The Knees Over Toes Movement: What It Got Right and What It Missed
The knees over toes movement has done something valuable: it challenged decades of bad advice about knee health. But the conversation has moved from one overcorrection to another, and for most people dealing with knee pain, the part that actually matters still isn't being addressed.
If you've spent any time in fitness spaces in the last few years you've encountered knees over toes training. The ATG split squat. The reverse nordic. Sled walking. The argument that allowing and even encouraging the knee to travel forward past the toe restores range of motion, builds resilient tissue, and resolves the kind of chronic knee pain that conventional movement restrictions have been maintaining.
On one level this is correct. The old "don't let your knees go past your toes" instruction was never grounded in evidence and produced decades of unnecessarily restricted movement patterns that loaded the hip and lower back to compensate for an artificial knee restriction. Rehabilitating that restriction through progressive knee flexion loading is legitimate and clinically sound.
But the knees over toes approach as it has been popularised also contains a significant gap. And that gap is the reason many people who follow the program diligently still have knee pain, or develop new pain in adjacent structures, or plateau in ways the program doesn't explain.
The gap is gait. And gait is where almost all chronic knee pain originates.
What ATG Gets Right
The foundational argument of the knees over toes movement is biomechanically sound. The knee is a hinge joint designed to flex through a substantial range under load. The patellofemoral joint, the cartilage, the tendons, and the surrounding soft tissue all adapt positively to progressive loading through range of motion when that loading is applied appropriately.
The patellar tendon, in particular, responds to eccentric loading through range in a way that is now well-established in the research on tendinopathy rehabilitation. Loading the patellar tendon through end-range knee flexion, done progressively, stimulates tendon remodelling and can resolve patellar tendinopathy that has been resistant to conventional rest and strengthening approaches.
The emphasis on tibialis anterior strength, the muscle on the front of the shin that controls dorsiflexion, is also valuable. Ankle dorsiflexion restriction is one of the most common and most consequential movement limitations in the lower limb, and the ATG program's focus on this is clinically appropriate.
So the program's core premise, that the knee should be loaded through full range progressively and that the restriction of this range has been producing problems, is correct.
What It Misses
The knees over toes program is an exercise program. It addresses the knee in isolation from the movement patterns that are producing the knee's loading environment in daily life.
Exercise programs are performed for an hour or less per day. Gait is performed for every waking hour. The mechanical environment of the knee is shaped primarily by how it loads across ten thousand daily steps, not by how it is loaded during a training session.
If the gait pattern is producing excess valgus stress at the knee, if the foot is pronating excessively on every stride, if the hip abductors are failing to control the femur and pelvis through the stance phase, if the ankle can't dorsiflex adequately and is compensating in ways that transfer load to the medial knee, then the knee is accumulating mechanical stress across the entire day in patterns that no amount of ATG split squatting is going to address.
The training session improves the knee's isolated load capacity. The gait pattern continues producing the mechanical input that is exceeding that capacity across the rest of the day.
This is the gap. And it is why people can follow the knees over toes program with genuine consistency and still have knee pain that doesn't fully resolve.
What's Actually Producing Most Chronic Knee Pain
Lateral Pelvic Drop in Gait
The single most consistent finding in chronic knee pain assessment at FP Brisbane is lateral pelvic drop in the stance phase of gait. When the hip abductors on the stance leg fail to control the pelvis, the pelvis drops on the swing side, the femur adducts and internally rotates, and the knee is placed under valgus stress on every stride.
This valgus loading is the mechanical input that produces medial knee pain, patellofemoral pain syndrome, and IT band syndrome. It is operating across every step the person takes. No knee strengthening program, however well-designed, is working against a load being applied ten thousand times per day in the wrong direction.
Correcting the pelvic control in gait removes the valgus stress from the knee. The load that has been accumulating in the medial compartment and the IT band is removed. The tissue that was sensitised by that load has the opportunity to recover. This is not achieved through knee-specific training. It is achieved through gait retraining.
Ankle Dorsiflexion Restriction in Gait
The ATG program correctly identifies ankle dorsiflexion restriction as important. But it addresses it primarily through isolated tibialis anterior strengthening and loaded dorsiflexion work in training positions.
Ankle dorsiflexion restriction in gait is a different problem to restricted dorsiflexion in a static assessment position. Many people who have adequate passive ankle dorsiflexion are still failing to use that range during the mid-stance phase of walking, because the gait pattern doesn't require it or because a previous ankle injury has produced a protective motor pattern that limits dorsiflexion under load.
When the ankle doesn't dorsiflex adequately in gait, the foot compensates by pronating to find the range it needs. This pronation internally rotates the tibia and loads the medial knee structures in exactly the way described above. Strengthening the tibialis anterior in training doesn't change this compensation if the gait pattern that produces it isn't corrected.
