Bow Legged or Knock Kneed? Causes & Proven Surgery-Free Correction Methods

Kaley Cuoco - celebrity with bow legs
Kaley Cuoco, star of “The Big Bang Theory”

There used to be a time when a bow legged or knock kneed person was a rare thing to witness.

However, if you start looking around you closely nowadays, it seems more and more people are starting to develop this problem.

This condition may not only start expressing itself as physical pain (knee popping and cracking, pain when running, etc.) – but also psychologically, affecting a person’s self-image and confidence in a negative way as they start developing knee deformities.

I know because I’ve been there.

Perhaps the worse thing of it all is the lack of resources out there for learning more about the real causes behind knock knees and bow legs – and more importantly, how to correct them.

The usual answer you’ll find out there when doing research is “The only way is invasive surgery that can cost upwards of $40,000 and leave you without being able to walk for a minimum of 4 months. Sorry.”

It’s the kind of answer that’s incredibly painful because it seems to take away any possibility of finding a solution for most people.

However, a determined few decide to go through with the surgery after jumping through hundreds of hoops with their insurance, work arrangements, and even dipping into their hard earned savings.

All for a chance to have a pair of straight legs like everyone else.

What really breaks my heart are the sub-par results that these people get. After spending thousands of dollars and being in excruciating pain for months, their legs look below-average at best. And that’s only the lucky ones that don’t have any major complications from such invasive procedures such as a high-tibial osteotomy (cutting a wedge on the side of your knee), one of the treatment methods recommended by medical “experts”.

before after high tibial osteotomy surgery
Image credit: Not a Cowgirl


Not only do I feel for these guys and girls, but it angers me that irresponsible doctors are performing these procedures with a complete lack of knowledge or interest in first finding out about their patients’ daily lifestyle habits – which in most cases are the real cause of knock knees and bow legs.

high tibial osteotomy x-ray

But hey, that’s way too much work right? It’s much easier to recommend surgery to a person desperate for a solution. Just like it’s much easier to prescribe a bottle of pills for a person suffering depression when all they need is to get out in the sun to get some Vitamin D and exercise to release some much-needed feel good endorphins.

It’s sad that we are slowly becoming becoming a nation of people dependent on medication and doctors’ “expertise”.

Thankfully, there are better much, much better alternatives.

Chances are you didn’t have knock knees or bow legs while growing up as a kid. The real cause behind either of these conditions is the negative lifestyle habits you’ve developed as you became a teenager and then settled into your current adult lifestyle.

Why do people become bow legged or knock kneed?

It’s important to understand the culprit of knee deformities before starting to look for a solution. Why? Simply because your corrective efforts will be that much more effective if you stop all the negative stimulus that keep you from having a normal pair of legs in the first place.

Believe it or not, the main reason for knee deformities such as bow legs and knock knees lies in our daily habits.

What happens when water drips over the middle of a rock for thousands of years? A gap starts forming on that spot until the rock is split two pieces.

What I’m trying to say is that a small stimulus can create drastic results over a certain period of time. A fact that is as true for a rock, as it is for our bodies.

The real key to straight legs is to identify and eliminate those daily stimulus that are slowly causing you to become bow legged or knock kneed. In addition, following the proper program will allow you to counter-act years of negative lifestyle habits.

Knock Knees Causes & Treatment

Let’s start talking about knock knees first, since it seems to be the most common today. What is the primary reason people become knock kneed today?

Short answer: A muscular imbalance at the pelvis.

The most common cause is having a sedentary lifestyle and sitting for long periods of time. Working an office job where you sit for more than 8 hours a day, in addition to all the time spent sitting at home, slowly – but surely – start creating a muscular imbalance in the pelvis and hip muscles.

I’ve already talked about how the pelvis is one of the keys to correcting bow legs or knock knees in a previous article. If you read it, you know that the conclusion was the following: sitting for long periods of times weakens the glutes and makes your hip flexors overly tight. This creates a forward rotation of the pelvis commonly known as anterior pelvic tilt.

And what are the consequences of anterior pelvic tilt? An inward rotation of your femurs (front of your thighs), causing your knees to start caving inward and giving you a knock kneed appearance.

internal femur rotation, external knee rotation

There’s a really important thing I want to mention here and that a lot of people get confused about when trying to diagnose their problem.

If you are inactive and sit down all day at your job, there’s a 90% chance that you are knock kneed, not bow legged!

Many people mistakenly believe they are bow legged because the lower part of their legs (their shins) seems to be bowing out. This is actually another consequence of sitting for long periods of time and it involves another key muscle: the hamstring.

I don’t need to be your doctor to know that if sit all day long, there’s a good chance that your hamstrings are very tight. Since your hamstrings are in a shortened position, they become overly active and tight.

A tight hamstring will exert a significant amount of pull at the top of the knee – making it rotate to the outside or inside. This is known as femoral torsion of the knee.

rotational deformities of the knee - external/internal

As you can see from the illustration above, a rotation at the knee will also give the appearance of bow legs when your hamstrings are overly tight. The most commonly seen case is external femoral torsion, or externally rotated knee. In this case, the long and short bicep femoris muscles (outside part of the hamstring) are shortened and rotate the knee to the outside.

bicep femoris - external tibial torsion

In other words, if your bow legs are only from the knees down, there’s a very high probability that you suffer from external tibial torsion from tight hamstrings, not bow legs! When your knees and ankles touch, but your shins seem to curve to the outside (giving the illusion of bow legs), it’s commonly known as false curvature of the knees.

