Knee Valgus 101: What It Is & How to Prevent It

Have you ever noticed one or both of your knees buckling unusually inwards when you squat? If so, then pay attention because you could be dealing with a potentially debilitating condition called knee valgus.

Knee valgus can cause a cascade of pain and injuries that keep you out of the gym and stunt your lifting progress. Protect yourself now by following our guide to knee valgus prevention.

Understanding Knee Valgus

Even if you’ve never heard the term knee valgus before, odds are that you’ve seen it. Commonly referred to as knock knees and scientifically as genu valgum, knee valgus is a misalignment condition in which the knees visibly buckle or bend inwards.

You’ll notice it in someone else when their knees point towards each other as they're standing up straight or squatting down. The inward bending of the knees is caused by an internal rotation of the hips. That rotation leads to caving of the femurs and the knees subsequently pointing towards one another. This cascade of reactions can be caused by one of two things:

1. Anatomical deformities
2. Tight, week, or poorly aligned muscles and ligaments that support the knee which includes your feet, adductors, glutes, hamstrings, and more.
   

While you can prevent and correct tight, week, and misaligned muscles, you cannot necessarily treat or correct anatomical deformities. However, you can do certain exercises and stretches to ease knee valgus symptoms caused by deformities.

If you do suffer from knee valgus due to muscular problems, it's very important to do what you can to treat it early.

Left untreated, knee valgus can set off a whole plethora of other problems such as:

• Knee injuries including ACL tears
• Knee pain including patellofemoral pain syndrome
• Knee joint degeneration 
• Varus (bow-legs)

So, if you're currently struggling with knee valgus or want to prevent it in the first place, then keep reading on for practical tips on how to keep the condition at bay.

Symptoms of Knee Valgus

It’s typically pretty easy to spot knee valgus because the primary symptom is visible caving in of the knees. You can spot it in yourself by simply standing up straight with your legs together while looking in the mirror; if your knees touch one another but there is a large gap in-between your ankles, then you may be dealing with knee valgus.

Note that everyone has a natural, slight inward curve of the knees that is not to be confused with knee valgus!

If you do notice that your knees are caving inward, ask yourself if you're experiencing one of these other common symptoms:

• Knee, ankle, leg, or low back pain
• Difficulty balancing and poor biomechanics (difficulty doing basic body movements)
• Poor range of motion in the lower body

If you're experiencing one or more of these symptoms along with caving of the knees, then the next step would be to see a physical therapist or orthopedic doctor for a formal diagnosis. They will come up with a plan for you to manage and correct the symptoms if possible.

The most important thing is to not ignore your symptoms! The last thing you want is to have the problem progress up to an osteotomy, ACL injury, or even a knee replacement.

Knee Valgus and Your Anatomy

To really understand knee valgus including how to prevent and correct it, it's important to have a basic understanding of the muscle groups that support and stabilize the knee. Without their support, the knees would misalign and cave inwards.

These muscle groups include the:

• Hip abductor and adductor muscles
• Hip internal rotators
• Hip external rotators
• Upper and lower legs
• Ankles and feet

To start, the hip muscles including the abductors and adductors as well as the internal and external rotators are some of the most important muscles in your body. If they're not strong, flexible, and able to reach their full ranges of motion, a whole cascade of injuries and problems can come as a result. In terms of knee valgus, strong hip muscles provide femoral support so that the knees don't go caving in.

The most important muscles within the hip muscle groups include the:

• Gluteus maximus
• Gluteus medius
• Gluteus minimus
• Tensor fascia latae

Second, muscles in the upper and lower legs including the quads, hamstrings, and calves all play a role in keeping the knees properly aligned. Like the hip muscles, if these leg muscles aren't strong and flexible, they won't be able to properly support your knees.

Third, your ankles and feet play a big role in the development of knee valgus. Specifically, lack of ankle mobility or inability to flex the feet is likely to lead to valgus. While these two body parts aren't typically recognized in the gym, it's important to make sure that they're strong and flexible.

