After writing my book Squat Science, I determined that there are only two absolutes everyone should adhere to:
- Knee valgus should be held to a minimum
- Don’t let your back round
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Other than these two, you can pretty much do whatever fits your goals and body type. Knee valgus is a phrase that gets thrown around all too often by people who don’t fully understand it. I coach some of the best weightlifters in the world, and some of them use knee valgus as a dynamic way of standing up from a squat. I will explain this in more detail a little later in this article. The moral of the story is that some champion weightlifters demonstrate knee valgus when standing up from a squat or a clean without any long-term damage to their knees. The key is whether this is a controlled or uncontrolled action. Let’s look a little deeper.
My friend Zach Long, DPT and I talked about this very topic a while ago when he was on my podcast “The Barbell Life.” He filled our audience in on what the research says, and he also gave us a theory that he has about weightlifters using valgus as a tool. When most physical therapists refer to the dangers of knee valgus, they are normally referring to uncontrolled valgus or dynamic valgus.
Dynamic Valgus
Dynamic valgus happens when the knees move medially inside of an imaginary line drawn from the ankle to the hip. For it to be considered dynamic knee valgus, the knees will travel inside of that imaginary line whether the load is heavy or light. You will notice this in younger athletes when they perform an air squat. The valgus will be accentuated when athletes jump and land. This is the knee valgus that is dangerous and leads to knee injuries. This type of knee valgus is especially prevalent in younger female athletes due to a steeper Q-angle. The Q-angle is the angle between the hip and knee. Females in general have wider hips than young males forming a steeper angle. Dynamic valgus is caused by:
- Weak glutes
- Faulty movement patterns
- Q-angle
- A combination
Valgus Moment
You see valgus moment most often as it is a slight tick or the knee moving towards the midline of the body, but not crossing the imaginary line formed by the ankle and hip. You might see this from powerlifters who purposely abduct their knees to create more torque at or slightly below parallel. This tick is the knee traveling back to neutral or in alignment with the toes.
Controlled Valgus
Now controlled valgus is the case of knee valgus I am most interested in because it is a theory formed by my friend Zach Long, DPT (also my colleague from Stronger Experts). This is a theory shared by many weightlifting coaches, and it’s a theory we’ve discussed for years.
During controlled valgus, the knees actually move inside of the imaginary line, but only during maximum or near-maximum loads. These athletes are able to display control during lighter loads or during air squats and jumps. This movement is something used by advanced athletes to assist with standing up from a heavy squat or clean.
Several of my athletes use this method during heavy squats or cleans. December Garcia is one of those athletes. She is one of our top female athletes. She is able to front squat 137 kilograms or 301 pounds. She’s able to clean and jerk 120 kilograms or 264 pounds weighing only 63 kilograms (138 pounds). Do you really think she has weak glutes? If you take one look at her, it’s easy to see her glutes aren’t weak at all. She’s an elite athlete who has learned to use this advanced technique to push through maximal loads.
Athletes like December aren’t taught this technique. She is a rare breed of athlete who I am privileged to coach. Her kinesthetic awareness (awareness of her body as it travels through space) is a truly amazing thing to witness. Every time I watch her lift, I stand watching in amazement as she hurls her body around the bar loaded with hundreds of pounds. Athletes like December use controlled valgus out of instinct not because she practices this advanced movement.
Zach Long believes that controlled valgus is a result of a forceful contraction by the quads and the adductor magnus. The adductor magnus adducts the femur, but it also creates about 50% of hip extension (recent research by Vigotsky and Bryanton). It’s often called the fourth hamstring as it originates in the same spot (the ischial tuberosity), but most people don’t think of the adductor magnus when it comes to hip extension. Therefore, valgus during controlled valgus is partially caused by recruiting this power hip extensor to stand up. A forceful quad contraction will also cause a bit of internal rotation that leads to this valgus. This is an idea that originates from my friend Bret Contreras.
This next part is where things get kind of cool. Zach Long says, “The inward movement of the thigh will slightly stretch the glutes, potentially allowing for increased force production to help the lifter drive up and out of the deep squat.” Talking with Zach really allowed me to see just how amazing my athletes really are. Females like December Garcia and Hunter Elam were able to figure this out instinctively. This is what makes these athletes world-class. This is something coaches can’t teach them. This is their body figuring out how to overcome a near impossible task. Amazing! I suggest you guys give this article from Zach a peep.
With all of this being said, am I saying that valgus is a good thing? May it never be! I am just saying that advanced athletes will figure out a way to complete whatever task is in front of them. It might not be the healthiest thing for their body, but high-level competition is seldom healthy. It’s competition with people trying to prove that they are the best in the entire world. This is a different world from the general population. Strength coaches and physical therapists alike need to realize that.
Fixing Valgus
Now what about valgus that is detrimental? If I witness athletes with dynamic valgus or any degree of valgus that causes pain, here are a few exercises I use to correct:
- Squats with bands or a strap around the knees- this will strengthen the abductors while teaching a new movement pattern. The knees will have something to push out against as opposed to their normal valgus pattern. I prefer a strap because a strap is a bit firmer.
- Belt squat with a strap or band- this one is my favorite as this movement accentuates hip extension while at the same time hip abduction. This is the best way to correct the dysfunctional movement pattern while strengthening the weak abductors.
- Hip Thrusts with a Band or Strap (made famous by Bret Contreras)- I really like this one for weightlifters to emphasize the glutes during extension with maximal resistance.
- Band Walks (teeter totter and duck walks)- this movement is a great way to warm up for glute activation purposes. I don’t believe that this by itself will correct dynamic valgus, but used in conjunction with some of the other movements along with some movement pattern corrections, it’s definitely a tool to use.
- Bring your feet in a bit- sometimes it is the simplest fix. If an athlete is taking a stance outside of the anatomical comfort zone, then valgus will be the result. By bringing their stance in a bit, it might be easier to keep their knees tracking with their feet and outside that imaginary line.
I hope that this article helps all of you make better decisions towards correcting knee valgus. Keep in mind that dynamic knee valgus is definitely related to knee injuries. However, now you will be able to determine the difference in dynamic valgus, moment valgus, and controlled valgus. Remember the general population and elite athletes are not the same thing nor do they share the same goals. It’s important that all of us understand the differences.
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Good article. C could be made a bit better by using frontal videos so you can really see the knee movement.