Running: How to Stop Knees Turning In (Knee Valgus)

How to stop knee turning in when running?

Correcting knee valgus (knees turning in) during running involves a multi-faceted approach focusing on strengthening key hip and core muscles, improving ankle mobility, refining running mechanics, and ensuring proper footwear.

Understanding "Knee Valgus" in Running

"Knee valgus," often referred to as "medial knee collapse" or simply "knees turning in," describes the inward movement of the knee joint during dynamic activities like running, squatting, or jumping. While a slight degree of knee valgus is normal, excessive inward movement can indicate underlying biomechanical inefficiencies and significantly increase the risk of various running-related injuries, including patellofemoral pain syndrome (runner's knee), IT band syndrome, Achilles tendinopathy, and even stress fractures. This inward collapse compromises the kinetic chain, placing undue stress on the knee joint and surrounding structures.

Why Do Knees Turn In When Running? Identifying the Root Causes

Understanding the "why" is crucial for effective correction. Knee valgus is rarely due to a single cause but rather a combination of factors throughout the kinetic chain.

• Proximal Weakness (Hip & Core):

  • Weak Hip Abductors: The gluteus medius and minimus muscles are essential for stabilizing the pelvis and preventing the femur (thigh bone) from adducting (moving inward) and internally rotating during single-leg stance, which is precisely what happens during running.
  • Weak Hip External Rotators: Muscles like the gluteus maximus and piriformis help control the rotational forces at the hip. Weakness here can allow the thigh to rotate internally, leading to knee collapse.
  • Poor Core Stability: A stable core provides a foundation for efficient limb movement. Weak core muscles can lead to compensatory movements higher up the chain, affecting hip and knee alignment.
  • Insufficient Hip Mobility: Tight hip flexors or adductors can alter hip mechanics, forcing the knee into an undesirable position to compensate.

• Distal Factors (Ankle & Foot):

  • Overpronation of the Foot: Excessive inward rolling of the foot (pronation) during the stance phase can cause the tibia (shin bone) to internally rotate, subsequently pulling the knee inward.
  • Ankle Dorsiflexion Limitations: Limited range of motion in the ankle (inability to bring the shin forward over the foot) can force the body to find compensation higher up, often leading to increased knee valgus to achieve proper ground clearance and shock absorption.

• Running Form & Mechanics:

  • Narrow Stride Width: Running with feet too close together or even crossing the midline can promote knee valgus.
  • Overstriding: Landing with the foot too far in front of the body can increase braking forces and place greater stress on the knee, potentially encouraging inward collapse.
  • Low Cadence: Slower step rates can increase ground contact time and impact forces, making it harder to control knee alignment.

• Other Contributing Factors:

  • Muscle Imbalances: An imbalance between stronger quadriceps and weaker hamstrings or glutes.
  • Fatigue: As muscles tire, their ability to maintain proper alignment diminishes, often leading to a breakdown in form.
  • Footwear: Worn-out shoes or footwear not suited to your foot type (e.g., a neutral shoe for someone who significantly overpronates) can exacerbate the issue.

Strategies to Correct Medial Knee Collapse

Addressing knee valgus requires a targeted and consistent approach, combining strengthening, mobility, and gait adjustments.

1. Strengthening Key Muscle Groups

Focus on exercises that build strength and endurance in the muscles responsible for hip stability and knee alignment. Aim for 2-3 sessions per week.

• Hip Abductors & External Rotators:

  • Clamshells (Banded): Lie on your side, knees bent, feet stacked. Keeping feet together, lift the top knee. Add a resistance band above the knees for progression.
  • Side-Lying Leg Raises: Lie on your side, legs straight. Lift the top leg straight up towards the ceiling, leading with the heel.
  • Lateral Band Walks: Place a resistance band around your ankles or knees. Take small, controlled steps sideways, keeping tension on the band.
  • Monster Walks: Similar to lateral walks, but step forward and out at a 45-degree angle.
  • Single-Leg RDL (Romanian Deadlift): Focus on maintaining hip stability and knee alignment in the standing leg.