Hip Extension Restriction
When the hip can't extend properly through the push-off phase of walking, the lower limb compensates in multiple ways. One of those compensations is increased knee flexion during stance to maintain forward momentum without hip extension driving the movement. This increases the load on the patellofemoral joint across every stride.
This is the mechanism behind patellofemoral pain syndrome in many presentations, and it is visible in gait assessment as a reduced push-off with compensatory loading through the knee. Addressing it requires restoring hip extension in the loaded movement patterns of gait, not just in training positions.
Foot Strike Position and Overstriding
Landing with the foot significantly in front of the body's centre of mass creates a braking force on every foot strike that loads the knee in extension rather than in the flexion-absorption pattern it is designed for. This is the mechanism behind the knee pain that runners experience at consistent points in their runs, because they are applying a consistent mechanical error at a consistent high rate.
The ATG program does not address foot strike position because it is not a gait retraining program. It is a strength and mobility program. Strength and mobility are necessary components of knee health. They are not sufficient components if the gait pattern is producing the wrong loading input.
Where the Two Approaches Need Each Other
This is not an argument that the knees over toes approach is wrong or that it should be replaced. It is an argument that it is incomplete.
Progressive knee loading through range of motion builds tissue capacity. It makes the knee more resilient to the loads it is going to receive. It restores range that restriction-based approaches had eliminated unnecessarily.
But tissue capacity is only part of the equation. The other part is what loads that tissue across the day. If the gait pattern is producing loads that exceed the tissue's capacity regardless of how well the training has been done, the knee will continue to have problems.
The combination that produces lasting resolution of chronic knee pain is gait correction, which removes the dysfunctional daily mechanical input, combined with progressive knee loading, which builds the tissue capacity to handle the corrected loading that gait now provides.
At FP Brisbane, both components are present. The gait assessment identifies what the gait pattern is doing to the knee across daily life. The corrective program addresses the gait mechanics that are producing the excess load. Progressive functional loading builds capacity through the patterns the corrected gait requires.
Neither approach alone is sufficient. Together they address both sides of the equation.
Client result: "I'd done the full ATG program for eight months and my knee pain had improved but hadn't fully resolved. At FP Brisbane the gait assessment found that I had significant lateral pelvic drop on the affected side and a foot pronation pattern from an old ankle injury that was loading my medial knee on every step. Six weeks of gait retraining alongside the strength work I was already doing and the knee pain resolved completely. I wish I'd had the gait assessment first." Brisbane client
What This Looks Like at Functional Patterns Brisbane
At FP Brisbane, knee pain presentations start with a gait assessment before any loading prescription is designed. We identify the specific mechanical input the gait pattern is applying to the knee across daily movement, what's driving that input, and what needs to change in the pattern for the knee to stop being overloaded.
From that assessment we build a corrective framework that addresses the gait mechanics producing the problem and progressively loads the knee through functional patterns that the corrected gait requires it to handle.
The knees over toes conversation has moved the field in the right direction. The next step is understanding that the training session is one input among many, and the most significant input is the one that's happening all day.
Frequently Asked Questions — Knees Over Toes and Knee Pain
Does knees over toes training fix knee pain?
For some presentations yes, particularly patellar tendinopathy that has been underprepared through excessive load avoidance. For most chronic knee pain presentations, the training addresses the knee's isolated load capacity without correcting the gait mechanics that are applying dysfunctional loading to the knee across the entire day. Both components are necessary for lasting resolution.
Why does my knee pain persist despite doing ATG training consistently?
Because the gait pattern is almost certainly applying mechanical loads to the knee that exceed the capacity the training is building. Lateral pelvic drop in gait, ankle dorsiflexion restriction in the walking pattern, hip extension restriction, and overstriding are common findings that produce ongoing knee loading in the wrong directions regardless of training quality. A gait assessment is the next step when training alone hasn't resolved the problem.
Is it safe to let the knee go past the toes?
Yes. The old instruction to prevent the knee from tracking past the toes was not evidence-based and produced unnecessarily restricted movement patterns. Progressive knee flexion loading through range is appropriate and beneficial when applied correctly. The relevant variables are the quality of the loading pattern, specifically whether the knee is tracking in line with the foot rather than collapsing medially, and whether the load is appropriate for the current tissue capacity.
How is FP Brisbane's approach to knee pain different from ATG?
ATG is a strength and mobility program that builds knee load capacity through progressive training. FP Brisbane starts with a gait assessment that identifies the mechanical input the knee is receiving across daily movement, corrects the gait mechanics producing dysfunctional loading, and then builds load capacity through functional patterns that reflect the corrected gait. The ATG program addresses one component of the equation. The FP Brisbane approach addresses both.