Still Have Knee Pain? 3 Things Most PTs Overlook

Knee pain is one of the most common orthopedic conditions out here. It’s a joint of two of the body’s longest bones, which means that mechanically, there are two powerful lever arms (the femur and the tibia) exerting their forces on a small space. That’s a lot of leverage to deal with for the knee, and a main reason why it gets the brunt of our movements all too often.

You’ve probably heard it all: ACL tear, PCL tear, meniscal tear, patellar tendonitis, arthritis, and others. There are a lot of possibilities (and surgeries) with the knee. But if you’re experiencing knee pain and are not in the surgical (or soon-to-be surgical) group, getting PT for your knee is probably your best option, and treatment varies widely from clinic to clinic. If you have been getting treatment to your knee, but aren’t seeing the results you’d expect, here are a couple of things you and your PT may want to re-investigate.

The Thoracic and Lumbar Spines

I talked about this when I talked about things PTs often miss when treating the hip , but it applies here as well. The spine is so important because when its vertebrae are restricted, the effects are far reaching (Read: Why Your Spine Health is Most Important of All). Big thigh muscles get weak, or just tight, simply because vertebrae in the spine are tight and held out of alignment. This changes the normal mechanics of our lower limb, and the knee becomes the victim. Once we get the spine properly mobilized, these muscles behave more normally, and the knee’s ability to recover improves greatly.

Hips

Dysfunction of the hip is usually noticed (as pain) at the knee before the hip itself, again because of the nature of the great leverage imparted onto the knee joint with movement. Most PTs are aware of the typical pattern of weak glutes in the back of the hip, and tight hip flexors (the psoas) in the front of the hip. You’ve also probably been told you have a tight piriformis muscle, hamstrings, or IT band. However, the unanswered question is WHY? The farthest most rehab programs go is simple stretching and strengthening of these muscles, without addressing the underlying cause. (Read: Why Your PT Exercises Aren’t Working) These muscles often remain dysfunctional because an earnest effort to mobilize the segments of the spine was never undertaken. The result, again, is abnormal mechanics of leg movement that put the brunt of things on the knee joint.

Ankles

If the mechanics of the hip can affect the knee, you’d better believe the mechanics coming from the link in the chain below can as well. The ankle can be tight, weak, or uncoordinated (usually these things all come together to some extent). The foot/ankle is a beautiful mechanism: it is both a shock absorber and a rigid lever we use to push with every step. It needs to maintain its inherent strength and flexibility (Read: Why I think Pronation Gets a Bad Rap) to fill both of these roles, and if it fails to do so, it will have an effect further up the chain, which means the knee.

To see our treatment techniques for the knee and other areas, see our videos page.