Have you ever had knee pain?
Well I have and let me tell you it is not great. I have had my fair share of knee pains over the years participating in basketball, shot-put, weightlifting, powerlifting, and running.
It's never fun to have to stop a workout session half way because the knee pain is too much or sit on the side-lines when the pain gets bad enough.
What's interesting is that I have had knee pain above and below the kneecap, on both sides of the knee, and even deep inside the knee joint that came on as a sharp pain when climbing up stairs post workout, BUT traditional knee exercises never seemed to work.
I would do the classic run of the mill quad extensions on a machine, wall sits, spanish squats, pedal on a bicycle, heat, e-stim, massage, etc. However, nothing made it better UNTIL....
I looked outside the knee!
Here are three of the most common reasons I see that are the Root Cause of Knee Pain - and some tips for what you can do:
1. It's an Ankle Problem
The ankle is one of the biggest players in knee, hip, and even lower back pain. For this reason, we screen the ankle in every patient who walks in our door. Most people have tight and stiff ankles from sitting at a desk all day or wearing tight and restrictive foot wear. On top of that, I haven't met too many people that sit in a deep squat multiple times per day.
As a result, when the ankle cannot move, somewhere up the chain has to take the rest of the load and move too much. This is why you can scrap, tape, cup, and percuss the knee and still see no benefit when you go to squat again. One thing that I really recommend is throwing a pair of 5lb plates under your heels and seeing how this modifies your knee pain. If you can squat almost pain free now, then you know that part of the problem is the ankle.
2. It's a Hip Problem
After the ankle, the hip is the second most likely place for us to see an issue. Where the ankle was a mobility issue, the hip is usually a stability issue. When the hip cannot stabilize the knee over the toes, the knee will often collapse inside or outside the foot and place excessive force onto the knee.
A great way to test this is to perform a single leg squat to about parallel or just above. Now compare one side to the other. Was there a difference? If there was, we recommend having a friend test your hip strength with you lying on your side and trying to keep your leg up in the air. Was there a difference side to side?
The best thing you can do with any exercise is test and retest, so try performing weighted hip abductions and retest the single leg squat. If this made it better, then you have your answer. If not, we may need something a little more specific.
3. We have a Center of Gravity Problem
This one is a bit trickier to interpret than the others.
When we stand there are certain markings that should follow one on top of the other. If our center of gravity should travel in front of this line, it will cause shear stresses to occur throughout several different joints in the body.
An example of this would be someone who always has a large arch in their lower back and as result leans forward. This results in pronated feet (the wrong way to pronate but that's for a different article =) ), the knees to be locked out, the hips to internally rotate and the pelvis to anteriorly rotate. As a result, we can have a problem anywhere along that chain and nothing will be fixed until we fix that!
This typically manifests as someone who will translate too far forward in the squat. A great way to work on this would be to use a squat wedge or plates under the heel and squat with a counterbalance in front of them trying to keep their center of gravity behind their body. This usually has a dramatic decrease on knee pain (similar to how a spanish squat works).
Hopefully these tips give you some more insight on why your knee pain may not be responding to the traditional knee treatments.
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