature, making it difficult to keep things stable during exercise.
Inexperience. One major cause, especially in youth athletes, is simply inexperience. It could be neuromuscular control, foot placement, weight distribution, poor instruction or even lack of confidence that causes the knees to collapse medially.
But, let’s be clear… if babies can walk in 9-12 months after birth, you can surely determine whether or not your valgus is because of being new to training, or if it’s caused by something else.
An athlete can only get away with this excuse for about 6-12 months. After you’re not a “beginner” anymore, it’s tough to blame things on motor control if you’ve been training consistently.
Anatomy. Even humans who are similar in height and weight can be built very differently in terms of their bone structure. Differences in bone length can cause some significant changes in the way we move.
Anatomy can play a big role in an athlete’s valgus, but these may be some of the easiest corrections to make. In many cases, simply adjusting technique and execution cues can clean up the movement in a matter of minutes. In other cases, a lifelong compensation pattern may have been taking place that needs to be corrected specifically to that individual.
How an individual is built (for example, wide hips, pigeon-toed stance or bow-legged posture) may change the difficulty of movement for individuals, making them more prone or even more resistant to valgus. It’s up to the coach to take anatomy into account as a possible cause of knees collapsing during activity.
How to Fix Knee Valgus
A great strategy for getting yourself out of the dangers of knee valgus territory is to analyze the four common causes above and think of which ones might be affecting you. You can start with the process of elimination.
Ask yourself, “Am I inexperienced?”
If yes, keep practicing and focus on mastering the basics of your body weight in a safe manner.
Next, ask yourself, “Do I have anatomical uniqueness/abnormalities?”
If yes, how are you treating or improving that situation? Reach out to a medical professional such as an MD, PT, ATC or DC and get a plan together. If no, move on to the next questions.
“Do I have poor ankle mobility?”, and/or, “Do I have a weakness in my posterior chain?”
Rule out what you can and then focus on what’s left. If you get to the point where these two questions remain, you can start to assume that it may be one or both issues causing this knee valgus. Don’t get me wrong, there’s still the potential it’s another issue, but you can feel confident in fixing these two problems either way. In general, more ankle mobility and stronger glutes never really hurt anyone.
Below is a quick warm-up series that you can add to your dynamic warm-up and daily routine. The goal here is to mobilize stiff areas, strengthen weak areas and introduce ranges of motion that may decrease and eliminate valgus over time. Treating this like a daily non-negotiable 5- to 10-minute meeting can lead to stronger, safer performance.
Half-Kneeling Ankle Mobilization w/ SMR
This is a great drill to decrease some tightness or neural tone in your calves and surrounding areas. By grooving into gradually increasing ranges of dorsiflexion and simultaneously applying some manual release techniques, you may be able to unlock some permanent ankle mobility. Perform 3 sets of 12 per leg before moving onto the next drill.
Mini-Band Hip Thrust
This can be done bilaterally or in a unilateral fashion. Both serve a great purpose. Shoot, why not do both? This drill promotes hamstring and glute strength with a slight focus on abductors, as well. Lying down gives the athlete feedback on pelvic and spinal position to make sure all tension is placed in the hips, glutes and hamstrings instead of the low back. Perform 3 sets of 12 (per leg) before moving onto the next drill.
Multi-Directional Bear Crawls
Bear Crawls are an incredible tool for optimizing dynamic posture and core strength. This drill trains your entire body in several planes of motion, which allows athletes to build stability through strength, and carry that over into other areas of training. Perform 3 sets of 4 in each direction before moving onto the next drill.
Deep Squat Climbs
The Deep Squat Climb allows athletes to put some of these drills into a more valgus-specific situation and test the waters. Again, we’re having the athlete groove themselves into gradually increasing ranges of motion, trying to identify and eliminate compensatory movements. Perform 2 sets of 10 per leg before moving on to the next drill.
Modified Snap Downs
Lastly, we always like to end a warm-up with something twitchy. Usually a jump or throw will suffice, but athlete’s struggling with valgus can look towards a Snap Down for a lower-impact version of CNS activation. Even a modified version like this can allow the athlete to go through the movement, feel how they respond and adjust as needed. Perform 3 sets of 5 per leg before moving onto the next drill.
It’s important to note that this is simply a circuit of warm-up drills that will help with the valgus issue. Training is still necessary. Strength is still very necessary. Collectively, the combo is a great plan of attack.