New perspective on Physio, Health & Wellness

Knee Pain: Why It’s Often a Consequence of Something Else

Knee Pain: Why It’s Often a Consequence of Something Else
Knee pain is often more than just a local knee issue. Photo courtesy of the brilliant wildlife photographer @markjdrury on Instagram. Please go and check out his work or visit his official website listed in his bio.

Let’s talk about knee pain for a minute. More importantly, I want to discuss why it’s not just the knee you should be thinking about.

Knee pain is so common that it’s estimated to affect 25% of all adults in some way, shape or form.

Terms such as growing pains, knee tendonitis, meniscal tears, patellofemoral pain, arthritis etc, are all becoming more widely recognized and understood by the general public.

It’s so popular there’s a strong chance either you currently suffer from knee pain, or you know someone who is.

Yet despite how common it is, we still often lack the necessary perspective to understand why it’s there in the first place. So here are some really important ideas to consider.

Knee Pain Is a Consequence

As I’m sure most are aware, the knee’s primary role is to hinge backwards and forwards. However this simplistic view often does it a disservice. We often forget it’s literal connection to the ankle and hip. It’s stuck in the middle. A joint of consequence if you will.

The knee is a joint of consequenceClick To Tweet

The knee isn’t a glorified door hinge floating around on its own, it’s just one aspect of your leg. This same leg functions as part of your lower body, which functions as part of your entire body. It all works together. This tendency to miss the bigger picture can make it hard to have the right perspective when there’s pain involved.

As a Physio it seems that most feel their knee pain just “happens”. So do accidents of course, but for the majority of us our knees are fine, until they aren’t.

Solving your knee pain is hard to do without context.

Why Do You Have Knee Pain?

A great way to think of knee pain is its onset is likely the last straw rather than the beginning of something new.

Yes it didn’t hurt until it started hurting, but its role within the leg means it’s prone to compensate for hidden dysfunction above and/or below it.

Clinically, there seem to be three major areas of the lower body that, when restricted, will change the way your knee is loaded.

The Ankle:

Thanks to modern heeled footwear and thongs (flip flops) our ankles have a tendency to be stiff.

Mechanically, a rusty ankle forces the entire leg to rotate inwards in an attempt to maintain some functional equilibrium.

This can often lead to knee pain on the inside or outside of the knee.

Read why modern footwear is setting our ankles up to fail.

Test Your Ankle Flexibility:

Squat as deep as you can while keeping your heels down and feet straight.

Next, squat again but allow your heels to lift and your feet to turn out if needed. You should find it easier the second time.

This highlights how your body will try to compensate for a tight ankle.

In the process you may notice your knees will likely track inwards relative to where your feet are pointing. This movement alters the loading pattern of your knee from that basic hinge to one with a twist.

Sure you could get down lower the second time, but in the long run you are unknowingly asking those knees to buffer poor mechanics. Remember, they’ll cope until they don’t. All because of some innocuous ankle stiffness below the knee.

Ankle Exercise to rectify: Banded Ankle Stretch

banded ankle stretch for achilles tendonitis
Use a strong band like this to mobilize your ankle stiffness

The Hip:

If the front of your hip is tight – a common side effect of prolonged sitting – the knee again has to compensate.

When walking, notice what your back leg is doing as it trails behind. Tightness at the front of the hip will ask your leg to rotate outwards to find more room. If you watch others walk you’ll notice a lot of turned out feet. This is more poor loading for the knee.

To compound this, tight hip rotators can make sitting cross-legged uncomfortable for your knees. If this is you then it’s likely your knees aren’t enjoying that lack of hip range!

Click through for more physicals signs the modern world is taking a toll on you.

Exercise to rectify: The Couch Stretch (Front)

Couch stretch for hip tightness achilles tendonitis
The Couch Stretch can be as brutal as it is effective

Pigeon Pose (Deep Rotators)

pigeon stretch for glute tightness achilles tendonitis
Use the Pigeon stretch for any gluteal tightness

The Low Back:

Stiff lower back segments directly and indirectly influence knee function. If your back is stiff your body will tighten surrounding musculature in support.

Our hip flexors can get caught up in this drama as they sneakily attach to the front of your lower back. This again forces the leg to find a rotational work around with long-term ramifications for the knee.

