By far, I help more people with knee and shoulder problems in my profession.  As a therapist and fitness pro, I often use lingo that some do not fully understand.  In fact, I often find myself analyzing gait patterns of people at the grocery store and even the ringmaster at the circus this past weekend. LOL

I guess I am a biomechanics geek of sorts.  It just seems as if faulty mechanics stick out like a sore thumb for me wherever I go.  Now, when it comes to bony alignment, you can thank  your parents to a large degree for your shape and knee alignment.

Obviously, girls have wider hips so they naturally tend to exhibit greater tendencies to have valgus overload (knees cave in with squatting or landing) than males.  However, other factors that contribute to valgus overload are:

  • Hip tightness (adductors and IT Band)
  • Hip weakness (gluteus medius)
  • Foot pronation (flatter or collapsing arch)
  • Pain (which leads to compensation)
  • Improper muscle firing patterns

So, we know valgus is bad.  Does this mean neutral and varus are free from worry.  Not so.  I have seen many people with neutral alignment fall into valgus due to imbalances, poor muscle memory and faulty motor patterns.  Varus knees are often subject to excess stress (compression) along the inside of the knee and gapping along the outside of the knee stressing the lateral collateral ligament.  Valgus knees offer increased compression on the lateral knee and gapping along the medial knee stressing the medial collateral ligament.

In the end, you simply want to know your alignment and then assess how gravity and ground reaction forces impact your joints.  Squatting and gait provide ample cues.  Once you know the imbalances, you can address them with exercises. 

I helped do orthopedic screenings last night for a local high school and noticed a few steady trends:

  1. Nearly all of the soccer players had varus knees
  2. All of the offensive and defensive linemen had valgus knees
  3. Cheerleaders had the best single leg squat strength and balance
  4. About 75% of the athletes I saw had less than exemplary single leg dynamic strength/balance

I included two very different pictures below of high school female soccer players doing a drop landing test from an 18″ box.  Obviously the valgus landing is more predictive for ACL and knee injury.


Minimal valgus at landing


Significant valgus at landing

Obviously the girl in the second picture has a higher inherent risk of a serious non-contact knee injury.  I recommend a knee prevention program for all cutting and jumping athletes, but when you see this type of valgus loading   sound the alarm and be sure to implement a corrective exercise plan to reduce injury risk.

I am putting the finshing touches on my ACL prevention DVD as I write this.  You can still take advantage of the pre order sale if you act now.  Visit for more info.