Why Knee Pain Might Not Be A Knee Problem: A Whole Body Perspective

You’ve stretched your quads. You’ve bought new shoes. You’ve cut back on your mileage. Used all the KT tape and even booked regular massages. And yet... your knee pain still has not gone away. It is frustrating, and is all too common. But here is the thing: the problem might not actually be your knee.

In many cases, knee pain is just a symptom, not the root cause. When treating pain, it is important to zoom out and consider the body as a whole. Dysfunction or instability in a joint above or below the knee often creates compensations that lead to pain, in this case, knee pain.

As a physical therapist, I see this all the time and spend a lot of time educating the patient about why I am treating their hips, feet or back when the pain is in their knee. We will discuss some of the most common issues that can lead to persistent knee pain.

Hip Weakness or Instability

Weakness in the gluteus medius (one of your key hip stabilizers) can throw off the alignment of your pelvis and leg. When this muscle isn't doing its job, it often results in hip drop that can create knee valgus (where the knee collapses inward during activity). This misalignment places excessive stress on the knee joint and is a common contributor to pain, especially in runners and athletes.

To help with hip strengthening, you can incorporate targeted hip-strengthening exercises (like standing clamshells, lateral band walks, and side plank with hip abduction) along with improving pelvic control during dynamic movements.

 Limited Ankle Mobility

The ankle’s ability to move into dorsiflexion (pulling the toes toward the shin) is critical for walking and running mechanics. When ankle mobility is restricted, your body compensates, often by pushing the load up to the knee. This altered movement pattern increases joint stress and can lead to injury.

Stretching the calf muscles regularly, mobilizing the ankle joint, and incorporating movements that improve range of motion of the ankle are key to healthy and happy joints, especially with running!

Core Weakness and Trunk Control

Your core is not just about abs (or the 6 pack), it is the central stabilizer for your entire body. Weakness here can create excessive trunk movement, poor control during arm swing and rotation, and inefficient energy transfer during movement. All of this can impact your overall body mechanics and can increase strain on your knees. Building a strong foundation with core stability exercises like planks, bird dogs, pallof press and dead bugs are essential for good core control. 

Poor Foot Mechanics

It all starts from the ground up. You might have heard of the term, overpronation (when the foot rolls too far inward). Overpronation can create rotational forces in the lower leg that ultimately affect knee alignment and its ability to take load appropriately. Most of the time we also see tightness or limitations in the Achilles tendon, big toe, or plantar fascia. Limitations or tightness in these areas can affect how your body is able to take the forces and transfer it up the chain to the knee. 

Working on foot and ankle mobility, strength of the foot intrinsic muscles, and getting a gait analysis can be beneficial to help see what is going on biomechaincally when running.

In conclusion, knee pain is often a messenger, not the problem itself. If you have been treating the knee directly and the pain just will not go away, it might be time to assess the entire kinetic chain. By identifying and correcting dysfunction in the hips, core, ankles, or feet, you can reduce the stress placed on your knees and move more efficiently, powerfully, and pain-free. Run gait analysis and or a physical therapy evaluation can help you better pin point the source of the pain and get you the treatment and exercises that are most beneficial to get you back on your feet running and help take away that knee pain!

Hope this helps and happy running!

Dr. Noelle O’Hara, DPT