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.  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!

 

LEARN MORE ABOUT OUR KNEES OVER TOES PROGRAM

patellofemoral prehab program the prehab guys

Looking for a knees over toes program? More importantly, are you having trouble with knees over toes movements or exercises like going downstairs, squatting, or lunging? Our [P]Rehab version of knees over toes programming is our patellofemoral (kneecap joint) pain program. That’s because the kneecap tends to be the pain site or painful source when knees over toes exercises aren’t tolerated. We have a 4-month program designed to improve your knee health and more importantly improve your knees over toes capacity! For more information, click HERE.

 

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 supposedly 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 that 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, that you can bulletproof your knees to be able to handle the stresses of your knees going over your toes in time!

 

How Deep Should You Go With Knees Over Toes?

Sample Knees Over Toes [P]rehab Program Education

 

Sensitive Knee? Learn These Knee Rehab Hacks From Home!

 

When To Back Off Knees Over Toes Motion

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.

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.

 

READ: HOW TO GET BACK TO RUNNINGhow to get back to running after an injury 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 Knees Over Toes [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

Sample Knees Over Toes [P]Rehab Program Exercise

  • HOW: Perform a single leg bridge by driving your heel into the floor to lift your hips up towards the ceiling. While maintaining this position, with the opposite leg perform a straight leg raise staying strong in your thigh to keep your knee straight, repeat

 

  • FEEL: You should feel your glutes work on the leg that is pushing into the floor. At no point should you feel your low back muscle working. If you feel it only in your hamstrings, try bending your knees a bit more and repeat. With the leg that is elevated, you will feel the muscles in the front of the hip and thigh working to keep the knee straight

 

  • COMPENSATION: Avoid arching at the low back as you perform the single-leg bridge. Avoid allowing the knee to bend when you are performing the straight leg raise.

 

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The Prehab membership is the anti-barrier solution to keeping your body healthy. Access state-of-the-art physical therapy, fitness programs, and workouts online in the comforts of your own home or gym! Taking control of your health with exercise & education from the palm of your hand has never been easier. Get access to 50+ programs, 100+ unique workouts, and 3000+ exercises to build your own workout routines. Trial it for free, and learn how to get out of pain, avoid injury, and optimize your health with [P]rehab!

 

Planks With Alternating Leg Lifts

Begin the exercise in a forearm plank position with the knees straight. Perform the exercise by moving at the hip joint to lift one leg into the air while keeping the knee straight, hold that position, then return to starting position and repeat on the other side. You will feel your glutes and quads working to lift the leg as well as the rest of your body and core muscles working to maintain the forearm plank position. Do not arch your back while you are driving the leg lift. Focus on lifting each leg while keeping the knee straight and the rest of your body still in the forearm plank position

 

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.

what tissues get stronger when loaded the prehab guys

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 the 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. Our Knees Over Toes [P]rehab Program incorporates this principle and progressively builds your exercise volume carefully, which will safely overload the knee joint to build capacity. You will find all the exercises below in our program!

READ: PROGRESSIVE OVERLOAD AND WORKLOAD RATIOS

progressive overload knees over toes the prehab guys

 

Knees Over Toes: Forward Step Downs

Sample Knees Over Toes [P]rehab Program Exercise

  • HOW: Stand on the step. Shift all of your weight to one leg. With the foot in the air, you will reach forward and lightly tap the ground with your heel, and then come back up to your starting position.

 

  • FEEL: You should feel all the thigh muscles and the butt muscles working in the leg you’re standing on, but primarily in the thigh muscles.

 

  • COMPENSATION: Avoid putting too much weight (if any weight at all) on the foot you are reaching down with. Don’t let your knee cave in, and avoid rounding your back or side bending.

 

Anterior Lunges

The anterior lunge is naturally going to place more load through the knee, versus a posterior lunge, which yes, will still load the knee joint; however, there will be more of an emphasis on hip muscle activation. Do you want to learn more about lunge variations? Watch this video!

 

Goblet Squat On Wedge

Sample Knees Over Toes [P]rehab Program Exercise

Utilizing a wedge as shown will force you to move your knees past your toes as you move into a squat position!

 

Closing Thoughts

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!

 

Commit To Our Knees Over Toes Program!

Prehab Membership The Prehab Guys

Knee discomfort is one of the reasons why people end up sitting out but that’s about to change through the tag team champs of the world: education and movement. Myths that surround the patellofemoral joint create fear and that fear may prevent you from moving. One myth we can bust is “Knees going over your toes is dangerous.” This natural motion needs to happen for function and by training it you can unlock the true power of the knee! For more information, click 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.

 

About The Author

Michael Lau, PT, DPT, CSCS

[P]rehab Co-Founder & Chief Product Officer

Michael was born and raised in Northern California but now currently resides in Sunny SoCal ever since attending the University of California, Los Angeles as an undergraduate majoring in physiology. After his undergraduate studies, he received his Doctorate in Physical Therapy from a cross-town rival the University of Southern California. As a licensed physical therapist with a strong background in strength and conditioning, Michael likes to blend the realms of strength training and rehabilitation to provide prehab, or preventative rehabilitation, to his patients. A common human behavior is to address problems after they become an issue and far often too late, which is a reactionary approach. He believes the key to improved health care is education and awareness. This proactive approach can reduce the risk of injuries and pain in the first place. He is a huge proponent of movement education and pain science. Clinically, he has a special interest in ACLR rehab and returning to sport for the lower extremity athlete.

 

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

About the author : Michael Lau PT, DPT, CSCS

6 Comments

  1. Adam Thierry November 28, 2020 at 1:56 pm

    Is it safe to do knee exercise if you don’t have much cartilage left?

    • Michael Lau November 29, 2020 at 1:58 pm

      It can and can be! Loading of cartilage is good –> overloading is bad. All in the right amount! If you have questions, best to consult with a PT in person who can help you out adam!

  2. Richard Waddle March 17, 2021 at 7:43 pm

    Kneebola, lol, ah the good old pre-2020 days back when something like Ebola seemed like a good word choice to signify a pandemic

  3. Carol Kaye February 9, 2022 at 4:09 pm

    I have a Baker’s cyst in my right knee that is currently causing a lot of discomfort. I was thinking of starting the Zero program, but should i wait until the inflammation is gone? Seems whatever I do right now is causing pain and swelling behind the knee. thank you.

    • Team [P]rehab February 15, 2022 at 3:54 am

      Hi Carol!

      Sorry to hear about the recent discomfort with your knee. In regards to the Zero Program you mentioned, did you mean you are thinking of starting at Phase 0 of our knee program? We would suggest discussing the state of your Baker’s Cyst with your physician first who evaluated you. Once you are deemed safe to exercise, starting at the first phase of the knee program is an excellent place to begin, which allows you to begin low-level exercise while creating a healthy healing environment for the knee! Please let us know if you have any further questions or concerns. Best of luck in your recovery!

      All The Best,

      Team [P]rehab

  4. […] Knees over the toes is normal. Scientific research has shown that proper knee alignment, along with maintaining balance between the hips, knees, and ankles, is key to preventing knee discomfort. Allowing the knees to move forward can actually help distribute forces more evenly and reduce stress on the knee joint. […]

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