You’re evaluating a patient who reports “knock knees” and anterior knee pain with squatting. As you observe their standing posture, you notice their knees track inward toward each other. This is genu valgum, a common alignment variation that can significantly influence your entire Plan of Care (POC).
What is Genu Valgum?
Genu valgum (JEE-noo VAL-gum), commonly known as “knock knees,” is a lower extremity alignment deformity where the distal segment of the leg (the tibia) angles outward in relation to the femur. This causes the knees to point medially and, in severe cases, touch each other while the ankles remain apart. It’s the opposite of genu varum (bowlegs). The normal tibiofemoral angle is approximately 5-7 degrees of valgus; anything significantly beyond this is considered pathological.
Why Genu Valgum Matters in Physical Therapy Practice
This alignment isn’t just a postural observation; it directly impacts joint loading and function. Increased valgus alignment places excessive stress on the lateral compartment of the knee and the medial collateral ligament (MCL). For your POC, this means you must address the biomechanical causes—often hip abductor weakness and overactive lateral structures—to reduce pain, improve joint mechanics, and prevent long-term degenerative changes like osteoarthritis.
What You’ll See in the Clinic
In the clinic, you might see a patient with a narrow stance, feet pronated, and patellae pointing inward. They may complain of diffuse anterior knee pain, especially with stairs or squats, and you might observe dynamic valgus collapse during a single-leg squat or step-down test.
“Patient presents with bilateral genu valgum, more pronounced on the left. Reports sharp lateral knee pain with stair descent. Dynamic assessment reveals significant medial knee collapse during single-leg squat. Strength testing shows 4-/5 hip abductors and external rotators bilaterally. I will initiate a program focusing on proximal hip strengthening and neuromuscular re-education for dynamic alignment.”
Common Pitfall & Pro Tip
⚠️ Pitfall: Focusing only on the knee. Genu valgum is often a symptom of a proximal or distal issue. Ignoring foot pronation or hip weakness will lead to poor outcomes. Always assess the entire kinetic chain.
💡 Pro Tip: Use a mirror or real-time video feedback during squats. Cueing the patient to “push your knees out over your second toes” can be powerful. For a more tangible cue, place a resistance band around their knees and have them maintain tension to activate the glute medius during the movement.
Memory Aid for Genu Valgum
Think of the “Valley” between your knees. A valley dips inward. Similarly, in genu valgum, the knees dip inward toward each other. The “V” in Valgum and Valley both point towards the midline.
NPTE Connection
Expect to see this in questions related to patellofemoral pain syndrome, MCL sprains, or post-operative total knee arthroplasty. You’ll need to identify associated muscle weaknesses and select appropriate therapeutic exercises to correct the faulty movement pattern.
Related Physical Therapy Concepts
Genu valgum is closely linked to Patellofemoral Pain Syndrome (PFPS) , as the altered tracking increases stress on the patella. It’s also a common contributor to iliotibial (IT) band tightness and is often seen in patients with femoral anteversion. Understanding this alignment helps you connect the dots between hip weakness, foot mechanics, and knee pathology in your comprehensive assessment.
Quick Reference
✓ Key values/findings: Normal tibiofemoral angle ~5-7° valgus; pathological >10-15° ✓ Priority level: High – Alters joint loading and increases injury risk ✓ PT Interventions/Considerations: • Strengthen hip abductors/external rotators (clamshells, side-lying leg raises) • Stretch tight hip adductors and IT band • Neuromuscular re-education (squats, step-downs with proper alignment) • Consider foot orthoses if excessive pronation is a contributing factor • Gait training to correct dynamic valgus collapse during stance phase
Bottom line: Recognizing genu valgum is your first step in designing a POC that corrects the faulty mechanics at the hip and knee, not just treating the symptom.