What Causes Knee Valgus

As we mentioned above, knee valgus develops either from anatomical deformities or weak, tight or misaligned muscles and ligaments in the lower body. Any of these conditions can eventually lead to poor stability and misalignment of the knees which is likely to result in knee valgus.

1. Weak or tight hip muscles:  Problems with the hip muscles are the most common cause of knee valgus. That's because hip problems are extremely common in our very sedentary culture. The more time you spend sitting down, the more likely your hip abductors and adductors are to be weak and tight. More specifically, tight adductors on the insides of the thighs will cause the hips to internally rotate and pull the femurs inward. And, having weak abductors on the outsides of the hips makes it difficult to pull the thighs out from the medial line of the body. Both of these problems are the most likely knee valgus culprits. 

2. Tights ankle muscles:  Tight ankles have a hard time with flexion. When they're unable to flex, they make it difficult for your tibia, which is a bone in your shin, to migrate forward. Unable to move forward, the tibia rotates inward which causes your knees to cave. Therefore, be sure to integrate ankle stretches into your regular stretching routine.

3. Overused quads and hamstrings:  If you have weak hip stabilizer muscles, particularly glutes, your quads and hamstrings are likely to overcompensate for that weakness. When this happens, the quads and hamstrings outdo themselves and cause the hips to internally rotate too far. To prevent overuse of your leg muscles, it's super important to keep all of the hip and glute muscles strong!

4. Naturally wide hips:  Unfortunately, having naturally wide hips is a common risk factor for knee valgus. This explains why knee misalignment is more common in women than in men. Having wider hips makes it more challenging to keep the knees aligned under the hips. As a result, the knees cave inwards.

5. Rickets, osteoarthritis, or other bone deformities:  Both rickets and osteoarthritis are common causes of knee valgus. Both diseases lead to a breakdown of tissues and bones that are essential for keeping the knees aligned. When the tissues get broken down, particularly in the patella, the knees begin to weaken and cave inward because they cannot support the body on top of them.

6. Anterior pelvic tilt:  Anterior pelvic tilts are usually caused by tight hip flexors and hamstrings or poor lower back posture. The way to spot it is to notice if your pelvis is pushed forwards rather than stacked underneath your hips. When the pelvis is tilted forward like this, the hips tend to rotate inward to compensate for the bad positioning.

Exercises for Preventing Knee Valgus

The best way to prevent knee valgus is to strengthen and stretch your lower body muscles as well as make certain lifestyle changes. And, if you already have knee valgus due to muscle problems, these exercises and stretches can be corrective. If you've ever been to physical therapy before to treat knee problems, then many of these exercises and stretches should look familiar to you!

Probably the best way to prevent knee valgus is to do strengthening exercises targeting your hip, glute, and thigh muscles. When these areas are strong, you’ll prevent malalignment in your legs by keeping your knees locked directly under your hips.

1. Glute bridges:  Start by laying flat on your back in a neutral position with your hands by your sides. Pull your feet in towards your glutes so your knees bend. When you’re ready, exhale and press through your heels and shoulders to peel your spine off the ground and lift your upper body off the ground. Imagine that a string is wrapped around your hips and pulling you up into the air. Squeeze your glutes at the top of the bridge, then slowly drop your body back down to starting position. To make them more difficult, you can also do single-leg bridges or go onto your tiptoes.

2. Hip thrusts:  Hip thrusts are an upgraded glute bridge. They’re more challenging for your glute muscles because you do them while holding a weight over your pelvis. Unlike glute bridges that require no equipment, you’ll need a flat bench and a barbell for hip thrusts. Start by sitting on the floor with the barbell resting in your lap, your knees bent to 90-degrees, and the flat bench behind you. Rest your shoulders against the edge of the bench and thrust your hips up to a tabletop position. Your head should fall back and your quads should be parallel with the floor. Squeeze your glutes at the top then slowly lower your hips back to the ground.