• Gluteus Maximus & Hamstrings:

  • Glute Bridges/Hip Thrusts (Single-Leg Progression): Lie on your back, knees bent. Lift hips off the ground, squeezing glutes. Progress to single-leg variations.
  • Banded Squats/Deadlifts: Place a resistance band above your knees. As you squat or deadlift, actively push your knees out against the band to engage glutes.

• Core Stability:

  • Planks (Forearm & Side Plank): Maintain a rigid body position, engaging core muscles.
  • Bird-Dog: On hands and knees, extend opposite arm and leg, maintaining a stable trunk.
  • Pallof Press: Use a cable machine or resistance band. Press the handle straight out from your chest, resisting rotation.

• Foot & Ankle Strength:

  • Calf Raises (especially eccentric): Strengthen the calf muscles, which play a role in ankle stability.
  • Toe Splay/Toe Yoga: Practice spreading your toes and lifting individual toes to improve intrinsic foot muscle control.
  • Short Foot Exercise: Actively shorten the arch of your foot without curling your toes.

2. Improving Mobility & Flexibility

Address any limitations in joint range of motion that might contribute to compensatory movements.

• Hip Flexor Stretch: Kneel on one knee, place the other foot forward. Lean forward to feel a stretch in the front of the hip of the kneeling leg.
• Ankle Dorsiflexion Stretches: Perform calf stretches against a wall, ensuring the heel stays down to target the soleus and gastrocnemius muscles. Consider a lunge stretch with the front foot close to a wall, trying to touch your knee to the wall while keeping your heel down.

3. Running Form Drills & Cues

Consciously adjust your running mechanics, often with the help of specific drills.

• "Knees Over Toes" Cue: As you run, mentally focus on keeping your knee tracking in line with your second or third toe, preventing it from collapsing inward.
• Increase Cadence: Aim for a higher step rate (e.g., 170-180 steps per minute). Shorter, quicker steps reduce impact forces and can naturally encourage a midfoot strike and better knee alignment.
• Widen Stride (Slightly): Instead of crossing over or having your feet too close, aim for your feet to land directly under your hips, providing a more stable base.
• Midfoot Strike: While not a universal solution, a midfoot strike (landing on the middle of your foot) can sometimes help distribute forces more evenly and reduce the tendency to overpronate compared to a heavy heel strike.
• Running Drills: Incorporate drills like A-skips, B-skips, Carioca, and Lateral Band Walks into your warm-up to reinforce proper hip and knee mechanics in a dynamic setting.

4. Footwear & Orthotics

• Assess Your Shoes: Ensure your running shoes are appropriate for your foot type and gait. If you have significant overpronation, a stability shoe with medial support might be beneficial. Visit a specialized running store for a gait analysis.
• Consider Orthotics: For pronounced overpronation that contributes significantly to knee valgus, custom or over-the-counter orthotics can provide additional arch support and help control foot motion. Consult with a podiatrist or physical therapist.

5. Progressive Overload and Consistency

Like any training, correcting knee valgus requires consistency. Start with foundational exercises, master proper form, and gradually increase intensity (e.g., add resistance bands, increase reps/sets, progress to single-leg variations). Be patient; significant changes in running mechanics take time and dedication.

When to Seek Professional Help

If you experience persistent knee pain, notice a severe inward collapse of your knees, or find that self-correction strategies are not yielding results, it is highly recommended to consult a professional.

• Physical Therapist: Can perform a comprehensive gait analysis, identify specific muscle imbalances or mobility restrictions, and design a personalized rehabilitation and strengthening program.
• Sports Medicine Physician: Can diagnose underlying conditions and provide medical guidance.
• Certified Running Coach: Can offer expert advice on running form and drills tailored to your needs.

By systematically addressing the underlying causes of knee valgus, you can improve your running efficiency, reduce injury risk, and enjoy a healthier, pain-free running experience.