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Knees Over Toes – Is it Safe?

How many times have you heard from your trainer, physio, or coach to not let your knees go over your toes?! One too many times I would say! The recommendation to never let your knees go over your toes is rooted in misinformation and unjustly injects fear into a very normal and simple movement that you perform countless times throughout the day as you are getting out of a chair, going downstairs, or kneeling on the ground. But this improper advice even extends to the weight room and gym, where you’ll hear that squatting deep or lunging with your knees over toes will blow up your knee.ย  This widespread inaccurate advice and fear is a pandemic I’m going to call “knee-bola”. In this article, I’m going to show you what happens when your knees go past your toes and why we need to eliminate knee-bola once and for all!

 

Knees Over Toes Is Normal – Very Normal

Before we demonize a movement altogether, let’s take a step back and think about all the times that this supposed horrible thing happens in day to day life. Let me take a guess that right now you are sitting on the toilet (haha), sitting at your desk at work killing time (read fast!), or sitting on a bench at the gym between sets (put the phone down and hit that next set!). When you are done reading this article, you are going to stand up and your knees are going to go over your toes. Your knees must go over your toes in order for you to stand up! It all comes down to physics. When you are sitting, your center of mass (where the majority of your weight is) is behind your feet. In order to stand up, you must get your center of mass over your feet by leaning forward at your hips and allowing your knees to come slightly forward – over your toes. This phenomenon is even more pronounced in activities like going up or downstairs or kneeling when we purposely translate our knees over our toes to keep us from toppling over!

Knees Over Toes Discussion w/ Physical Therapists Dr. Michael Lau and Dr. Arash Maghsoodi

 

What Happens When The Knees Go Over Toes?

Well, to keep it simple, they just simply go past your toes! And usually for a split second of time! It’s not like an earthquake happens or your knee cap instantaneously explodes anytime your knee goes beyond your toes. Now, are certain structures under a bit more load or stress the further the knees go over the toes? Yes of course. And we’ll break down the biomechanics of that position in a bit. But before diving into the science, just remember…

Knees over toes is just a position or movement. We shouldn’t be demonizing a natural position or movement.

knees over toes influenced by bar position

Via Rippetone and Kilgore

Biomechanically speaking, as your knees go over your toes the amount of torque around the knee increases. Torque, in this case, is the force applied by your quadriceps muscles which cause the knee to extend (coming out of a squat) or slowly control the knee to bend (going into a squat). When it comes to barbell squats, to move the heaviest amount of weight you must keep your center of mass over the middle of your foot. In order to do this and achieve adequate depth, the knees must translate over the toes to keep the barbell over the midfoot. Thus, front squats (see far left) will see a much larger translation of your knees of your toes than say a low-bar back squat (far right). This larger translation means that the quadriceps have a much larger moment arm and can produce more torque around the knee. This means that certain structures like the knee cap joint (patellofemoral joint) or the patellar or quad tendon will be stressed to a greater degree the further the knees go over the toes.

 

Knees Over Toes: Is Extra Stress Bad?

As with anything in life, too much of anything that your body isn’t prepared for will eventually lead to sensitivity and potentially pain and discomfort. So if your knees aren’t strong enough to repetitively handle the forces of that movement, especially under load, then, of course, it may not be the best movement for you – at least at this point in time. But just because it can lead to some sensitivity now doesn’t mean that the movement or position is inherently inappropriate for you forever. Or that by doing so now you are destroying your knees as some outdated professionals would encourage you to believe. With adequate training, proper volume, and good execution, having your knees go over your toes is perfectly safe and fine. Meaning, you can bulletproof your knees to be able to handle the stresses of your knees going over your toes in time!

Patellofemoral Pain [P]Rehab Program

Knee cap and anterior knee pain can be one of the most frustrating and self-limiting injuries to deal with. The common issue we see is most of these injuries are never addressed or rehabbed correctly in the first place and the same underlying issues remain, which can be a recipe for another vicious cycle of pain and setbacks in the future. Weโ€™ve designed a comprehensive solution for you to get back to normal life and simple things like squatting and going down stairs pain-free! For more information, click HERE.

Knees Over Toes: When To Back Off

We’ve now determined that knees over toes is just a position or movement. And in fact, it does place more stress on the cartilage behind the knee cap or the quad/patellar tendon. Because of this, there will definitely be some times when it’s appropriate to back off and limit the number of knees over toes volume in your training or daily life. Say you just finished your first marathon, did a grueling new hike in the mountains, or some other new activity/stressor and your knees are feeling “a bit wonky”. That new activity and volume placed a good deal of stress on your knee, and it would be completely normal if your knees were talking to you a bit after that…we’d expect it! This may be a great time in your training to either give yourself a day off from the gym or if you are going to train legs, choose exercises that are a little more forgiving on your knees by limiting the amount of knees over toes.

READ: HOW TO GET BACK TO RUNNING AFTER SURGERYrunning after surgery knees over toes the prehab guys

You may choose to do completely non-weight-bearing exercises like straight leg raises or planks with alternating leg lifts that still hit your quads, but place minimal amounts of stress on the knee. We include tons of exercises like these in our Phase I Knee [P]Rehab Program! Or if opting for weight-bearing exercises, you may choose to do low-bar squats over front squats. Training modifications like these are perfect for those that also experience an acute injury as well. The goal is always to continue training if you’re able to by modifying the loads placed on structures that may be sensitive at the time.

