Knees are Simple and Misunderstood
Written by Calvin Thai, PT, DPT
Knee pain is one of the most common diagnoses seen in the clinic. It shows up across all populations, from older adults reporting they have no cartilage left in their knees, to individuals in their twenties experiencing new and unfamiliar knee pain for the first time. This raises the question: is everyone destined to develop knee pain?
A large portion of knee problems are not actually caused by the knee itself. In many cases, knee pain is not the result of a mechanically “damaged” knee, but rather a symptom of dysfunction within a larger movement system.
To understand this, it helps to simplify the role of the knee. The knee primarily bends and extends. As long as the surrounding musculature, particularly the quadriceps and hamstrings, are strong and coordinated enough to control those motions, the knee itself is generally well supported. In contrast, the hip and ankle are capable of far more complex movement. The knee sits directly between these two highly mobile joints.
The knee functions as a bridge within the lower extremity. The hip and ankle largely dictate how forces are absorbed and transferred through the knee due to their greater degrees of freedom, including rotation, inversion, eversion, and multiplanar control. When viewing the system dynamically, if the body shifts excessively in one direction, the structure must compensate elsewhere to maintain balance. In many cases, that compensation occurs at the knee, which contributes to the development of pain and dysfunction.
The body constantly seeks to self correct, which means that when one area loses control, another area will compensate. If the ankle collapses inward, the knee will often shift outward in response to maintain alignment. If the knee collapses inward during a squat, the underlying driver is often insufficient control at the hip, the ankle, or both, with the knee simply absorbing the imbalance to allow the movement to continue.
Effective knee rehabilitation must therefore go beyond the knee itself. It requires evaluation of how the entire lower extremity system is functioning together. Is the knee being asked to compensate for deficits elsewhere? Or do the hip and ankle need to better fulfill their roles so the knee is no longer overloaded?
In clinical practice, truly isolated knee pathology without involvement of the hip or ankle is rare. For this reason, a comprehensive assessment of the entire kinetic chain is essential. Treatment that focuses solely on the knee often addresses symptoms rather than the underlying cause.
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No referrals, no waiting, just answers. Did you know that we offer free 1-on-1 injury screens? Wattage Physical Therapy will take an in depth look at your ergonomics, posture, muscle tone, muscle weaknesses, and movement patterns to create a plan for YOU. If this article intrigues you, you can directly email me, Calvin at Calvin@wattagept.com. I would be happy to help you start the process of living a life free from pain.