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Genu valgus - Knock Knees

Knock knees can be acquired or inherited.  We can help a little with inherited knock knees, but we have to blame your family for most of the problem.  The next time you go to a family reunion you will notice, ‘Hey, everybody on Uncle Bob’s side of the family has knock knees!’  Lucky you.

A lot of patients with knock knees, especially female runners, have developed a movement pattern where their hips rotate internally and turn the kneecaps toward each other.  There are a lot of reasons for this, but it is beyond the scope of our website.


Your knee joints bump into each other when you walk or run.  Your feet are always wider than your knees with running, sitting, or other activities.  There is no history of trauma (unless you fight with in-laws at family reunions).


  • When you stand in front of a mirror with your knees straight forward, your knees are closer together than your feet.  Your kneecaps point towards the middle.  
  • This posture is usually worse with those good-old mini squats.    
  • When you run your feet fling to the outside and you probably have excessive arm-swing with running to compensate for this excessive lower extremity movement.  
  • It is pretty common for these patients to have flat feet.  (interestingly, which came first: the flat feet or knock knees.)


There is not a lot we can do to fix genetic genu valgus.  Acquired genu valgus is trickier and more complicated.  Try our exercise routine and if it does not fix your knee pain, there are more things we can do to stretch your hips and knees in a clinical setting.


Manage the pain
  • NSAIDS will help.  Kinesiology taping to stabilize your knee until you get your strength back.  LIN Over-the-counter knee sleeves with a patellar cut-do not help a lot.
  • Continue running but avoid aggressive speed work and hill repeats, especially downhill running.
  • Some patients with flat feet can benefit from over-the-counter inserts.  Again, just because it is more expensive does not make it more better. (Bad grammar but funnier?)

Restore full motion 

  • A lot of patients with knock knees have very tight hip flexors and adductors.  This is especially true if your job involves mostly sitting.
  • Stretching should focus on your hip flexors and adductors.  LIN
  • Stretching does not have to be part of your warm-up or cool-down.  But it HAS to be part of your training program. LIN

Begin non-weightbearing exercises to restore strength without all the pressure on the joints

  • Most strength training exercises involve minimal movement of the knee joint to reduce pressure on the joint as it recovers
  • My favorite is KISS.  Keep it simple Sam (Or Samantha)
  • Your exercise program should emphasize strengthening the hip abductors and external rotator muscles.  LIN 
  • STOP the hip adductor machine at the gym!!
  • Other great exercises you can do at home are: Side lying hip abduction, side bridges.
  • You will not be at this level very long; we just need to increase your strength while minimizing stress on your knee.

Begin body weight exercises with emphasis on control versus strength and power

  • Apply the kinesiology tape to your knee before you start your weight-bearing exercises.
  • These are done slowly, with a short range of motion, and STOP BEFORE IT HURTS.
  • Standing hip abduction, standing hip external rotation, Wall-slides with very wide knees, sit-to-stand, static lunges, lateral step-ups, etc.  LIN 
    • If you can, complete these in front of a mirror so you can watch your knee stay in track
    • above your foot.
  • As soon as you can watch yourself complete a dynamic lunge or deep squat without ANY stupid knee movements (your knees squeezing together as you move) you can progress to more aggressive exercises.
  • Continue to tape your knee before your hard workouts

Correct running mechanics

  • Gradually return to your previous running. 
  • Start on relatively flat ground or even on a treadmill.  The best part of returning to running with a treadmill is that you can actually hear your footsteps.  Also, a lot of treadmills are in front of a mirror so you can see your hands move and your feet move. 
  • If your arms or legs swing weird, you may want to have a physical therapist complete an evaluation before you return to full running.  Listen and ‘feel’ how you run. 
  • Is one leg hitting the ground harder than the other?  Does one arm swing differently than the other?  Until you can run without pain and with fairly symmetrical running mechanics, you are still at risk of reproducing your old injury or creating a whole new injury to another part of your body.
  • As soon as you can run without pain and without a limp you can return to your normal running routine.

Return to running speedwork and hills 

After you have been able to run on flat ground for a week with your with your normal training and have not had any pain, you can begin to add speed and hill training to your program.

My favorite step, get back to full running! 

Have fun.  Eventually you will bust something else and be back to the website to fix that.  


If you follow the steps on the website for 2-6 weeks (depending on how badly you hurt yourself the first time and on how long you tried to ‘run through the pain’) and your problem does not resolve, then call our clinic for an appointment and we can do something Dr. Google cannot do.  We can complete a hands-on evaluation, in-person evaluation to determine the cause of your pain.


Call for a free injury screen.