Hip Strength Again: Correcting Knee Valgus

by Mary on November 13, 2017

Recently my patellofemoral pain flared up and I sought the help of Emily, a PT with a dance background who specializes in rehabbing dancers, gymnasts, and the like. She’s moving in a month so our time together will be brief.

I shared some video with her of my skating and she immediately spotted this especially egregious moment where my knee is in a knocked-in or ‘valgus’ position.


Despite my previous efforts at rehab I still get into this valgus position quite often. I can’t expect my knees to feel good when I’m doing this to them. It happens particularly with single-leg activities, and of course skating is virtually all that.

I’ve worked to resolve this problem several times. The most recent time before this was the ill-fated knee PT that caused my back injury. The problems likely go in the other direction, too. The assistant to my previous PT thought that spinal nerve issues might be making it harder for me to build up the necessary hip muscle strength to resolve my knee problems. I certainly have done plenty of clamshell exercises in my life.

The larger issue underlying it all is my hypermobility, and I’ll have more to tell you about that soon. Meanwhile, back to those clamshells and other exercises. Here’s my current worksheet:

hip strength exercise worksheet

I do a much easier modified version of the first exercise. Bending plus twisting is not my friend, in fact a freestanding version of this first exercise is how I blew out my back last year.

The squats, even though they are supported, are problematic for my knees, doubtless I need to work harder on form. I’m jealous of all the folks I see squatting around the gym with weights.

For the side-stepping I don’t use a band. I use the banana sling that I bought from QTEK to use it on my own with cable machines, like so:

The side-lying ball press mentioned is a way to exercise my hips similar to a squat. But it’s very controlled, so not irritating to my knees, and it’s single leg so I can make sure the left side gets worked as much as the right.

{ 32 comments… read them below or add one }

Jo November 14, 2017 at 2:31 am

Mary, you and I definitely share some issues as far as knees are concerned! I have been doing different exercises targeting the adductor muscles (inner thigh) and it seems to help this issue as well as my overall alignment. Thanks for the videos–those look like great alternatives to squats.
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Mary November 15, 2017 at 1:50 am

Thanks for the tip. Strengthening the adductors would be a good idea for skaters since we use the outside of the legs so much. I hear ballet dancers are the opposite and tend to overwork the insides of their legs.

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Eva at Eva Bakes November 14, 2017 at 1:23 pm

I’ve done those side stepping exercises except the band was placed on my shins. I had to build up hip strength after I tore my meniscus so I totally understand what you’re going through here. I hope you get some great PT time with Emily before she moves!
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Mary November 15, 2017 at 1:57 am

I’ve done it that way too. I have to work really hard to keep my knees facing straight when I do it that way. It’s very counterproductive to let them turn in!

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Melissa November 18, 2017 at 2:04 am

Mary, I’m glad you’ve got some good exercises to work on for the knee pain. Interesting to see the side steps with the band at the thighs. I will have to try that. And the ball exercise looks good to try, too. Hope you can make the knee pain stay away!

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Mary November 19, 2017 at 10:15 pm

If you try the band one make sure your knees are facing forward as you step sideways, otherwise it will make them worse. Thanks! I haven’t been on the ice much this past week, that in itself helps.

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Andrea November 27, 2017 at 11:07 pm

Hope your pain goes away quickly and you’re back on the ice soon!
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Mary November 27, 2017 at 11:11 pm

Oh I’m on the ice! I’m getting to be a slightly smarter bear and start dealing with these things before they keep me from training. A few years ago my sports medicine doc praised me for coming in before my problem got too bad to train and that made me feel better about coming in with the smaller problems.

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Nicole November 27, 2017 at 11:11 pm

I need to get back to doing a lot of these exercises. I find that when I slack off, I fall back into old patterns! I hope you get better soon!
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Mary November 28, 2017 at 12:12 am

It’s hard to stay motivated on the maintenance phase of PT exercises, but we need to do it to ward off the injuries. I hope we both can keep up on them.