Similarly, the nerves that supply the function of the knee exit here and can become physically over-tensioned. This can pull slack from, and tighten any tissue associated with the nerve as it travels down the leg. For example, if kneeling and sitting fully back on your heels is uncomfortable, it’s likely that the muscles at the front of your thighs (the Quadriceps) are tight. This restriction is often a consequence of back stiffness/increased neural tension.

To follow this idea further, check out what I’ve come to understand about Knee Tendonitis and also Osgood Schlatter Disease.

Exercise to rectify: Lacrosse Ball or Foam Roller

foam roller stretch back
Let a lacrosse ball like this or basic foam roller like this gently press into your mid-low back

When performing any of the stretches above remember that we want to move away from traditional passive stretch holds. Instead, consider reading our article on using a Power Band with PNF stretching.

How to Best Manage Your Knee Pain Once It’s There

Like most pain and dysfunction the best way to treat knee pain is highly individualized. However there are some essential basics to lay the foundation for optimal recovery.

Improve Your Leg Mechanics

As mentioned above, work hard on improving the way you load your knee.

Optimize it’s function by freeing up your ankles, hips and low back.

Once you remove some of these hidden handbrakes any irritated and sore knee tissue can begin to settle even before you’ve directly treated the area. If you want your knee pain to go away (and stay away) it’s vital that you go after its mechanical cause.

Feed Slack to the Knee Itself

Similar to freeing up the joints above and below the knee, go after any restricted tissue around the knee.

Take a foam roller or massage ball to your calves, hamstrings and quadriceps. Regardless of your specific diagnosis, you will likely have some tight tissue either side of the knee and above the knee cap.

Work on freeing these areas up and you may find some more immediate symptomatic relief.

Avoid Using Ice and The RICE Protocol

This one can take a moment to sink in, but give ice and the RICE protocol a miss. In short, it may be slowing down your recovery.

I’ve covered this in great depth before but here’s a quick summary.

Despite having used ice and the RICE protocol to treat pain and injury for over 40 years now, there’s a strong disconnect between why we use it and what the body is trying to achieve on its own.

We typically ice to reduce pain, swelling and inflammation despite these not only being normal, but vital for optimal healing.

We preach rest despite the body needing movement to flush out accumulated swelling and promote optimal tissue regeneration and remodeling.

Similarly, we also compress our sore and injured tissue in an attempt to limit swelling coming in to the area, despite it also limiting optimal waste removal.

And finally we elevate to help swelling removal but also limit blood flow – the one thing carrying the cells and nutrients necessary to support the healing process.

It’s worth noting that ice is an effective pain reliever, but one that comes with a hidden cost.

Encourage Respectful Pain-Free Movement

With controversy now surrounding the use of ice to treat all pain and injury, it’s important to use other techniques to help your knee recover.

With this in mind encourage as much respectful, pain-free movement as your condition allows. Engage the muscles around your knee by simply tensing and relaxing them. Bend your knee or go for a walk if it’s appropriate for you.

Your body needs a certain amount of motion to allow optimal recovery – you just need to work out what your threshold is. All it often takes is to listen to your body. Too much movement and use may cause extra pain, swelling and inflammation. Too little won’t facilitate progress. Speak with your Physiotherapist (Physical Therapist) to work this out if needed.

Improve Your Strength

Again, this may be the realm of a trusted Physio but it’s very important to strengthen your knee where possible.

Pain, swelling and fluid on the knee can inhibit muscle function. If left unchecked, this can lead to a spiral of dysfunction.

Make sure that you are improving the strength of the following muscles:

  • Gluteals
  • Quadriceps (more specifically the inner quad)
  • Trunk/Core
  • Calf
  • Hamstrings

It’s important to note there will always be a level of strength training appropriate for you.

Much like the ankle, hip and low back mobility exercises, sometimes it helps to target your calves, glutes and core first before addressing the knee itself. This will again help improve the way you load the knee making it easier to specifically load the knee later on.

Knee Taping

If your knee pain is persistent consider the short-term use of rigid taping. If performed correctly tape can provide much needed support and control to the area.

When we consider most non-traumatic knee pain to be a consequence of poor leg mechanics and loading, tape can be a highly effective way to correct any poor loading while the broader mobility and strength exercises take effect.

