For the last couple of years, I have been very fascinated with knee valgus movement. Knee valgus is when someone’s bone or joint is pointed inward of the body. I would constantly watch athletes in person and on television who had some type of knee injury; including ACL, MCL or meniscus tears. I would ask myself “I wonder if that person has a huge amount of knee valgus”This movement should be a fire alarm to any fitness professional or coach to identify it as a problematic movement and start attempting to fix it. There are different methods used to approach correcting valgus knee movements. Some research states knee valgus is caused by reduced gluteal activation, while other research indicates use of bands will not help in preventing knee valgus movements that lead to injury. Essentially, there is no universal way to correct knee valgus movements. However, the number one objective for any strength coach or trainer is to prevent injury. Incorporating specific mobility exercises into their program may be ideal in achieving that goal.
In 2012, a research study by Dr. Padua, Dr. Bell and Michael Clark wanted to find the exact muscle amplitude associated with valgus knee movement during a double leg squat. Additionally, they also wanted to observe if a heel lift would change it; either preventing or intensifying the movement. They took two groups of people: one group that exhibited valgus knee and the other that did not. They tested the amplitude of the gluteus maximus, gluteus medius, adductor magnus, medial, lateral gastrocnemius, and tibialis anterior. The results showed that the tibialis anterior muscles, gastrocnemius, and hip adductors were stronger in those with valgus knee. The valgus group had a 34% increase in activation of their adductors. The amplitude of the muscles was substantially less when a two inch heel raise was incorporated.
What does all of this information tell us? It helps us to determine a proper action plan to prevent and fix the problem. Back to the analogy of the fire alarm; it not only lets us know a fire is occurring, but which room it’s in. I like to look at all the elements that cause this alarm. First let’s start with the ankle; its stiffness causes restricted dorsiflexion which in turns results in the foot being pronated and internal rotation of the tibia causing the knee valgus. This study showed valgus movement had a large increase in these specific muscles which is causing overcompensation. The body is used to this, but the great thing about the body is that over time, we can change bad habits. Anatomically, we know the antagonist muscle of the gastrocnemius is the tibialis anterior, than the antagonist for the tibialis anterior is the tibialis posterior, soleus, plantaris, and fibularis longus. Finally, if we are very strong in our adductors, that means we have to work on getting the abductors stronger. No agonist and antagonist muscles are going to have an exact 50/50 split when being activated, but you want to decrease that ratio as much as possible.
In my experiences, mobility exercises are sometimes the elephant in the room. Depending on how much time coaches or trainers have to spend with their players/clients, determines how much mobility time is dedicated. If there is not enough time, mobility gets neglected. Granted, coaches can assign mobility exercises to their players, but it is not guaranteed that they will do them on their own. Let’s start from the ankles and work our way up. Start by completing ankle mobility exercises against the wall, have the person stand almost in a lunge position. Have them bend and lean forward with the front knee.? Ensure the entire foot is on the ground and the heel does not rise on either foot. Do this 10 times forward, internal rotation and external rotation each leg.
Tibialis anterior and soleus stretches take care of three things at once: you are stretching the soleus, tibialis anterior and plantaris.? Sit down on the ground and place a jump band in a figure eight position, loop it over the toe, move it in a clockwise and counterclockwise position for about 30 seconds on each foot. Finally, incorporating lateral band walks will get those abductors firing. Complete it for 12-15 steps in each direction.
Finally, having a two inch lift in the heel will assist in ensuring those muscles are not being fired as much as before. There are obviously a plethora of other exercises you can do to ensure these muscles are being worked. I feel this is a solid formula of exercises to minimize knee valgus in your athletes or clients which will prevent you from hearing that proverbial fire alarm going off. Please comment in the section below and share which exercises you use to help with this problem.
References
- Padua, Darin A., David R. Bell, and Micheal A. Clark. “Neuromuscular Characteristics of Individuals Displaying Excessive Medial Knee Displacement.” Journal of Athletic Training. National Athletic Trainers Association, 47:525-536. 2012.
- Fox, Aaron S., Jason Bonnacci, Scott G. Mclean, Michael Spittle, and Natalie Saunders. “A Systematic Evaluation of Field-Based Screening Methods for the Assessment of Anterior Cruciate Ligament (ACL) Injury Risk.” Sports Medicine. 5th ed. Vol. 46. N.p.: n.p., n.d. 715-735. 2015.
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