The chain reaction Few Actually explain
If you’ve been dealing with knee pain for more than a few weeks, there’s a good chance the knee isn’t the problem. Often, it’s the victim of a problem happening somewhere else.
Your knee is sandwiched between your ankle and your hip. Both of those joints have to move correctly for the knee to function without getting overloaded. When either one fails, the knee compensates. Do that long enough and you get pain.
The most common scenario we see: limited ankle mobility changes the way the shin bone rotates during a squat or stride, which shifts the kneecap slightly off track. Or weak hip abductors let the femur drift inward with every step, stacking load onto the inner knee. Often it’s both at once.
What our assessment actually finds
We start every knee case with a movement screen. A double leg squat, a single leg squat, a step down from a box. In that 60 seconds we can almost always see where the problem is coming from.
Then we go joint by joint: ankle dorsiflexion, tibial rotation, hip internal rotation, glute strength.
Aside from movement imbalances, one of the main issues we find is certain muscles doing too much, and other muscles not doing enough. Often, either the hamstrings are quads are very dominant (doing jobs they’re not supposed to do). The TFL is dominant as well. This pulls on the IT band and frequently causes lateral knee pain. Here’s the thing though, so far- these are all symptoms of the problem. Other muscles, like your glutes, are not doing enough. And the issue is that doing “glute exercises,” doesn’t fix it. When you do the “right exercise,” your body is doing it using the wrong set of muscles. This is the reason most PT fails because when this happens, it only makes the problem worse.
The three phase approach
Phase one is manual therapy. We use hands-on treatment to reduce pain, calm the guarding response, and restore normal movement at the knee. Phase two is root cause work. We address whatever the assessment found. Phase three is progressive loading. Once the mechanics are cleaned up, we load the whole chain progressively so the gains stick.
Why it keeps coming back
The reason knee pain recurs is almost always the same: the symptom was treated without addressing the cause. Once you address the actual driver, the recurrence cycle tends to stop. The knee can finally do its job without being the weak link.
At Land and Sea PT in Oceanside, every session is 1-on-1 with a Doctor of Physical Therapy for a full 60 minutes. If your knee has been a recurring problem, we’d love to take a proper look at it.
If you want to contact us or book an appointment, check our business profile page.
Dr. Jonny Blue is a Doctor of Physical Therapy and founder of Land and Sea Physical Therapy in Oceanside, CA. He specializes in orthopedic PT, root cause methodology, and helping active adults in North County San Diego get back to the activities they love without surgery or pain medication.