October 22, 2025
You’re a strength and conditioning professional working with an Olympic weightlifter who is experiencing knee pain while walking. The athlete grows frustrated as she has been in physical therapy for weeks. But hasn’t seen improvement.
A movement analysis of a heavy squat shows her knees caving inward (i.e. valgus) during the ascent, a common theme in barbell athletes. Her physical therapist, who doesn’t specialize in lifting mechanics, explains the problem as “weak glute muscles” and prescribes clamshells and band walks.
Fast forward 8 weeks and nothing has changed. Her pain persists, her frustration grows, and her trust in physical therapy fades.
For years, coaches and physical therapists have deemed the terminology “dynamic knee valgus” a dangerous movement pattern. However, most coaches and physical therapists don’t understand that it depends on the context.
In barbell sports, a brief and controlled inward knee motion during an ascent of a squat, clean, or snatch is often seen, even with elite athletes. There is research that suggests that this movement is an adaptive strategy to optimize force production from the hip adductors and internal rotators. As a result, it helps barbell athletes drive out of a bottom position more efficiently.
The main differences are control and consistency. Knee valgus becomes a “red flag” when it is uncontrolled, persists throughout the movement despite the load, or is linked to pain. The patient in the scenario above only reported pain with walking, not during the ascent of a squat. In fact, she didn’t experience pain at all during weightlifting. It is normal if it is only momentary, only occurs near maximal loads, or if there is still foot and ankle stability.
I have had multiple patients tell me, “If I hear that I have glute weakness and just need to strengthen them one more time, I will lose it.” I get it. Labeling every valgus pattern as glute weakness oversimplifies how humans move. A barbell athlete may have “strong glutes” but lack timing, coordination, or my personal favorite: decreased neural output going to the muscle. That’s exactly why I always make it a point with my evaluation to test strength in different positions. It can’t be a true muscle strength issue if there is muscle weakness in sitting or standing but not while laying down on the back, stomach, or side.
True progress happens when rehab meets performance. Athletes don’t need to be “fixed.” They need to be understood. Training demands, load tolerance, movement strategies, sport position, nutrition, recovery, etc. are more complex than what traditional rehab addresses.
Performance-based physical therapy looks beyond one specific joint or impairment. Instead, it involves how the human body coordinates and function under load. It’s not about avoiding movement patterns or not allowing athletes to practice and compete. It’s about Improving capacity, control, intent, and resiliency.
Great outcomes and patient’s motivation are a result of shifting from “correcting” to “coaching” movement.
At Vital Force Physio, we get it. We’re not just rehabbing an injury; We’re training the human body. We bridge the gap between physical therapy and performance, so all athletes can move, lift, and compete in all aspects of their life.
Give us a call if you’re ready to stop second guessing your rehab.
PT, DPT, MSEd, EMR-A, CSCS, PRA, USAW-L1
This information is not intended to be used as medical advice but for educational purposes only. Please consult your Physical Therapist, Physician or Healthcare Provider for more information.