3. Lunges:  Stand up straight with your feet hip-width apart and hands on your hips. Take a big step forward with your right foot and bend your left knee until it hovers just above the ground and your right quad is almost parallel to the floor. Press back up to standing, pull your right foot back next to the left, then repeat the exercise by stepping the left foot forward.

4. Resistance band squats:  Stand with your feet about shoulder-width apart and place a looped resistance band above your knees to create light tension. Squat down by sending your hips backward and bending your knees until your thighs are parallel with the floor. Hold in the low squat position, then come back up to standing and repeat.
   

5. Hip abductions and adductions:  Hip abductions and adductions describe different types of frontal plane movements initiated from the hip joint. To do both hip abductions and adductions, start by standing with your feet shoulder-width apart and hands on the hips. For abductions, lift the right leg straight out from the side of your body running along the frontal plane. The movement should fire up the muscles on the side of your glutes and hips. For adductions, pull your right leg in towards the center of your body running along the frontal plane. You should feel the burn in your inner thighs and groin area.

Stretches That Prevent Knee Valgus

Overly tight muscles are another very common cause of knee valgus. Tight muscles prevent the muscles intended to support the knee from functioning to their fullest extent. As a result, other muscles overcompensate which leads to knee valgus.

To prevent the muscles that support the knees from tightening up, do these stretches regularly:

1. Hamstring stretch:  Start by sitting on the ground in a straddle position, then pull your right foot in towards your left inner thigh while keeping the left leg extended. Stretch forward towards your left toes as if you were trying to touch them. Do not rotate your waist as you lean towards the left side! Hold in that position for one minute then switch to extending the right leg.

2. Ankle pulls and circles:  To stretch out your ankles, all you need to do is rotate them and pull them forwards and backward to increase their range of motion. Simply sit on a chair or the floor and slowly circle your ankles. Then, grab a hold of the bottom of your foot and alternate flexing and extending the ankle.

3. Child's pose:  Child's pose is a simple way to release tension and stretch out your hips in between exercises or on their own. Start by kneeling then sending your hips backward until your glutes get close to or rest on your heels. Stretch your arms forward with your palms facing the ground and feel the tension being released from the hips. Hold for as long as you need to!

4. Pigeon pose:  Pigeon pose is a great stretch for opening up your hip muscles. Start in a downward dog then lift your right leg into a downward dog split. Slowly bend your right knee, draw the right leg forward in between your arms, and lay the right knee on the floor on the outside of the right hand. Relax into the stretch and keep your hips squared forward.

5. Foam rolling:  Just foam roll! Foam rolling your entire lower body from your hips to your feet is beneficial for preventing knee valgus. Not only will it stretch the muscle, but it will also reduce soreness and inflammation.

Lifestyle Changes That Prevent Knee Valgus

In addition to adjusting your strength training and stretching routines, you should also try and make certain lifestyle changes to prevent knee valgus deformity. Not only that, but they'll also lead to an overall healthier and stronger body.

1. Practice good posture:  Having a good posture, especially in your back, protects your entire lower body from injuries because it promotes proper ligament alignment. Try to become more aware of when you're slouching your back, rounding your shoulders, or pushing your pelvis forward to maintain good back posture.

2. Fix flat feet:  When your feet are missing that natural, healthy arch, your feet tend to collapse inward which results in your knees also caving in. A simple way to prevent this is to wear shoes with arch support to create an artificial curve in your foot.
   

3. Spend more time standing up:  Are you someone who spends their weekdays sitting behind a desk and evening sitting on a couch? If so, then beware that you could be silently causing debilitatingly weak hip and glute muscles which, as you now know, is the number one reason why people develop knee valgus. So, the next time you go to sit down for dinner, watch TV, or answer your email, do it standing up! Investing in a solid standing table or desk will do wonders for your health.

The Bottom Line on Knee Valgus

Protect yourself from knee valgus by strengthening and stretching your muscles while also making some healthy lifestyle changes. That way, you prevent yourself from developing a potentially debilitating injury that keeps you out of the gym for the long term.

Bonus tip: Want to do even more to protect yourself from knee valgus? Then give our top hamstring exercises a try!