It's been a couple of years since I wrote this article. It's time to go back over it with my 2021 eyes to see whether I still feel the same.
Having gone through the article again, I spoke about injury prevention without evidence. I've removed this and hang my head in shame.
Recently I posted this video about ankle stability, foot arch strength, and how they both can contribute towards knee cave in various movements such as the squat, lunge, and any other movement where your foot is in contact with the ground.
Below is the flow chart I use in my head when watching someone move who has valgus collapse or knee cave during a particular movement.
Knee cave or valgus collapse if you want to go over your grandma's head, is often caused by a combination of factors which is why coaches must get frustrated when endless band walks do achieve nothing when the person performs the movement they are struggling with.
The common solution to deal with knee cave is to perform a kind of exercise called RNT or reactive neuromuscular therapy. Which makes you sound very smart and like it must be scientific and correct.
RNT comprises of tying a resistance band to a post, standing far enough away from it that the band wants to pull the offending appendage in the direction it isn't supposed to go, thereby strengthening the muscles that keep the knee out. The idea is then to take the band away and the problem goes away.
Does it work?
Absolutely.
Do I give them to my clients?
Yes, but only when we've done a full exploration to discover where we think the problem lies.
As you can see in the picture above the client has a good ankle position. If this is the case during an athlete's movement then RNT is a great shout.
However, often it's something a little closer to the ground that is the route of the issue. When the foot arch isn't strong enough or the ankle isn't stable enough you are on shaky ground and you are likely to see knee cave in certain movements.
Let's do a self-assessment:
Take your shoes off and stand on one leg.
Look down at your feet.
Has the arch collapsed and/or your knee caved in?
If the answer is yes and your knee caves in then the ankle and foot arch should be addressed.
Once you can stand on one leg without the ankle collapsing or the ankle collapses less you can learn to squat without your ankles collapsing inwards. This doesn't necessarily improve your squat performance or prevent you from getting injured, but you will have a very pretty squat.
Being aware of the foot arch being important is enough for many to make sufficient changes in their movement to correct or see improvements with the issue.
Others will need specific warm-up exercises that focus on 'rooting' the feet to the floor and encourage a strong arch.
Others need to do specific paused work where they will pause in the position where their knee caves in and work on correcting the movement from that difficult position.
If you get one thing out of today's article it should be that you should work on the roots. The feet and the ankles. Once they are positioned well many movements will improve.
We aren't looking for perfection here. Sometimes you'll lose your foot arch and sometimes your knees may cave in sometimes no matter what you do, the strategies above will help you prevent it some of the time.
I forgot to mention wearing decent shoes too. If your shoes are big spongy monstrosities then get rid of them when you are in the gym. They are ruining your gains! (and strength.)
By Chris K
The Heavy Metal Strength Coach
Coaching for the overthinking powerlifter and those looking to build confidence in strength training.
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