Why Are My Knees Caving Inward?
The question at hand is: Do your knees move inward when you are walking, running, going up steps, or getting up from a chair? This minuscule movement is more common than we realize and unfortunately can be a huge source of knee pain and injury. Some people notice their alignment changing over time, while some people may not notice it happening at all, even though it is. The good news is, there ARE some things that you can do about it. Before we can understand what we can do about it, let’s first talk about what exactly is going on and why.
What is Knee Valgus?
When we talk about malalignment of the knees (while looking at them from the front), there are two basic angles they can take. The first is what we call “varus.” This may be what you picture when you think of someone who is bow-legged. The picture below is an example of this type of alignment.
The second form of deviation from neutral is called “valgus” alignment, which is what you probably picture when you think of someone who is knock-kneed. This is the type of malalignment I would like to focus on in today’s article. See the picture below to view this type of alignment.
It is worth noting that these measurements of alignment are not all-or-nothing, but a spectrum of varying degrees. Some people have A LOT of valgus in standing while some people have very minimal valgus. We refer to the exact measurement as “Q angle.” Can you live a happy life with a large Q angle? Of course, you can! It is worth noting however that as the angle increases, so does the potential for some of the negative effects that come with it.
Am I stuck with Knee Valgus or Varus?
Yes and no. At any point in your life, there is a relatively fixed amount of valgus/varus that your knees will have, which is held in place by the ligaments and muscles surrounding the joint. If you try to relax your knee and push it into valgus or varus, you will find that there are only a few degrees of wiggle room. This is not moving much- at least not immediately.
However, this angle can change slowly over time based on the forces you repeatedly place on your knees during every day life and extracurricular activities. For example, you may notice that your grandmother became more knock-kneed in her eighties than she was in her sixties. You may think of a horse jockey in their sixties who is bow-legged. Or you may observe that someone who took up long-distance running becomes slowly more knock-kneed over the course of a decade. In all of these cases, the changes took place over long periods of time as a result of lifestyle and aging. As cells die and new cells are born, the forces we place on our bodies can slowly change how the tissues continue to develop and form. Over the course of time, repetitive valgus or varus forces can result in slow changes to your “resting” alignment.
What is Happening When I Go Knock-Kneed
Well, the answer lies not in the knees, but in the HIPS.
You see, every time you ambulate up a stair, stand from a chair, take a step while walking, run or squat down to pick something up, your knee bends to a given degree in the flexion/extension plane. In an ideal world, it will not move much in the side-to-side (unofficial term) plane. In reality, however, as it bends forward and backward it may also move out to the side, stay in a straight line, or move in towards the other knee. The better you can control this action, the less unbalanced forces you will place on the joints throughout your lower extremity.
What Can Happen From Being Knock-Kneed?
SO many of us, whether we notice it or not, allow our knee or knees to cave inward when they are under stress, applying what we call a “valgus force” to the joint. We do this because it is the easiest way for the body to get the job done (I won’t get into all the physics). The problem is that if we do this repeatedly over time during daily activities, or as an athlete during rigorous activities, we can place an unnatural, unbalanced stress on the joint. As we move the knee inward, we apply compressive forces on the lateral side of the joint, stretching forces on the medial side of the joint, and twisting forces through the entire thing. This can allow for slow and chronic tissue damage as well as acute injuries such as meniscus tears. Furthermore, it also affects the angles of your lower leg, creating unnecessary stress on the ankles and feet. Oh- AND you can create hip impingements and bursitis/tendinitis! Let’s not even talk about lateral shifts in the low back… Sheesh!
What Do I Do to Fix Valgus Knees?
This is the ultimate question to be answered in this article. What can you do to actually affect this alignment? So, back to the good news: It is actually not that complicated to start working on this problem!
Almost all of this, as I stated above, circles back to activation of the hip muscles!
This is because most of the valgus forces placed on your knee actually come from movement at the hip. When you move into a valgus position, the structure that is really moving too far inward is the thigh bone. Movement of this thigh bone (or femur) is controlled by muscles of the hip joint, namely the gluteal and other small supporting muscles. As your thigh moves inward towards the midline of your body, it brings the knee with it, creating the valgus angle of which we have been speaking. So in essence, you need the hip muscles to fire correctly in order to control the thigh bone from moving inward and wreaking havoc on your lower extremity.
Watch how the man’s thighs move in this video, for example.
Now try watching yourself in a mirror, on a video, or just look down at yourself as you propel up a stair, perform a squat, or stand up from a chair. Do you see your knee(s) move inward as you do it? If not, great! If your knee does move inward, the good news is that you can help this with some hip strengthening! It will also help to simply be more cognizant of this movement and use intentional effort to keep the knees “wide” during the motion.
Exercises To Fix Knock-Knees
I have four exercises below to help you work on the hip muscles that control these motions. If any of them hurt, do not do them. I cannot tell you that if you have pain, these exercises alone will solve it, but they are a great starting point to helping you support your knees better and getting things going in the right direction. These exercises are then pictured in respective order below. Enjoy!
- Clamshell- The key with this exercise is do NOT let the front of your pelvis start rolling upward and facing the ceiling. Keep your hips facing parallel to the wall in front of you, or even angled slightly down to the surface.
- Sidelying hip abduction- The same rule from the clamshell applies. Keep that pelvis facing forward- not up. Lift the leg straight up towards the ceiling, and not forward. You should feel the burn in the SIDE of your buttcheck and hip, NOT the front of your hip.
- Fire Hydrants- Try to keep your pelvis steady as you do these.
- Banded squats- Make sure as you squat that you keep the pressure outward into the band, not allowing your knees to cave inward.
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In Summary:
- Weakness in the hips can result in valgus forces at the knee
- Over time, these forces can create permanent changes in the alignment of the knee, creating a more permanent valgus position which delivers unbalanced forces.
- Temporary valgus alignment during functional movement can create chronic wear and tear as well as acute injury
- To fix all of this, work on strengthening muscles in your hips as well as consciously making efforts to keep the knees wider during functional activities such as squatting, rising from chairs, running, or ambulating stairs
If you have any issues with your knees, hips, or feet that you can’t seem to figure out, schedule a call with us today and we would love to start problem-solving for you immediately.
I hope that you found this article helpful and I appreciate your time!
Be well!
Dr. Andrew Trem, PT DPT