Should we train/rehabilitate knee valgus?
Valgus motion at the knee consists of Flexion, Abduction and Internal Rotation and is often the cause of disabling knee injuries such as ACL tears.
Video of Michael Owen ACL tear
But should we train or rehabilitate our client in this valgus position? My answer is yes, we should train all our athletes who participate in sports that involve, cutting and change of direction.
One of the most common rehab or training misperceptions is that the knee has to be in line with the 2nd toe, and cannot go over it!However, there are examples where this may be the case e.g. heavy squats, Olympic lifting etc. You don’t want to create a knee valgus with 120kg over your head!
This aside valgus at the knee is normal, obviously there are various degrees of normal, but this is a motion that has to happen if we are getting normal pronation at the foot and ankle. Pronation is a tri-plane motion that occurs during movement and combines calcaneal eversion, forefoot abduction and dorsi-flexion. This in turn will create an internal rotation and abduction of the tibia – knee valgus, so it is normal!
If we want to do our best to prevent ACL injuries or rehabilitate our clients back from this injury to their sporting environment then we have to train them in a valgus position incorporating gravity, ground-reaction force, mass and momentum and external loading.
Can’t we just keep the knee moving in the sagittal plane?
No. In any sporting environment it is normal and essential for the knee to go through a valgus motion.It has become common place in many countries to work their athletes to turn the feet more to prevent knee valgus i.e. if turning off the right foot the initial motion should be to turn the foot inwards (Int Rot) then push off. This would not be possible if we have very quick changes of direction in multiple planes, which is commonly seen in a lot of sports especially Basketball.
This clip is great especially if you loved basketball back in the 90’s. Michael Jordan demonstrates multiple changes of direction and valgus at the knee = normal movement patterns, not enough time to adjust foot position!
What are we training and why?
We are training the muscles, neurological system, joint capsules to control a motion and bring it back. This creates a loading in the FP and TP especially to the hamstrings, adductors, medial quad, calf and gluteals. Movement creates information and the more information we can provide to the neurological system the better.
Remember we are not training them to go into valgus, we are teaching to body how to deal with these forces safely and effectively.
How do we train into a valgus position at the knee?
Start easy. One of the fundamentals of the Applied Functional Science approach to training and rehab is to start with success and tweak in/out resources. An example of this would be a forward lunge. If you rotate both arms to the same side as the forward leg this creates an eccentric lengthening to the gluteals in the transverse plane giving more resources to the knee. If you rotate both arms in the opposite direction this ‘tweaks out’ the gluteals in the TP giving the knee less resource to help control the motion.
There are 100’s of thousands of different exercises that can be used with this process once we understand the biomechanics and the capabilities of the individual client.
In my opinion it is essential to rehabilitate all ACL patients into a valgus position at the knee so that the body knows what to do in that position when they return to sport and to prevent further problems.
G.I.F.T. Gray Institute
Mark Leyland is a fellow of Applied Functional Science from the Gray Institute
Momentum Physio. Locker 27, Brooklands, KT13 0YF