The Dreaded Knees Over Toes Dilemma

    During my tenure as a swimmer, I worked with many different strength and condition programs. While each one had its own style of training, one theme remained the same: NEVER perform a resisted leg movement with knees over toes. The fear of doing even one rep “wrong” was instilled in me and it wasn’t until several years later when I began to truly understand human movement and the body’s ability to adapt that I questioned that dilemma. The truth of the matter is that that statement is one of the most common misconceptions in lifting and loading. For years movement screens and treatments have been used to try to eliminate people from putting their knees over their toes. But that said movement is a fundamental motion of loading our knees. Don’t believe me? Have someone take a video of you when you go down a pair of stairs. Your knees go over your toes without even thinking. 

    Equally as important, we need to understand that the body is resilient and that by avoiding a certain load around our knees we are actually robbing ourselves of pliability and resiliency. For example, walking backwards, a movement that loads our knees over our toes, is actually a predictor of balance and falling as we age. Falling is one of the leading causes of serious injuries in the elderly population. Research has shown walking backwards is more of an indicator of risk of falling than walking forwards due to a greater reliance on control of the muscle around our knees when our vision starts to fail.

In addition, loading our knees over toes is an important concept to apply when we strengthen our tendons. How do we build up more resilience in our tendons? By using progressive overload concepts and loading our tendons in different ways. The reason why knees over toes exercises work so well in building up our tendons is because our tendons in our knees are stressed more the greater the degree our knees go over our toes. One of my favorite exercises I give to prevent AND treat patellar tendonitis are incline squats which force you to put your knees over your toes and load your patellar tendon eccentrically ( in other words, loading the tendon under length). Other exercises include backwards sled pulls. Most people don’t have a sled but all you need is a resistance band and willing partner to help you out! 

    In short, we need to stop scaring people with the knees over toes dilemma. It is just another way of loading our knees and is actually very beneficial for you now and in the distant future. If you have knee pain or know someone with knee pain, let us know! 

Alec Domjan, DC

Works Cited

Maritz CA, Silbernagel KG and Pohlig R. Relationship of backward walking to clinical outcome measures used to predict falls in the older population: A factor analysis. Phys Ther Rehabil. 2017; 4:14. http://dx.doi.org/10.7243/2055-2386-4-14