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When Your Knee Pain Isn’t Coming From Your Knee

Knee pain is rarely due to something in the knee.  Yes, if you have a traumatic injury to your knee, that pain is absolutely is coming from your knee.  But most knee issues stem from something else.  With that said, meniscus and cartilage injuries in the knee are technically a knee issue, but when the pain just comes on randomly rather than due to trauma, the injury is often caused by areas outside of the knee. 

These outside issues are biomechanical issues that can stem from a number of causes. 

Hip issues 

When it comes to hips, you can have decreased mobility, decreased strength and stability, or a combination of both.  Any of the three scenarios can contribute to knee issues. 

If you are lacking mobility in the tissues around the hip, your body will compensate for the motion in order to let your body complete a task or activity, resulting in abnormal forces and torque on the knee.   

Similarly, if you are lacking stability in the hips (and pelvis), the pelvis may drop and/or the hip may rotate inward when standing on a single leg, such as when running.  When on both legs, such as landing from a jump, you may see the knees falling inward.  Both scenarios can create abnormal forces and torque on the knee, just like lacking mobility can. 

Foot/ankle issues 

At the foot and ankle, we often are lacking mobility in the ankle and lacking stability and control of the foot, both of which can give us problems for different reasons. 

Mobility issues in the ankle often create problems when doing tasks that require you to squat, kneel, or lift.  If the ankle does not move well, you will have to compensate up the chain at your knee, hip, and trunk.   Because of the anatomy and mechanics of the knee, eventually the knee develops issues. 

Stability issues are seen in both dynamic activities, such as running and jumping, as well as in more static activities, such as squatting and lifting.  If you lack good control in your foot, the foot will collapse inward which causes the knee to follow suit. The knee collapsing inward causes abnormal forces, torque, and pressure on the knee, resulting in injury over time. 

Movement pattern faults 

Our bodies are great at learning bad habits and keeping them. 

As a child, you moved amazingly well.  Then as you began sitting in school and doing different things in life, you developed movement and strength deficits as mentioned above.  Because of that, you compensate for years (and perhaps decades) and that is what your body learned is “normal.” 

Once you improve the mobility and strength deficits, your body continues to move incorrectly because that is what your body knows.  It then becomes a matter of retraining your body how to move properly.  This can actually be the hardest part – breaking habits of what the body knows can be a very difficult and frustrating process! 

As long as you continue to move with movement pattern faults, the knee pain issues you are dealing with will remain. 

Low back 

Another thing not often considered when you develop knee pain is what may be going on at the spine.  At times, knee pain can actually be referred pain from an irritated nerve coming off the spine.  This can feel just like knee pain from an injury, so it is an easy mistake to make. 

This is not as common as the above issues when it comes to athletes, but something to think about if nothing else you are doing is working to resolve the pain. 

Have questions about your knee issues?  Email me at 

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Comments (2)

Great blog and insight. Many of my patients that are runners come in with insidious knee and/or hip pain, have had weeks if therapy with poor results because the clinician was looking at the symptom not the cause. Thank you!!

Glad you enjoyed it, Jan. Thank you for taking time to read it.

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