​When it comes to lifting, sports, and physical activities in general, even something as simple and natural as gait (walking) you have got to pay attention to the details in which your body moves. Lack of body awareness can lead to a lack of realization you have a movement pattern dysfunction. Lack of realization becomes a dysfunction unaddressed, which in return, resulting in a dysfunction reinforced.
In this post we will be focusing on just a couple common details in your lower extremity -knee and ankle valgus.
I realize pictures ‘click’ far better than words so before I get into it, below are a couple pictures of each dysfunction I would like to address to help you know, understand, and begin to improve your movement patterns. Keep in mind, the reason these details are issues is because 1. The correct anatomical position is neutral and 2. When not corrected they can cause a host of pain, injury, and functional movement problems.

​Knee Valgus

​Knee valgus is the inward collapsing at the knee(s) along with the internal rotation of your hip(s). The opposite of this dysfunction in knee vagus. You can assess yourself through a number of ways such as watching your forward gait, squat, step down, or landing of a jump.

​Ankle Valgus/Eversion

​Ankle valgus or eversion refers to the inward collapse at the ankle joint, or your foot rolling inward. The opposite of this, also pictured below, is ankle vagus or inversion. This can be assessed just like knee valgus with watching your gait, squat, step down, jump, even balancing on one leg. 
​Correcting this issue begins with acknowledging you have it. If you do not first realize your body is reflexively performing valgus to begin with, you aren’t going to know that it is a dysfunction that needs your immediate attention.
Considering power is generated from the ground up, these dysfunctions directly inhibit the strength an athlete can produce for their lifts. Not only do squats and deadlifts require power to flow from the tips of their toes up, but if you are a competitive powerlifter you are well aware the significance of drive from the ground up to accomplish maximal strength and efficiency during the bench press as well. So, improving what may seem to the untrained eye as small, could in fact be a huge factor in improving an athletes strength, efficiency, longevity, and functionality.
Not only is this clearly problematic in powerlifters, but if valgus is not corrected among all other athletes and individuals, the pain and injury consequences are extensive. Any individual experiencing this dysfunction is increasing their probability of low back, hip, knee, ankle and foot pain; are prone to injuries at the hip, knee, and ankle joints; iliotibial (IT) band syndrome; compensation patterns that indefinitely lead to a host of issues; weakness of the core (including the pelvic and lumbar spine), gluteus maxiumus and medius, external hip rotators, hip abductors… truly, it is nearly an endless list of possibilities and chain events.
All of that being said, I hope this brief introduction makes it understandable that no matter who you are or what you do, this is an issue that needs your attention for correction.
So lets start by finding out if you have any degree of knee or ankle valgus…

​Assessment

​As briefly mentioned, you can fairly easily assess both of these LED’s (Lower Extremity Dysfunction). Typically in the professional scene, a coach would walk you through an overhead squat assessment or a standard/arms down squat and observe your movement pattern for any dysfunctions themselves. However, if you are identifying for yourself perform first the overhead squat and if that causes excessive forward leaning (you find your upper body practically in your lap to catch your balance), anterior tilting (butt perks up), and/or shoulders elevate, perform your squat with your arms down.
Watch yourself through a mirror or, better yet, film yourself from a frontal view. With the video you can watch as many time as needed to spot possible dysfunctions. It’s extremely likely that if you notice you have one (either knee or angle valgus), you have both. If you would like to observe your gait, step down, and/or jump, film those movements as well to see if your initial squat assessment results are the same, more or less prominent in these other motions.

​Correction

​There is a vast number of exercises, from strengthening weak, under-active muscles involved, to release and lengthening exercises for the tight and over-active muscles, to condition your mind and body to correct knee and ankle valgus. I am going to provide a progressive program below, so that if you are experiencing these issues you can have easy access to a ‘go-to’ plan and progression to assist in correcting this dysfunction. That being said, the exercise selection and program designed below is inspired by my favorites in addressing this issue with clients and one you can use in your own training, but is by no means the only effective design. If you would like to learn more, I have linked exceptional sources for more of these exercises at the end of this post under ‘Sources’.
 Keep in mind, your body will want to perform these exercises incorrectly, defaulting to rotating your knee and/or ankle inward. It is up to you during each of these exercises to resist your initial reflex to collapse your knees and/or ankles and to instead focus and push against the resistive force coming for an external resistance or and internal habit. The goal here is to retrain your mind and body and build the muscle strength needed to correct the dysfunction. This is why reinforcing the dysfunction (especially with the use of bands, as you will see below) will strengthen the muscles involved in keeping your knees and ankles vertical by having to pull them to neutral against a resistance. Resistance builds strength and muscle.
On top of the weak muscles involved in knee valgus needing strengthened, you also will have opposing muscles that are too tight. These muscle aren’t in need of strengthening but in need of lengthening through release techniques. You can do this by stretching the gastrocnemious at different angles and using a foam roller to provide relief of tension along your adductors (inner thigh down to soleus/inner calve muscles).

PROGRAM

Instructions: Accomplish the first progression before advancing to the next. If one is too difficult, causes pain, or you can see needs to be practiced more before advancement, stop there. I would suggest beginning your training sessions with this as a warm up/activation. 
Single Leg Balance Progression: Hold position with careful consideration and practice in resisting internal rotation of the ankle for 10-20 seconds each leg; If needed touch a hand to a stable surface to keep balance but do not use the surface support weight. Progress to not needing something to hold to keep balance for time indicated.

  • Bodyweight Single Leg Balance
  • Single Leg Balance on Foam Pad
  • Contra-Lateral Weighted Single Leg Balance (Hold weight in opposite hand to foot on the floor)
  • RNT Single Leg Balance (Reinforcing dysfunction with resistance band at the knee forcing internal rotation)

RNT Squat Progression: Complete 10-20 reps resisting internal rotation of the knees and ankles.

  • RNT Parallel Box Squat (Band reinforcing dysfunction around just below the knees)
  • RNT Low Box Squat (Band reinforcing dysfunction around just below the knees)
  • RNT Squat (Band reinforcing dysfunction around just below the knees)

Single-Side RNT Progression: Perform if valgus is effecting just one side, resisting internal rotation/collapsing of the knee and ankle with the dysfunction, for 10-20 reps.

  • Half-Kneeling RNT (Band reinforcing leg with dysfunction just above knee in lung position – resist internal rotation for 15-20 seconds each rep)
  • RNT Box Squats – Parallel or Slightly Below (Band reinforcing the leg with dysfunction just below the knee)
  • RNT Squats (Band reinforcing the leg with dysfunction just below the knee)
  • RNT Step ups (Band reinforcing leg with dysfunction just below the knee during step ups and downs on a box no higher than positioning your thigh parallel to the floor)
  • RNT Split Squat (Band reinforcing leg with dysfunction just above the knee)
​After the initial completion through these exercises and their progressions, I would suggest completing them, at minimum, on a weekly basis till dysfunction has significant improvement. If you find any progression to be rather easy, pass on that single exercise the week following and focus on the progressions that are still difficult to some degree. Once your dysfunction has reached significant improving during the overhead or arms down squat assessment, you can continue using any of these exercises as an activation tool to reinforce correct movement patterns in main lifts.
Just like with any new movement or habit, correcting valgus does not occur immediately. It takes consistency in performing correction techniques (both strengthening and releasing muscles involved), but also a lot of focus in not unintentionally resorting back to the old habits once faced with a loaded barbell, or other athletic movement. So, don’t get discouraged if it isn’t resolved as soon as you would like. Keep working at it and make it a priority and the results and new habits will follow.

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