Knee pain: It may be all in your hips

You’re trying to get yourself back into shape, eating healthy, hitting the stair master, lifting or jogging… everything you’re supposed to do right. BUT, after a couple weeks your knees start to bug you. You wonder: “Am I doing too much? Am I too old for this? What am I doing wrong?” Someone suggests shoe inserts, someone says don’t buy inserts. What next?

Knee pain can be a tricky and is also one of the most common issues we see. The knee is the center point of what us PTs (or to-be PT in my case) call the “kinetic chain” of the lower limb. This kinetic chain involves the lower back, hip, knee, ankle and foot. Dysfunction at any part of this chain can be the underlying cause of knee pain. Determining where and why this dysfunction is occurring is the key to solving most knee issues.

One of the first things we try to determine is if your legs are resting in similar alignment, if leg-length-discrepancy-not we call this a leg length discrepancy. Leg length discrepancies generally fall into two broad categories: structural or functional.

Structural discrepancies account for a very small percentage of what we see and stem from anatomical differences in the length or shape of the bones of the leg. This usually results from previous injury, illness or can be present from birth. Structural discrepancies are a little more challenging to treat dalton01__1_1_5760and sometimes require orthotics, inserts or other devices to help your body compensate for the anatomical differences.

With functional discrepancies, all the bones are the right size and shape but aligned incorrectly. This can be caused by a variety factors like posture, muscle imbalances, restricted joints or training errors. Functional discrepancies are usually correctible with manual therapy to realign the bones and exercise techniques to help the correction to stick. Shoe inserts are typically not useful for functional discrepancies because they don’t correct the underlying alignment issue and can actually lead to more problems.

It’s impossible to create a single solution that will fix every individual person’s pain and discomfort. Interventions must be tailored to each patient’s unique profile. Before investing in a pricey pair of orthotics it’s important to determine if you are actually likely to benefit from their use or if you would be better off with corrections and therapeutic exercise

Kit Durban, SPT

Physical Therapy Student, Boston University

Synergy North Clinic




Knee Pain and Your Kinetic Chain

The knee joint needs to be trained and strengthened properly to avoid excess wear and tear (arthritis) on the joint that can eventually lead to knee pain. Running, hiking, agility training, yoga, and even strength training improperly can create or increase improper knee mechanics leading to pain or even arthritic conditions. On the flip side, performing proper balanced exercise routines can help reduce knee pain and slow down the production of arthritis in the knees. Decreasing knee pain or joint break down can also help regulate energy expenditure, increase overall performance, and slow down the production of arthritis.

Stretching and strengthening are always good to increase joint performance and improve joint mechanics. Closed chain exercises (squats, lunges, and leg presses) are more functional for lower extremity joint strengthening. However, these exercises done improperly can create increased pain.  Ideally you should be performing these exercises with your weight in the heel and the base of the big toe to engage gluteus maximus which helps support knee function while decreasing forces being distributed in the knee joint. Two additional open chain exercises (exercises done without your feet planted on the ground) that can increase glute strength are the clamshell and side lying hip abduction (see pictures). Lastly, hip flexor and calf stretches held for 30 seconds or longer can complete a great routine for the biomechanics of the knee.

Mechanically the knees, feet, ankles, hips, and spine all coordinate to provide the linear motion and disperse the impact during walking or running so individual joints do not take all of the gravitational forces. Structurally, if all these joints are coordinating their movement and muscle firing patterns, then in theory no pain should exist and arthritic production will decrease.  If there is stiffness or tightness in spine or other lower extremity joints, it can lead to excessstress and impact on the knee joint during running, walking, or even standing. This is why when assessing a runners form, we typically begin in the hip and lower spine and move down the kinetic to the foot, then reverse this and assess the ankle/foot on up ensure the runner is able to maintain the proper lower extremity mechanics. To read more on the kinetic chain during running check out this article on RunningMechanics,com, “Running Injuries and Kinetic Chain Disruptions.

Decreasing knee pain can simply take a few extra steps to improve function and lower extremity mechanics. With these additions to a training regimen the lower extremity joints will perform better, improve knee pain and reduce the breakdown of the knee joint. So if you are suffering from knee pain, rather than just “running through it”, try a few of the tips I suggested above. If this doesn’t help within a few weeks stop by one of our clinics for a thorough assessment by one of our physical therapists trained in running and gait mechanics. We look forward to helping you!

– Brett Barnes, PTA

Synergy Manual Physical Therapy

North Office (map)
4105 Briargate Parkway
Suite 255
Colorado Springs, CO 80920
phone 719.282.2320
fax 719.282.2330

South Office (map)
600 South 21st Street
Suite 130
Colorado Springs, CO 80904
phone 719.634.1110
fax 719.634.1112