Similarly, a knee brace may also help improve your quality of life in the short-term. It is however vitally important to see these tools as short-term commitments only. They will not cure your knee pain on their own. You should distance yourself from them as your condition improves.


So with all this in mind there are some important things to remember. If you have a sore knee, or know someone who does, take a step back. Consider how your ankles, hips and low back are also going. Sure they may not immediately seem dysfunctional, but restriction in these areas holds a powerful influence over the knee. After all they share a physical and mechanical connection. It’s just often hard to appreciate if you’re not looking for it.

Also double-check whether your management technique are getting results. Make sure your Physio is working hard to see progress.

At the end of the day, this is a lesson in perspective. It’s important to understand that almost everything that happens to the knee is a consequence of something else. You just need to take a big enough step back to appreciate what it actually is.

It’s important to understand that almost everything that happens to the knee is a consequence of something else.Click To Tweet

If you can make positive change you’ll hopefully surprise yourself with how your knees start to feel.

Are you dealing with any knee pain at the moment? If so, has anyone taken this perspective with you before? Let us know what has worked for you and what hasn’t in the comments.

If you found this take on knee pain insightful, I’d genuinely appreciate you giving this a share. I’d like as many people with knee pain to read this as possible. Thanks in advance!

Alternatively, please consider following YWN on the socials and join in the conversation in our Your Wellness Nerd forum?

6 thoughts on “Knee Pain: Why It’s Often a Consequence of Something Else”

  • I suffer from severe side left knee pain. ITB
    I went to phisiotherapist with no relief. And im doing a marathon in 8 weeks.
    I am a triathlete

  • Thanks for the article.
    I do have R sore knee which i believe was sustained after a long haul flight a couple of months ago and has stayed with me since then.
    I run also almost every other day and have had sore muscle (below R knee, which came before the soreness on the knee itself) nad sore muscle above the R knee, which came after the soreness on the knee). My ankles are doing well, son far i have no problem with them from running.
    Now what happened was i saw my dr for the sore knee. He advised that was the rubbing in the knee that caused the inflammation and running can make the problem worse.
    Against my dr’s advice i still take up running (pls dont tell him). Surprisingly, i notice that running doesnt make the sore knee worse. But lots of squatting or heavy lifting during the day will make me feel restless at the R knee thru that night.
    Your article gets me thinking if there is a connection among all the soreness. Will try some exercises recommended. Will let you know how i go with them.

  • At first, my L knee hurt to the point that I was not able to run..or walk upstair. If I tried, it is painful, and there are crepitus sounds loudly when I bend ad straight my kbees after the run. I rested for about 2 weeks, did not run, pain subsided . I started running again, slowly up to 6 is ok. Then R knee pain while L knee is ok. I found out, if I do not run, my knees get stiff and in pain. If I run daily, no pain. It has been 11 months since that happened, now after running, my knees are no.longer ptoduced crepitus sound and I feel no pain. What has happened to my knees ? I had X ray done all dementions of knees 8 XRay total, my sport ortjo doc said L knee maybe mild arthritis. In my case, I ran too many marathons in short period of time( 2 a month) and increase milleages so quickly. Now I take time to retrain slowly , my knees problem gone. I am 61 years old. I think the most common mistake which runners made is increasing miles too quickly , as a result..injury occured. What do you think about my case? Thsnk you.

    • Hi Betty,

      Thank you for your question. If I may there are a few things to consider. The first is that running and using your knee should be considered normal. Its part of what they’re designed for. Secondly almost all non-traumatic knee injuries are the result of the way your leg functions. As per the article, I’d be willing to bet that you’ll have something somewhere setting your knee up to feel sore. It could be a stiff front of the hip, a stiff ankle, a stiff lower back at the base of your ribcage. They’re hard to find without knowing what to look for sometimes because they dont stand out.

      In most cases mild arthritis should never be considered the main source of pain for a number or reasons. If you can get to work on some of your hidden handbrakes, you’ll begin to load your knee more optimally and create a haven for pain and crepitus to disappear.

      There might be more to it than just the above, but the foundation is often the same for most people. Start there and perhaps see someone you trust for more specific guidance.

      Best of luck!

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