The Ultimate Knee Valgus Guide: What It Is and How To Fix and Prevent It

Knee valgus can significantly hinder your lifting progress and set you back on your strength and muscle gain goals. However, most lifters have no clue they are suffering from knee valgus until someone points it out to them. 

Per Physiopedia, valgus knee or knock knee is a lower leg deformity where the bone at the knee joint is angled out and away from the body’s mid-line. Chances are, you know someone with a knee valgus, also known as medial knee collapse. 

Knee valgus in this article refers to a particular incidence encountered while squatting. It is when a lifter’s knees collapse inward during the lift’s concentric (upward motion) part. You might also experience knee valgus during the lift’s eccentric (lowering) part. Knee valgus results from an internal rotation of the hips.

Notably, while we might mostly talk about squats in this article while discussing medial knee collapse, lifters can also experience the phenomenon in exercises like the lunge. 

What is Knee Valgus?

Knee valgus refers to the inward movement of the knees while bending or extending your legs. Furthermore, the opposite side of your pelvis might drop as your knee caves inward while performing unilateral exercises like the lunge.

If you are a strength sports fan, you’ve probably seen knee valgus in action at some point or the other. Notably, it’s more prominent within the beginner to intermediate lifting circles. 

Now picture this, a swole bro at your gym loads up a barbell to set a new squat PR. He tightens his weightlifting belt and wraps his knees for assistance. While he descends into the hole with a perfect form, you suddenly hear his cheerleaders chanting “knees out” as he pushes back to the starting position. This inward lateral knee movement is known as knee valgus. 

Most lifters experience their knees buckle inward at a particular point during the range of motion, and their knees return to the normal position as soon as they are out of the trouble zone. 

According to research, knee valgus can result in knee pain. Plus, the steeper the angle of your inward knee collapse, the greater the pain you might experience. [1]

Knee valgus can cause patellofemoral knee pain, ACL tears, and IT band syndrome. To make matters worse, your knee valgus might worsen with time if you do not take corrective action. 

This article discusses the reasons behind knee valgus, the severity of the condition, and a few exercises to help fix the issue. 

What Causes Knee Valgus?

There could be several reasons for medial knee collapse while squatting. The most common causes include the following:

1. Genetics

Knee valgus often arises from anatomical disformities. How to know if you have genetic knee valgus?

Stand upright in front of a mirror with your knee touching. You have knocked knees if there is a large gap between your ankles and your lower legs are angling out. 

According to a study, your pelvic width to femur length ratio can dictate the degree of your knee valgus. People with relatively wider pelvic and longer femur bones are more prone to knocked knees [2]. Furthermore, the ratio between your heel width and midfoot width when standing can determine the severity of your knee valgus. [3]

Knocked knees can cause knee, ankle, leg, or low back pain, poor biomechanics, compromised range of motion, and difficulty balancing your body, especially on a single leg. 

2. Lack of Practice

Some people have their knees buckling inward during a squat due to poor form. Following an incorrect form for a prolonged period can make fixing the problem harder. 

Practice squatting with the correct form to improve your knee valgus. It doesn’t end here; you should also increase your squatting frequency to make the proper squatting form second nature. 

Also, please don’t expect your knee valgus to vanish as soon as you fix your form. Re-learning the correct squat form and fixing your knee’s inward lateral movement can take up to eight weeks of practice. 

3. Muscle Imbalances

Muscle and strength imbalances are prominent but often downplayed reasons behind medial knee collapse during squatting. 

By bringing your knees under your torso during a squat, your body is trying to help you complete a rep by getting you in a position that can generate more power. It is one of the earliest signals of strength imbalances. 

4. Inadequate Mobility

Stiff hips, quad, hamstring, core, calves, and ankles can hinder your mobility and range of motion, resulting in your knees caving inward during a squat. [4]

Tight ankles make it harder for your tibia to migrate forward while squatting. Ankle stiffness causes your tibia to rotate inward, causing your knees to cave in. Your knees move toward the center of your body to get assistance from your adductors. 

5. Poor Posture

A poor posture can cause your knees to buckle inward while squatting. A hunched back and anterior pelvic tilt can also cause knee valgus. Anterior pelvic tilts can be due to tight hip flexors and hamstrings. The hips tend to rotate inward to compensate for a forward-tilted pelvis.