Advanced Straight Leg Raise Variation

Planks With Alternating Leg Lifts

 

Progressive Loading Is Good For Your Knees

Our bodies are extremely resilient and capable of getting stronger over time with adequate loading. As you can see in the picture below, muscles, bones, ligaments, tendons, cartilage, and even intervertebral discs in your back are all stronger in those populations in which they are loaded the most.

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Your body is: โœ…Strong โœ…Tough โœ…Adaptable โœ…Robust . It is capable of amazing feats and just how โ€œpractice makes perfectโ€, progressive loading leads to tissue resiliency and injury prevention. . Progressive is the key word here. Just like everything good in life, too much (and too fast) of loading isnโ€™t necessarily the best thing either. Progressively building on the foundation you have with each training sessions will ultimately lead to success. . [P]Rehab = education = smart loading. . Thanks to Anthony Halimi (and @trustmephysiotherapist) for making this awesome infographic. ๐Ÿ˜Š๐Ÿ‘ . Looking for the ultimate movement library with both lower lever rehab to higher level strength and conditioning exercises? Look no further than our PrehabX Exercise Library! (link in bio) ______________________________________________ ๐™๐™๐™š ๐™‹๐™ง๐™š๐™๐™–๐™— ๐™‚๐™ช๐™ฎ๐™จ ๐™ž๐™จ ๐™–๐™ฃ ๐™š๐™™๐™ช๐™˜๐™–๐™ฉ๐™ž๐™ค๐™ฃ๐™–๐™ก ๐™ฅ๐™ก๐™–๐™ฉ๐™›๐™ค๐™ง๐™ข ๐™ฉ๐™๐™–๐™ฉ ๐™ฉ๐™š๐™–๐™˜๐™๐™š๐™จ ๐™ฅ๐™š๐™ค๐™ฅ๐™ก๐™š ๐™๐™ค๐™ฌ ๐™ฉ๐™ค ๐™ฉ๐™–๐™ ๐™š ๐™˜๐™ค๐™ฃ๐™ฉ๐™ง๐™ค๐™ก ๐™ค๐™› ๐™ฉ๐™๐™š๐™ž๐™ง ๐™ค๐™ฌ๐™ฃ ๐™๐™š๐™–๐™ก๐™ฉ๐™ ๐™ฉ๐™๐™ง๐™ค๐™ช๐™œ๐™ ๐™ค๐™ฃ๐™ก๐™ž๐™ฃ๐™š ๐™ฅ๐™๐™ฎ๐™จ๐™ž๐™˜๐™–๐™ก ๐™ฉ๐™๐™š๐™ง๐™–๐™ฅ๐™ฎ #prehab #rehab #TPG #theprehabguys

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The key is that the loading must be progressive and not over the top. Progressive loading for a marathon runner when it comes to mileage would be starting at 3 runs of 3 miles one week (9 total miles), then 3 runs of 4 miles the next (12 total miles), and then 2 runs of 6 miles (12 total miles) after that and so on and so forth until they’ve built up the knee capacity and stamina to reach marathon mileage. Or even better, this marathon runner should also be choosing exercises that specifically load the knee to build tissue resilience and increase capacity. In the case of building tissue resilience to tolerate the knees over toes position, we should choose exercises in which we try to push the knees over the toes! Examples of exercises like these include front squats, forward step downs, anterior lunges, half-kneeling isometrics, or any exercise on a wedge that forces the knees over the toes to an even greater degree!

Volume is the most important aspect of training tissue resiliency

For these exercises, maybe it’s just 1 set of 12 every other day to start. Or if you have a higher capacity than someone training for the first time, maybe it’s 3 sets of 8 at 75% 1RM twice a week. Volume is all going to depend on YOU. Your training history. Your anatomy. Your sensitivity. Phase 3 of our Knee [P]Rehab Program builds off the first two phases and incorporates this principle or progressively overloading the knee joint to build capacity. You will find all the exercises below in our program!

Knees Over Toes: Forward Step Downs

Anterior Lunges

Goblet Squat On Wedge

Half-Kneeling Isometrics

Anterior Reach On Wedge

Also, understand that diagnoses such as “chondromalacia patella” (wear and tear of the cartilage under your knee cap), meniscal tears, or ligamentous injuries do not automatically preclude you from loading your knee. Although in many cases the anatomy of the knee may lead to a slower progression of loading or smarter training workarounds – this is where working with a Doctor of Physical Therapy who can help you determine the right amount of load and when to load would be extremely beneficial.

LISTEN: ACL REHAB WITH Dr. WESLEY WANGacl rehab knees over toes the prehab guys

READ: WHAT IS THE MENISCUS WITH DR. NEMA MEHRANwhat is the meniscus podcast the prehab guys

 

Conclusion

Knees over toes is just a position or movement. This position/movement should not be ostracized. If anything, it should be trained to build a tolerance to not just everyday activities like going up/downstairs, but also to bulletproof your knees to handle anything life throws at them!

Master The Lunge [P]Rehab Program

The lunge is one of the most functional exercises that can be modified in multiple ways! The Master The Lunge [P]Rehab Program will help you understand and improve your performance with lunge variations, how to move with intention and effectiveness, and ultimately enhance your fitness level. Learn more HERE

 

REFERENCES

  1. Rippetoe M, Kilgore L. Starting strength: Basic Barbell Training. 2nd ed. TX: The Aasgaard Company; 2007.
  2. Hartman H, Wirth K, & Klusemann M. Analysis of the load on the knee joint and vertebral column with changes in squatting depth and weight load. Sports Med. 2013;43:993-1008.

 

Disclaimer – The content here is designed for information & education purposes only and is not intended for medical advice.

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