RSM-DPA-005
Written by Hironori Ikeda, MSc Sports Medicine
RSM International Academy · Chiang Mai, Thailand
What Does It Mean When the Knees Move Outward Under Load?
A wide squat can make the knees appear bowed, while a painful knee may suddenly move outward as weight is accepted during walking. Those findings should not receive the same correction.
At RSM, I separate the starting alignment from the movement that develops during the task. I then compare hip rotation, foot contact and stance while asking which condition changes the client's familiar symptom.
This guide explains why lateral muscle anatomy does not automatically explain lateral loading, how to choose a useful stance comparison and when a painful or unstable knee needs assessment. The aim is a better decision, not a forced change in leg shape.
In This Article
- What Does It Mean When the Knees Move Outward Under Load?
- In This Article
- 1. Bowed Alignment or a New Outward Movement Under Load?
- 2. Hip Rotation: Follow the Femur Before Blaming the Knee
- 3. Outside-Foot Contact: Muscle Belly, Tendon or Support Strategy?
- 4. Stance Width and Foot Angle: Compare One Change at a Time
- 5. Re-Test Symptoms and Recognise a Knee That Needs Assessment
- Related RSM Clinical Blogs
- Study Dynamic Posture Assessment at RSM
1. Bowed Alignment or a New Outward Movement Under Load?
First separate the starting position from movement that develops under load. In a comfortable squat, does the knee stay on a similar path, or move farther outward during lowering or rising? If the complaint occurs while walking, observe weight acceptance rather than substituting a squat.
Varus thrust usually describes an abrupt or increasing bowing-out during the loading phase of walking. A recent scoping review found inconsistent definitions and measurement methods in knee osteoarthritis research. It should not be used as a label for every outward knee position.
I record the phase, familiar pain and any sense of giving way. A front-view image does not measure the knee's mechanical axis, cartilage stress or each foot's force. Comfortable longstanding alignment and a new painful outward thrust therefore lead to different next questions.
2. Hip Rotation: Follow the Femur Before Blaming the Knee
Gluteus maximus lies behind the hip, over the short rotators that connect the pelvis to the proximal femur. It contributes to hip extension and external rotation. As hip flexion changes, the rotational leverage of these muscles also changes; they cannot all be assigned one fixed action in every squat position.
With the thigh supported in sitting, compare gentle internal and external rotation while keeping the pelvis steady. The lower leg moves outward for internal rotation and inward for external rotation. Record pain or pelvic turning instead of forcing equal angles.
Then relate the finding to the phase where the knee moves outward. If the femur and foot both rotate, the front-view knee path changes without proving a knee-joint deformity. An unusual path does not establish a shortened rotator or justify stretching the inner thigh simply to draw the knees together.
3. Outside-Foot Contact: Muscle Belly, Tendon or Support Strategy?
Ask where the client feels contact as the knee moves outward. Compare a comfortable shallow squat with the heel and both sides of the forefoot resting on the floor. Do not force pronation or claim that visually equal contact means equal measured pressure.
Fibularis longus and brevis run along the lateral leg and evert the foot. Their tendons pass behind the lateral malleolus; longus continues beneath the cuboid to the medial forefoot, helping plantarflex the first ray. This is why outside-edge loading cannot simply be blamed on an overactive lateral muscle.
If local symptoms justify palpation, support the ankle and distinguish accessible lateral-calf muscle from the tendon corridor behind the malleolus. Use tolerable contact rather than pressing a painful tendon to change knee alignment. Persistent tendon pain, snapping or weakness warrants further assessment; a contact trial is useful only if the original complaint changes meaningfully.
4. Stance Width and Foot Angle: Compare One Change at a Time
If the presentation is stable, first compare a modest stance-width change while keeping the foot angle and depth similar. Ask whether the familiar knee or hip symptom changes. If foot direction is the next question, test it separately instead of changing both variables at once.
Stance width and limb proportions influence the hip, knee and ankle motion required during a squat. A wider or narrower stance is therefore not universally better. The useful option is one the client can repeat comfortably without the foot rolling or the pelvis twisting to escape the position.
I do not press the knee inward to produce a preferred outline. Reducing depth or load may make practice tolerable, but it also reduces demand. Label that result as a modified task and return to the original conditions before attributing any change to tissue treatment.
5. Re-Test Symptoms and Recognise a Knee That Needs Assessment
Repeat the same squat depth, stance and pace, or the same comfortable walking route and footwear. Compare the phase of outward movement together with familiar pain and confidence. A different silhouette alone is not a reason to continue massage.
Marked swelling, locking, inability to bear weight, severe pain or giving way needs prompt assessment. A hot red knee with fever or systemic illness requires urgent care. New painful thrust or progressively worsening function also deserves a proper joint assessment rather than repeated corrective drills.
If the original task remains comfortable and the finding is longstanding, no forced correction may be needed. If a stance adaptation helps, document it as a practical option. If symptoms persist, broaden the examination and care plan; one easier set does not establish lasting improvement or readiness for heavy lifting.
Related RSM Clinical Blogs
Browse all Dynamic Posture Assessment clinical guides
▷ Foot Stays on the Outside Edge: Supination & Compensation — Dynamic Posture Assessment · Explore outside-edge foot loading and distinguish an adaptable strategy from tendon or progressive foot problems.
▷ Squat Shifts to One Side: Foot Pressure, Hip & Trunk — Dynamic Posture Assessment · Compare outward knee motion with a sideways pelvic shift during the squat.
▷ Limited Hip External Rotation: Adductors, Hip & Pelvis — Deep Tissue Massage · Learn why hip-rotation findings and medial-thigh contact require more than an observed knee position.
Study Dynamic Posture Assessment at RSM
In Dynamic Posture Assessment & Kinetic Chain Training, practise distinguishing alignment, movement and symptoms before selecting a test or cue. Completion of Trigger Point Therapy supplies a clinical palpation foundation.
Deep Tissue Massage develops the anatomical contact choices that may follow a relevant calf or hip finding. Remedial Massage broadens joint-versus-muscle assessment and treatment priorities. Confirm the appropriate learning sequence through the current course information.
View the course schedule and entry requirements · Ask about course suitability and registration
About the Author
Hironori Ikeda, MSc Sports Medicine
Hironori leads RSM International Academy in Chiang Mai, Thailand. His teaching connects functional anatomy, clinical palpation and kinetic-chain assessment with practical massage decisions.
Read Hironori’s professional background and teaching approach