Knee Pain

Knee Pain

Knee pain.  It’s not just for “old people” and former athletes.  Knee pain affects people of all ages (growing pain anyone?), all activity levels, and all sizes.  A quick Google search for “knee pain” yields about 11,000,000 results in under a half a second.  One study found that on average 21% of Asians reported knee pain, and another study found that 30% of Germans reported knee pain.  American studies show similar results.  Knee pain is more common in women than men (I’ll explain why later) and increases with age for both sexes.

At first glance, the knee seems to be fairly simple.  It bends and straightens, right?  I mean, so does the elbow, and you don’t hear nearly as much about pain there.  And yet, the knee is the most common joint for pain.  So why the problem?  What causes knee pain?  And more importantly, what can be done about it?

Back when I was in junior high and high school (OK, maybe college, too) the knee was classified as a simple hinge joint.  And like the hinge on your door, it moved forward and back.  Well, time and science have taught us that it is far more complex.  In fact, the knee is the most complex joint in the body.  Although it looks like the knee only bends and straightens, a slight amount of “twisting” also takes place at the knee every time it moves.  And while other joints like the elbow or hip have great bony stability, the knee has very little.  Instead, the knee is stabilized almost entirely by ligaments which are reinforced by muscles.  That makes a lot of components that can have problems.

And because the knees support everything above them, the simple act of walking more than doubles your body weight from the perspective of your knees.  Running can quadruple that force.  (Anyone have New Year’s resolutions to lose weight?)

Is it any wonder that joints which can sustain up to 4x your body weight and rely on small ligaments and muscle coordination for stability end up having problems?

Causes of knee pain

Knee pain can come from several general causes, many of which overlap.

  • Trauma
  • Degenerative conditions
  • Biomechanics (imbalances, weakness, structural abnormalities)
  • Overuse

Trauma causes direct injury to the knee and includes sprains, strains, and fractures.  While technically a “sprain”, meniscus tears usually also fall under trauma.  ACL tears are another example.

Degenerative conditions are the result of normal wear-and-tear.  Arthritis is the most common, but also included are patellar chondromalacia and a specific type of meniscus tear.

Biomechanics refers to the way a joint is put together and how its parts work together.  When muscles on one side of a joint are too tight, it puts abnormal stress on the joint as it moves.  The same thing happens when muscle strength is out of proportion or unbalanced.  Poor biomechanics can both cause knee pain and aggravate other causes of it.  Examples of biomechanical knee problems include “bow-legged”, “knock-kneed”, Osgood-Schlatter disease, patellar tracking disorder, runner’s knee, and even plica syndrome.  This is also why women tend to have more knee problems than men.  When the pelvis fans out, creating “feminine” hips, it creates a sharper angle between hips and knees and puts additional strain on the inside of the knee.

Overuse injury is usually the result of altered biomechanics over a long period of time, but any motion repeated excessively and with enough force can begin to break down structures.  Examples include patellar tracking disorder, runner’s knee, and tendonitis.

6 Things You Can Do For Knee Pain

Regardless of the cause, most knee issues have some problems in common that can easily be addressed at home.

(# 1 & 2) Two of the biggest biomechanical factors of knee pain are poor hamstring and quadriceps flexibility.  Both muscles cross two joints—the hip and knee.  I have already mentioned the importance of hamstring flexibility in treating low back pain.  It is equally important to knee pain.  The hamstrings cover most of the back of the thigh.  They bend (flex) the knee and straighten (extend) the hip.  When walking or running, they pull the body over the planted foot.  They also help stabilize the knee, supporting the ACL.  The quadriceps are the large muscle on the front of the thigh.  They help bend the hip (raise the knee when walking) and straighten (extend) the knee.  They prevent the knee from buckling when you put weight on your foot.  Tightness in one or both of these muscles drastically changes how well you knee works.

Here are some stretches for your hamstrings and quads:



Lay on your back with one leg on the ground through a doorway or at a corner.  Rest the other heel on the wall so that you feel a gentle stretch.  Lay in this position for 10 minutes each side.




Lay on your back with a rope or strap around one foot. Lock the knee on that leg and slowly raise it as high as you can. Pull gently on the strap to get extra stretch. Hold 3-5 seconds. Repeat 20-30 times.

Lay on your stomach with one leg off the edge of the bed or table and your knee bent above your hip. With your hand or a strap, bend the other knee toward your buttocks until you feel a stretch on the front of your thigh. Hold 10-30 seconds. Repeat for up to 2 minutes total.


(# 3) Another common factor in knee pain is uncoordinated muscle contraction, particularly of the quadriceps.  It is not unusual to see someone who has good knee strength but still has knee pain.  The outer part of the quads can overdevelop and the inner part doesn’t develop enough.  Incorporating a straight leg raise into your routine can help balance the parts of the quads.  Just be sure your knee is “locked” as you raise it!

Lay on your back with one knee bent. Lock the opposite knee and raise it 12-18 inches off the floor. Slowly lower. Repeat 60 times.

(# 4) Strengthen your core and glutes.  A weak core allows your spine and pelvis to fall into the easiest position, changing how well your hips and knees move.  Weak hips can cause the knees to collapse inward, putting additional strain on the inside of the knee.  Here are a few of my favorite core and glute exercises:

Plank—Lay face down with your arms bent and elbows under your shoulders.  Hands should be straight forward, not turned in.  Flex your toes down into the floor.  Rise up on your elbows and toes.  Hold 5-10 seconds.  Repeat 10 times.  Do not let your hips sag or form a teepee.

Bridge—lay on your back with your knees bent.  Perform a pelvic tilt and raise your hips up.  Try to make a straight line from your shoulders to hips to knees.  Hold 5-10 seconds.  Repeat 15 times.

Bird dog—starting from hands and knees, find a “neutral spine” by sagging and arching your back.  Hold this neutral position and raise one leg backward.  At the same time, raise the OPPOSITE arm.  A stick or rolled up towel placed across the low back can give you feedback about whether you are stabilizing your back well.   Hold 5 seconds.  Repeat 15 times per diagonal.


(# 5) Heat things up.  Take a hot bath or use a hot pack for that sore, aching knee.  However, do NOT try this right after an injury or when you have these 4 symptoms:  heat, redness, swelling, and pain.  In that case, ice is your best option.

(# 6)  Reduce the forces on your knee.  Consider biking or swimming instead of running or stair machines.  Lose weight.  If walking more than doubles the force of your bodyweight on your knees, think about the effects of an extra 10, 20, or 30 pounds!

Bonus:  if you are starting a new exercise program, ease into it.  Start low on the weights and low on the distance, then gradually increase as you build strength and endurance.


There are times to seek medical attention for your knee pain:

  • Your knee doesn’t “look right” after an injury. (Bent unusually, very swollen, etc.)
  • Your knee pain is accompanied by heat, redness, and swelling.
  • You can’t put weight on your knee or it gives out.
  • You can’t bend or straighten your knee completely.
  • You have tried the 6 tips above for 6 weeks or more and your knee pain is not improving

Admittedly, I am biased, but a physical therapist is a great place to start when seeking medical advice for painful knees.  Many knee problems can be addressed without medication, injections, MRI’s, or surgery.  A physical therapist can evaluate your knee pain and develop a treatment plan to meet your individual needs.

**As always:  this blog is not intended to diagnose or prescribe specific treatment for individuals.  If you have a history of serious medical problems, questions, or other concerns, consult an appropriate medical professional.**

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