I have been working with a client with knock knees. She is a marathon runner and her lower leg is rotated laterally so that when she does a step up her weight falls into the arches of her feet. I have been working her adductors but am looking for some more information, or ideal exercises to help her. Perhaps a way to help build the popliteus more efficiently? Foot strengthening? Please let me know if anyone can give me some helpful pointers in these areas.

Hi Amanda, My case study was knock-kneed. I’ve done some research to how to address this issue in Pilates. Here are some; We may not erase the knock-knee and create completely normal alignment, but we can develop muscular support that lifts space between the bones and approaches a more normal alignment or at least supports the legs so that the degree of knock-knee does not increase over time. This can be achieved by developing good abdominal strength to help lift the spine and torso from bearing down on the pelvis and legs and then create a strong mid-line of the legs (strong adductors ) that also works to lift the entire body upward away from gravity.

We create midline of the legs initially when legs are straight strongly connect the heels to strengthen the adductors. But when the knees knock and legs straighten the heels are apart as Knees are in the way. So client must bend their knees only as much as needed. The stronger your client’s adductor become, the less bend and external rotation they will need. This hug of the heels, of the midline must come from the adductors and not from the glutes/sit bones/butt, etc.

When apply this on the mat or on Reformer: Anywhere they would have straight legs that should be together. The Hundred, The Roll Up, Double Straight, Corkscrew, Leg circles, Footwork arches , Side split , Open V Position on Heels , standing IT stretch for stronger adductors etc.

I also read about a Pilates instructor experience that she was taught many years ago Knock-Kneed people should have feet parallel and hip socket width apart on the reformer foot bar or when standing. However she suggests keeping knock-kneed people in that position doesn’t give them the closed-chain connection that they need to make an inner thigh connection. They lost in space and never form a “core of their legs”, as she put it. And some people’s degree of knock is so dramatic that working parallel and hip socket width is a better option than heels together, toes apart with as little rotation as possible. Those people have to have severely knocked-knees or have so much flesh between their thighs that it’s nearly impossible for them to make this heel connection. In which case, you might put a small tennis ball between the heels to help them make this mid-line connection.

Great info, Serap! Amanda - Has your client been assessed professionally? It would be helpful to know if this is mostly structural (bone shape) or perhaps more a connective tissue issue - (that rhymes so nicely!). The structural issues are what they are, but the connective may be ameliorated. And... when I see "marathon runner" + valgus, that scenario suggests early osteoarthritis (wouldn't it be great if she decided she wanted to do something else?).
Serap's suggestion of finding ways to cue the midline is very important. Aside from that I might add that I would focus on three areas: side lying hip work, side lying leg work, and foot/ankle work. It is highly likely, given her scenario, that if the knees are not functioning optimally, the hips and ankles/feet are not either. .... continued....

The ADduction firing and strength issue is often addressed in many Pilates exercises, but with valgus, ABduction strength of the hip/leg needs to be assessed and likely improved, hence my suggestion of side lying hip/leg work.
Madeline Black has an excellent footwork class here on PA, Class 403: Madeline Black Foot Work Class Hope that's helpful.