'Knock knees' a challenge for athletes, coaches

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If you ask most orthopedists, athletic trainers and physical therapists, there will be agreement that the knee is simply one lousy structure. Take your own statistics and make a note of how many people you know, work with, befriend or participate with in sports who suffer or have suffered from a knee injury, knee surgery or chronic knee pain.

One particular event common to youngsters of both genders, and frequently females of any age, is referred to as a "valgus knee" -- or a "knock knee." This condition is fairly easy to spot in younger athletes, especially as they perform squatting movements in which the knees begin moving toward each other at the midline of the body.

As the athlete (and nonathlete) develops physically and begins exerting more force on their knees, however, the forces experienced by the knee joint can be greater in one "compartment" -- which for valgus knees occurs usually at the outside of the knee or the "lateral compartment." As a result, it can create a gap at the inside or medial compartment of the knee and cause stretching of the medial ligaments, as well.

In females, where frequently wider hips create a greater increase of the angle at which the femur directs toward the midline of the body, more emphasis must be placed on proper mechanics of squatting to standing in order to distribute stresses experienced at the knee joint most evenly. But males are certainly not exempt from demonstrating valgus knee angles.

In my training center, we are always on the lookout for valgus misalignment and helping fitness-minded individuals work on strengthening and stretching exercises to lessen this disparity. While some valgus knee angles are a function of genetic deformity, many occur as a function of muscle imbalances. When musculature is responsible for a valgus knee angle, it can be a result of tight hip adductors (those muscles that pull the legs together), weakness in the external rotators (or the medial "glutes"), foot pronation or inward angling of the foot, and sometimes even as a way for compensating from pain in another area of the leg, foot or hip.

It is critical that coaches, athletic trainers and strength coaches learn to recognize the behavior of the valgus knee and know some of the basic corrections and cues to decrease its incidence:

• Spread the floor: When squatting, with or without weights, it is important for the athlete to push laterally against their shoes, creating pressure on the outer edge of the foot; this will fire the medial glutes and help stabilize the knee as it goes into both flexion and extension.

• Utilize hip adduction machines: These machines are frequently laughed at in many gyms and training facilities, but they can play a significant role in strengthening those external rotator muscles that stabilize the upper leg and ultimately the lower leg.

• Rubber ankle bands/cuffs: Try placing a rubber ankle band around the athlete's legs, just above the knee, while they squat. Their goal is to maintain an even distance between the legs during the squatting motion. While placing the band around the ankles helps, it does not stop the knees from angling inward.

• Visual cues: When performing squats, athletes and the fitness minded should use a mirror to not only identify any imbalances but use those visual cues to make corrections.

I have always held onto the belief that many sports seasons are won and lost in the weight room. Coaches and strength coaches who oversee proper biomechanics are doing more than maximizing an athlete's muscular response. They are also assisting the athlete in his or her goal to play an injury-free season.

Bill Victor owns Victor Fitness System Professional Fitness Trainers, Flashpoint Athletic Speed & Agility Specialists, and Performance Nutrition Consultants. Reach him at 360-750-0815, billv@victorfitsystems.com, theflashpoint.org or victorfitnesssystems.com