San Francisco Symphony

Let's Get Physical ... Therapy! Help! I’m Knock Kneed

By Ilka Felsen
Staff Writer

Dear PT-roomie, my knees touch when I walk, and sometimes I have knee pain after a long hike or spinning class.  What’s the deal?

First of all, being knock-kneed is not necessarily a bad thing.  But it can predispose the body to knee pain with activities that require repeated knee flexion, such as running, cycling and stair climbing.

What are knock knees?

Knock knees is an informal term for genu valgum, when the knees nearly touch from angling inward.  Genu valgum is the result of three factors:  skeletal alignment, muscle strength and muscle activation.  Skeletal alignment is not easily modifiable and is related to the intrinsic posturing of the femur, tibia and patella, with the femurs angling towards each other and tibias angling outwards. 

However, muscle strength and activation are modifiable!  Often weak quads, weak gluteals (i.e. butt muscles) and weak abdominals are the culprits.  Additionally, a tightened IT band (which runs along the side of the upper thighs) and collapsed arches can contribute to genu valgum.

Why do I feel pain?

The pain is related to loading forces on the tibiofemoral and patellofemoral joints.  Individuals with genu valgum often have pain on the outside of their knees, from increased compression at the lateral tibiofemoral compartment, or a tight IT band that courses laterally to insert onto the outside of the femur, patella and tibia.  Anterior knee pain is due to poor alignment of the patella on top of the femur, usually from too much angling inward of the femur during weight bearing.

What are three simple things I can do?

1.  Strengthen your gluteals.  This large muscle group is responsible for hip extension, external rotation and abduction, all of which are usually deficient in individuals with genu valgum.  This means that squats, bridges, monster walks and clamshells should be your new best friends!

2.  Clench your butt cheeks together when you walk, and point your knees and toes forward.  Often individuals may have adequate muscle strength, but are not actively recruiting their muscles while walking—which basically counteracts the whole point of having strong muscles!

3.  Wear supportive shoes with arches, and strengthen your arches by folding clothes with your feet (yes, really!), grabbing objects with your toes and scrunching a towel with your toes.  Collapsed arches make it easier for the thigh bones to angle inwards and allow the feet to roll medially.  Giving your arches some lift actually supports your entire leg.

Ilka Felsen is a second-year physical therapy student.