6. Impaired Quad and Hamstring Function

Poor VMO (vastus medialis obliquus) strength results in inadequate knee stabilization, causing the knee to track inward while squatting. On the flip side, a bad medial hamstring prevents proper knee stabilization, resulting in the inward lateral movement of the knee during a squat. 

7. Hitting a One-Rep Max

Many elite and intermediate lifters experience knee valgus while attempting a one-rep max (1RM) or when the loads approach their strength upper ceiling.

You’ll often see Olympic lifters coming out of the hole with their knees buckling inward. The knee valgus, in this case, is not a sign of weak hips but helps stabilize the lift.  

Knee Valgus and Genetics — Not Always Bad

It is essential to elaborate on genetics while talking about knee valgus. Contrary to what most people think, each case of knee valgus is not a cause for concern. Some lifters might experience a small degree of knee valgus due to their limb length and biomechanics, which is generally safe [5]. 

A study found that individuals with longer femurs relative to their hip widths are more prone to knee valgus. [2]

Furthermore, a study concluded that performing relatively stable movements like the conventional air squat is less risky than performing a jump with high degrees of knee valgus. [6]

How Much Is Too Much?

This is a million-dollar question. After a lifter establishes that their knees cave in during a squat, their next question generally is, “but to what degree is the inward buckling of the knees safe?”

If your trainer told you that your knees should move out during a squat and even the slightest inward movement of the knees is not acceptable, it is time to find a new coach. 

In a conventional barbell squat with a shoulder-wide stance, your left knee should be pointing at 11’o clock while the right knee should be at 1’o clock. You are in the knee valgus territory if your upper legs are parallel to each other during the eccentric or concentric part of a squat or if your upper legs break the 11 and 1’o clock barrier.

Still not sure if you are dealing with knee valgus while squatting? Ask an experienced lifter to analyze your form. Alternatively, ask your lifting partner to film your set and consult a professional about your technique.

As mentioned above, many lifters experience knee valgus while dealing with relatively heavy weights. However, if your knees begin caving inward while lifting below 80 percent of your 1RM, it is a sign of deteriorating form. In this case, you should lower the weight and focus on mastering your technique before attempting a PR. 

How To Fix Knee Valgus?

Correcting knee valgus requires a lot of work, patience, and consistency. You must work on your entire lower body and core to prevent your knees from caving inward while squatting. 

Focus on strengthening and improving the mobility of your midfoot, ankles, core, calves, hamstring, glutes, hips, groin, quads, tensor fasciae latae, adductors, and abductors. 

Knee Valgus Exercises

Working on the muscle groups mentioned above to treat knee valgus can sound overwhelming, but you can achieve your goal by adding the exercises mentioned below to your exercise regimen:

1. Iron Cross Stretch (Tensor Fasciae Latae)

Steps:

1. Lie supine on an exercise mat.
2. Place your arms on the floor at your sides, perpendicular to your torso. 
3. Lift your left leg towards the ceiling until it is perpendicular to the floor while keeping the right leg planted on the ground.
4. Without moving your torso, place the left leg on the opposite side of your body, parallel to the right arm. 
5. Hold this position for 30-60 seconds.
6. Raise your left leg towards the ceiling and return to the starting position.
7. Repeat with the right leg.
8. Alternate between sides for recommended reps.

Check out our full tensor fasciae latae guide!

2. Butterfly Stretch (Groin)

Steps:

1. Sit on the floor with your back upright.
2. Bend at your knees to bring your feet together. Place the bottom of your feet against each other.
3. Push your knees down.
4. Aim to feel a stretch in the groin.
5. Hold for 30-60 seconds.

3. Static Calf Stretch (Calf)

Steps:

1. While holding on to a chair, get into a staggered stance.
2. Keep the knee of your back leg straight and your heel flat on the floor. 
3. Slowly bend your elbows and front knee and move your hips forward until you feel a stretch in the calf of your back leg. 
4. Hold this position and contract your calf for 30 to 60 seconds. 
5. Switch legs and repeat.

Check out our full calf stretching guide!

4. Banded Squat (Lower Body and Core)

Steps: 

1. Wrap a resistance band just below your knee level.
2. Stand upright with a shoulder-wide stance. 
3. Lower into a squat by pushing your hips back and down. 
4. Focus on pushing your knees out as you get into the hole.
5. Slowly return to the starting position while pushing through your heels. 
6. Repeat for recommended reps. 

