Knock knees (aka knee valgus) – is it really a problem?
About 10 years ago, a “ground breaking” idea began to sweep across the physical therapy and fitness world…the idea that the knees caving in (called “valgus”) is bad and is a result of weak glutes. A considerable amount of research has been done on the topic since then with a vast majority of it in favor of this idea.
However, research in this field has some limitations. Rather than diving into the details of this (because it’s boring and unnecessary for this article) I will say this: research cannot always define, measure, and explain all the nuances of muscle performance. With that said, some determinations have to be made via inference from other established concepts AND, dare I say, from actual clinical experience. These two things have guided my dive into this knee valgus idea. You see, I began to question the hard and fast rule that “knee valgus is bad” when clients weren’t responding to treatment as I expected. I had to go back to the drawing board and think more critically, do more reading, consult other experts to figure out what I was missing. As I confronted this conception, these are the questions that kept running through my mind:
Can we really say that knee valgus is always bad?
And if it’s not always bad, how do we know when it is acceptable?
Furthermore, how do we then treat and train effectively to reduce injury risk and preserve performance?
After spending many years working with thousands of clients, reading and learning from many experts, and spending countless hours pondering the topic, here are my conclusions:
1. Depending on the conditions, knee valgus can be entirely unavoidable.
2. Knee valgus is not always bad.
3. The control of the knee valgus (or any other movement/posture) is what matters.
If you have ever watched a basketball game and zeroed in on the players’ knees, I guarantee you saw a considerable amount of knee valgus. Heck, Michael Jordan used it. Certainly you could train these athletes to avoid it but there will still always be circumstances in the game with which it is unavoidable. Furthermore, there are many experts who argue that it can helpful for direction changes, deceleration, or acceleration.
But we aren’t all professional athletes, right? So let’s talk about the amateur athletes, middle-aged gym goers, and elderly power-walkers. The approach I have taken with this group (who happens to be who I mostly treat) is multifaceted. The things I look for are as follows:
1. Good static/isometric strength in all hip and knee stabilizing muscles. (I am referring to static/isometric strength here)
2. Good strength in pelvis and low back stabilizing muscles. (Once again referring to static/isometric strength)
3. Good control of any movements that occur at these body regions – meaning, it isn’t so much where the joint or body part is going, but instead how it gets there…did it occur sloppily and too quickly for the task at hand? Did it occur at a rate appropriate for the task? What did the rest of the body look like – controlled or floppy?
4. Good movement variability – meaning, can that individual use different movement strategies depending on the task or are they ALWAYS dropping into knee valgus?
5. Items 1-4 all in context of their injury and symptoms.
After assessing a client on and off the table, I analyze all of the above to determine what the best approach to treatment might be. For some, treatment may be a classic avoid knee valgus strategy. For others, I may help the client learn how to control the valgus better. For some, the knee valgus may have no bearing on their injury at all.
So if you were looking for a definitive answer, you’re not going to get it here. It depends! Nonetheless below is a video that gives you some snippets of exercise go-to’s for different knee valgus treatment strategies that I commonly use. If you know your knees dive in (and you don’t have pain – if you have pain, come see me rather than trying these), beginning to work on these might be a great way to make them more resilient to injury. As always, don’t hesitate to reach out with any questions!