How to control knee valgus?

Knee valgus is a very common occurrence in the weight room as well as in sports. One of the biggest misconceptions about lower body training particularly involving aspects of squatting, landing, jumping and change of direction is that knee valgus is inherently bad. This false thinking needs to be changed. In this new post, I am going to highlight the biggest factors involving knee valgus and how to control excessive valgus collapse. 

 

What is knee valgus?

Knee valgus is also referred to as valgus collapse and medial knee displacement. It is characterized by hip adduction and hip internal rotation, usually when in a hips-flexed position, in which the knee actually abducts and externally rotates. It can also be thought of as knee caving as you sink down into a squat or landing. When standing on one limb, the opposite side pelvis will usually drop during valgus collapse as well.

Knee valgus is one of the more common positions of an ACL injury and during early rehab for an ACL. It’s best to avoid an excessive valgus position and teach more “ideal” mechanics and alignment. Specifically, when it comes to strength and conditioning programs, teaching clients and athletes to CONTROL knee valgus is an absolute MUST. It is a position that athletes will undoubtedly find themselves in during competitions, regardless of how well trained they or in their mechanics. Therefore, it’s critical to coach individuals to get IN and OUT of knee valgus with CONTROL.

Knee valgus most commonly occurs during upright ground-based movements that require eccentric action and deceleration. I’ve said this many times when presenting on eccentric training that loss of deceleration means loss of eccentric control, which in turn means loss of force absorption and ultimately force production as well. Essentially, gravity acting on the body induces large adduction and internal rotation torques on the hips while the hips move into flexion. The hips must absorb and reverse the sagittal plane flexion torque while stabilizing the femur in the frontal and transverse planes For many individuals, this is easier said than done.

You’ll often find many movements that have limited valgus including hip hinge patterns and even with most lower body machines. However, sometimes it does occur during these movements with RDL’s. Many of these people who exhibit knee valgus are so weak at low loads that they are compensating for other layered issues or have experienced a previous lower body injury or rehabilitation that has not been addressed. 

 

Who is more prone to knee valgus?

Women are more prone to experiencing knee valgus due to their proportionately wider hips, increased Q-angles, decreased hip strength among other reasons. 

 

What other contributing factors are there for knee valgus to occur?

Decreased Hip Strength

Decreased gluteal/hip strength including the glute max, gluteus medius, minimus, and hip external rotators are among the biggest contributors for knee valgus. If these muscles lack strength, it prevents adequate stabilization of the femur. For example, when the adductors are overactive in comparison to the glutes/hip external rotators, the knee is similarly pulled into valgus collapse.

Weak quad and hamstring strength

Impaired quad strength will fail to allow for adequate knee stabilization, which will cause the knee to track inward. Most people forget that when squatting, the quads, and especially the knees move out in the frontal plane, particularly when the stance is wider vs. narrow stance. The strength of the medial hamstrings also work in conjunction to assist in knee stabilization. When the hamstrings have impaired strength, knee stabilization will be decreased, similarly to the quads, but on the opposite side of the leg. To improve your quad and hamstring strength, check out these posts: 

The Science and Application of the Rectus Femoris

Bulletproof Hamstrings

Other important factors to consider

There are also numerous other factors influencing knee valgus. These include insufficient ankle dorsi-flexion, hip stability or overall neuromuscular coordination. In short, you can test ankle dorsiflexion ROM from a half-kneeling position or a split stance position with your hands on the wall. For more information, read my post about ankle stability and ROM.

How do you determine how much functional ankle dorsiflexion ROM an individual possesses? 

I prefer testing weight-bearing positions rather than non-weight-bearing positions because: 

1). Individuals have much more ROM during weight-bearing.

2). Weight-bearing is characteristic of the squat and other functional positions, so it’s more specific to what you’re trying to improve.

Knee valgus can also be exhibited through faulty movement patterns. Specifically, many recreational lifters have never been properly coached on the in-depth analysis of squatting to learn adequate and customized technique. They may possess adequate mobility and stability, but simply lack the proper coaching cures for better execution.

What are some of the best ways to control and improve knee valgus?

1). One of the more optimal approaches is to use cueing for improved control.

Cueing can be highly beneficial in helping to better control knee valgus. The ultimate goal is to either not need cues or to focus on external cues, which focus on the environment around you. You can incorporate a cueing hierarchy to reduce excessive knee valgus such as:

Tactical: Place a band around the knee to feel and push against.

Visual Cues: Provide a target in the inner knee to avoid.

Internal Cue: Push your knee out.

External Cue – Spread the floor.

Of course, there is not a one-size-fits-all approach, so practice what specific cue might work the best for the person at hand.

2). Ankle mobility drills and calf stretching makes a difference. Go check out my posts about dynamic ankle mobility, ankle strength and calf movements for detailed anatomical information and suggested exercises for implementation.

3). Hip abductor or external rotation exercises

Using various exercises to enhance hip external rotation strength is very valuable to help control knee valgus. This category includes x-band walks, monster walks, sumo walks, band seated abductions, band/cable standing abduction, side planks, pallof presses with hip rotational, and band hip rotations. However, if/when you perform these exercises and the variations, make sure you perform them in a more deeper flexed/crouched position as this focuses more on hip external rotation strength.

Practical Application

While knee valgus itself is often touted as a bad thing, it cannot be completely avoided due to the inherent nature of the sport or movement a client or athlete is performing. If you suffer from excessive knee valgus, perhaps finding a highly qualified physical therapist or neurokinetic therapy specialist can provide much needed relief. However, it’s important to be conscious of the multiple factors involved with the whys and hows of knee valgus occurring and what you can do to better control it to maximize your performance.

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