5. Banded Seated Hip Abduction (Abductors)

Steps:

1. Sit on a flat bench or an elevated platform, so your upper legs are almost parallel to the floor. 
2. Wrap a resistance band around your knees. 
3. Open your knees to either side.
4. Pause and contract your glutes at the top.
5. Slowly return to the starting position.
6. Repeat for reps.

6. Pistol Squat (Lower Body)

Steps:

1. Stand upright with a shoulder-wide stance.
2. Raise one leg off the floor and hold it straight in front of you while keeping the other leg planted on the floor. 
3. Descend into a squat by flexing the knee of the supporting leg. Lower yourself until your hamstring touches your calf.
4. Explode back to the starting position.
5. Repeat for the desired number of repetitions before switching sides.

Check out our complete pistol squat guide!

Frequently Asked Questions

Can knee valgus cause long-term damage?

Yes. Training with an incorrect form for an extended period can lead to chronic issues. Knee valgus increases your risk of meniscal/cartilage tears, premature arthritis, ligament damage, knee cap tracking problems, and ACL tears.

How to fix knee valgus?

Fixing knee valgus requires you to work on your midfoot, ankles, calves, hamstring, glutes, hips, groin, and quads. Add the exercises mentioned above into your exercise regimen to prevent your knees from caving inward while squatting. Visit a doctor if you are experiencing groin pain while performing knee valgus-related lower-body exercises. 

Are women more prone to knee valgus?

Yes. Women have genetically wider hips than their male counterparts, which increases their ‘Q’ (valgus) angle and hampers their hip strength. 

Wrapping Up

Genetics, lack of practice, muscle and strength imbalances, poor posture, inadequate mobility, and impaired quad and hamstring function are some of the most common causes behind knee valgus. You could prevent your knees from buckling inward by adding the exercises mentioned in this article to your training routine. 

Fixing knee valgus doesn’t happen overnight. You might need more time depending on your experience level. Conversely, advanced lifters might need months of re-learning to address their knee valgus. Nonetheless, your medial knee collapse while squatting might worsen if left untreated. Addressing the issue might take time, but your knees will thank you for it!

References

1. Scholtes SA, Salsich GB. CONSISTENCY OF DYNAMIC KNEE VALGUS KINEMATICS AND PAIN ACROSS FUNCTIONAL TASKS IN FEMALES WITH PATELLOFEMORAL PAIN: A CROSS-SECTIONAL STUDY. Int J Sports Phys Ther. 2020 Dec;15(6):985-994. doi: 10.26603/ijspt20200985. PMID: 33344015; PMCID: PMC7727413.
2. Pantano, K. J., White, S. C., Gilchrist, L. A., & Leddy, J. (2005). Differences in peak knee valgus angles between individuals with high and low Q-angles during a single limb squat. Clinical Biomechanics, 20(9), 966-972. https://doi.org/10.1016/j.clinbiomech.2005.05.008
3. Mozafaripour E, Seidi F, Minoonejad H, Mousavi SH, Bayattork M. Can lower extremity anatomical measures and core stability predict dynamic knee valgus in young men? J Bodyw Mov Ther. 2021 Jul;27:358-363. doi: 10.1016/j.jbmt.2021.02.004. Epub 2021 Mar 3. PMID: 34391258.
4. Coelho BAL, Rodrigues HLDN, Almeida GPL, João SMA. Immediate Effect of Ankle Mobilization on Range of Motion, Dynamic Knee Valgus, and Knee Pain in Women With Patellofemoral Pain and Ankle Dorsiflexion Restriction: A Randomized Controlled Trial With 48-Hour Follow-Up. J Sport Rehabil. 2021 Dec 29;30(5):697-706. doi: 10.1123/jsr.2020-0183. PMID: 33373976.
5. Mozafaripour E, Seidi F, Minoonejad H, Mousavi SH, Bayattork M. Can lower extremity anatomical measures and core stability predict dynamic knee valgus in young men? J Bodyw Mov Ther. 2021 Jul;27:358-363. doi: 10.1016/j.jbmt.2021.02.004. Epub 2021 Mar 3. PMID: 34391258.
6. Agnethe Nilstad, Erich Petushek, Kam-Ming Mok, Roald Bahr & Tron Krosshaug (2023) Kiss goodbye to the ‘kissing knees’: no association between frontal plane inward knee motion and risk of future non-contact ACL injury in elite female athletes, Sports Biomechanics, 22:1, 65-79, DOI: 10.1080/14763141.2021.1903541

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