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Rachel Frutkin November 28, 2017 at 12:49 am

I suffer from hypermobility as well. It makes strength training super important and also very challenging to make sure we don’t overdo it!!
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Mary November 28, 2017 at 1:01 am

So you know exactly what I’m talking about. And you know how challenging and yet how important it is to hit that strength training window where we’re getting stronger without getting injured.

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Deborah Brooks November 28, 2017 at 1:02 am

I do some of these moves within my regular strength training. It’s really important to have a balance in your leg and hip muscles to avoid injury. Take care of yourself!
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Mary November 28, 2017 at 1:07 am

I’m glad you are already doing some of these moves, I hope that will prevent injury. Muscle strength balance is important: between the sides, between the front and the back of the leg, and I’m sure some other ways as well.

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Nicole November 28, 2017 at 1:31 am

Glad you’re getting the issue solved!
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Mary November 28, 2017 at 3:11 am

This is my fourth try so I’m not too optimistic about ‘solved,’ but I’ll take settled down.

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Wendy November 28, 2017 at 1:42 am

I feel like all I do is hip stuff! When I go to CrossFit, I’m doing hip and glute work. Seriously. I don’t think I’d be running anymore without it.
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Mary November 28, 2017 at 3:12 am

Wendy, you must be so strong in the hips with all the heavy weightlifting that you do. I’m glad it keeps you on the road, and I hope my exercises will keep me on the ice!

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Kimberly Hatting November 28, 2017 at 1:55 am

I need to do more focused work on my hips. Both of my knees do the “turning inward” thing (my right knee more so than my left). If I’m fatigued, like at mile 12 of a half marathon, it’s my hips that will feel it the most due to the strain. UGH.
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Mary November 28, 2017 at 3:58 am

The hip strain sounds like no fun at all. Because of my hypermobile patellae (kneecaps) and hips I can’t get away with much malpositioning without causing the classic ‘runner’s knee’ aka patellofemoral pain.

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Kim G November 28, 2017 at 3:17 am

These are exactly the exercises that I need to do to help combat my IT band and knee pain. There are a few moves on here that I haven’t seen before – thanks so much for posting!
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Mary November 28, 2017 at 4:31 am

Oh I hope they will help. Even though I’m a skater, what I have is pretty classic runner’s knee, so I’m not surprised that you have similar issues. Stretching and foam rolling can really help too. I have some other exercises here that you might find helpful: http://fitandfed.net/2017/03/14/hip-strength-exercises-for-skaters-gluteus-medius/#comment-3318

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The Accidental Marathoner November 28, 2017 at 3:29 am

I’m not good at doing these hip exercises at all. I’m sure I’m doing myself a disservice. They can only help with my running and stability.
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Mary November 28, 2017 at 4:01 am

It’s hard to stay motivated without the additional prodding of pain and knowing you need to fix it. Hopefully you have a good degree of natural stability and won’t need to do them for that reason. Since we’re about the same age I’ll give you another motivator, though: it will probably be good for your bone density at the hip (higher impact activities like jumping and hopping would be even better).

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Agness of Fit Travelling November 28, 2017 at 11:01 am

These workouts are so excellent and effective, Mary. I will definitely try to incorporate them into my workout routine.

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Mary November 29, 2017 at 12:07 am

I hope you will find them helpful on your travels Agness.

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Jenn November 28, 2017 at 1:28 pm

All of these are great exercises, for the injured and non-injured alike! Most of us don’t keep our hips at top strength!
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Mary November 29, 2017 at 12:08 am

No, we don’t.

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Elle November 28, 2017 at 6:45 pm

I do hope that your exercises help with your issues. I like to do clam shells myself.

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Mary November 29, 2017 at 12:08 am

They are a classic way to work your hips.

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Sandra D Laflamme November 30, 2017 at 3:59 pm

oooh! I hope that you get some relief. That sounds very painful! I am happy that you have some PT to help you out!
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Mary December 5, 2017 at 5:03 am

Thanks Sandra. Luckily I took action before it got too bad, so I’m doing well.

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