Myth Busting Monday: Knees Over Toes

If you participated in sports or even gym class growing up, you, like me, were likely told to not let your knees go over your toes when lunging or squatting. This was drilled into our heads as a rule, based on the belief that this knees over toes position was dangerous for the knees. So is this really "bad" for your knees? Let's break it down.

When the knee is positioned over the toes, it does put more load on the patellofemoral joint, the quadriceps tendon, and the patellar tendon. In someone who has existing knee pain due to things like patellar or quad tendinopathy, retropatellar osteoarthritis, or patellofemoral pain, this position can aggravate pain. However, the position of knees going over toes is a functional movement pattern. We use it every time we go up and down stairs, walk downhill, and get out of a low seat. Go ahead, try to get up from a chair without letting your knees go forwards over your toes - it's extremely awkward! Not coincidentally, these activities of daily living that require the knees over toes position are often the activities that people with the above mentioned conditions report as painful!

So, now that we know we need to be able to load the knees in a position over the toes, it makes sense that we should be training, at least some of the time, in this position. Obviously, if you pain in this range of motion, you shouldn't just jump into knees over toes lunges. Gently work into these exercises, slowly increasing the range of motion. This builds the strength of the muscles around the knee to better tolerate this position and improve the related functional movements.

This doesn't mean that all activities need to be done with the knees over the toes. A lunge where the knees and ankles are flexing more to achieve a knees over toes position will bias the quadriceps muscles and anterior structures of the knee, while a lunge with the knee stacked on top of the ankle and more hinging occurring at the hips will load the glutes and proximal hamstring more. Both are important exercises, but the form changes the purpose. It's important to load both the quads and the glutes, so both versions of the exercise are valuable in your workouts!

The bottom line: Knees over toes is not bad, and is actually an important functional range of motion. The next time someone tells you that you shouldn't let your knees go over your toes while you exercise, you can politely tell them that it's actually okay to do! And if they have pain when their knees go over their toes, they can go see a physical therapist to work on that!

Thanks for reading!

Dr. Elizabeth Karr PT, DPT, OCS