How to tell if you are suffering from knock knees due to anterior pelvic tilt

  • You work sitting for more than 8 hours.
  • You live a sedentary lifestyle and don’t exercise.
  • You have inactive glutes.
  • You are overweight by more than 50 lbs.
  • Your hamstrings are really tight and it’s hard to touch your toes without bending your knees.
  • When you look at yourself in your underwear in front of the mirror, your underwear’s elastic line seems tilted forward instead of sitting in perfectly straight line (see the anterior pelvic tilt diagram here for reference).
  • You have a weak core (abs) and usually struggle with most abdominal exercises.
  • You suffer from mild to severe low back pain.

Correcting knock knees without surgery

So what is the fix? Simple: stretch your hip flexors to loosen them up and strengthen your glutes to pull back your knees to a neutral stance. Make sure you also focus on stretching your hamstrings if externally rotated knees are present. The effectiveness of the stretches alongside with a proper strength training routine will play a major role in how quickly you can return your knees and body to a neutral balance.

It’s easy to see how strengthening your glutes will start shifting your knee position. To illustrate, I’ll show you an easy way to test it yourself:

First, take off your pants and shoes. (Don’t get too excited, this is for scientific purposes only!) Now stand shoulder-width apart in a place in your home where there is tile floor or it’s easy to slide around. What we want is for your feet to have as little traction as possible. The kitchen or bathroom is usually a good spot.

Now, I want you to squeeze your glutes hard and see how the front of your thighs and you knees move away from each other when this happens.

As you start your strength training program, you’ll start noticing how your femurs will go back to their original place, and so will your knees! It’s all a matter of pulling back on your knees to get them to track perfectly over your ankles in a neutral grid position (like illustrated below). Your anterior pelvic tilt should also disappear completely, along with your low back pain.

load-bering joints body grid

Bow Legs Causes & Surgery-Free Treatment

Now it’s time to talk about the other side of the coin. Bow legs, just like knock knees, occur because of an imbalance that starts at the pelvis.

As I’ve already mentioned before, when your glutes become overly strong they start pulling your pelvis backwards, lengthening your hip flexors and weakening them. Remember that a lengthened muscle becomes a weak muscle – just like a short muscle becomes a tight muscle.

What happens when your gluteal muscles are overly active, they start rotating your femurs to the outside (the opposite of what happens in our knock knees case above), therefore pulling your knees apart and causing a real case of bow legs.

Now, I’ve already talked about how real cases of bow legs are rare. Most people that believe they suffer from bow legs actually have knock knees, which causes their knees to rotate to the outside and give their shins a bowed look due to false curvature of their lower legs.

It’s important to identify whether you really suffer from bow legs or knock knees before starting a rehab program for your knees – otherwise you could end up making the problem worse by strengthening already tight muscles, and stretching an already weak one!

Remember that to restore balance and bring back our legs to a neutral stance, tight (or short) muscles need to stretched, while weak (or long) muscles need to be strengthened.

How to tell if you are suffering from bow legs due to posterior pelvic tilt

  • You work standing up all day
  • You look like you have no butt due to your posterior pelvic tilt
  • If you work sitting, you can’t sit straight and your lower back tends to round
  • Your glutes feel tight

Correcting bow legs without surgery

Tackling bow leg correction is just a matter of doing the opposite as our knock knees strategy. The first thing you need to do is start stretching your glutes everday! The glutes are powerful muscles and they exert a lot of pull when overly active. Have you ever seen a professional athlete with weak glutes? It’s rare.

The other key is to start strengthening your hip flexors. If you are standing all day, your hip flexors are in a stretched position and will become weak. If your job or lifestyle demands you being on your feet all day, incorporate a strength training routine at the gym or at home where you work your hip flexors everyday.

Following a unique strength training program for maximum results in the shortest time.

I hope that with this article I was able to open your eyes a little bit about the real causes behind bowed legs or knock knees.

More importantly, I hope you understand that there is hope for you and that correcting your knock knees or bow legs without surgery is very much possible! It’s just a matter of strengthening your weak muscles, and then stretching your tight ones.

The best program I’ve found during the past 5 years is without a doubt Sarah Brown’s “Bow Legs No More.” Sarah has put together a fantastic rehab program for anybody suffering from either bow legs or knock knees (and false curvature).

This program contains an incredibly effective routine of exercises/stretches that will start bringing your lower body to a neutral stance in the shortest time possible. Many of her clients report seeing a drastic difference in their legs in as little as 60 days. I’d highly suggest you check it out if you want to say goodbye to ugly knee deformities and start living the life you are supposed to; confident and ready to take on any challenge or opportunity that is presented to you with a great big smile and a “Let’s do it!”

UPDATE: Unfortunately, many people experience little to no benefits from Sarah’s program due to their bodies catching quickly to the new exercises. Also, “Bow Legs No More” doesn’t really tackle a big problem today: false curvature and knee hyperextension.

That’s the reason I’ve designed a program to not just correct bow legs, knock-knees, and false curvature, but also to keep your leg correction progress moving in the right direction by using the principles of “Progressive Correction.” Click here to learn more about the new program.

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