What's Actually Driving Your Knee Pain
The knee is one of the most frequently treated joints in musculoskeletal care. It's also one of the most frequently treated in the wrong place. The knee is where the pain shows up. But in a large portion of cases, the knee isn't where the problem originates.
Understanding what's actually driving knee pain changes the treatment approach entirely. And getting that wrong is one of the main reasons knee pain keeps coming back after treatment.
The knee is a victim of what’s above and below it
The knee is a hinge joint. It flexes and extends. It's not designed to control significant rotation or side-to-side movement on its own. The hip above and the foot and ankle below are responsible for controlling those forces. When either of those areas isn't functioning properly, the knee absorbs the mechanical consequences.
Hip abductor and external rotator weakness is one of the most well-documented contributors to knee pain, particularly patellofemoral pain syndrome, which is the most common knee complaint in active and athletic populations. When the gluteus medius and hip external rotators are weak or poorly coordinated, the femur internally rotates and adducts under load. That shifts the position of the kneecap relative to the groove it tracks in, creating abnormal contact pressure and irritation. The research is consistent: runners with patellofemoral pain demonstrate significantly lower hip abduction strength than pain-free runners. Strengthening the hip is one of the most evidence-based interventions for front knee pain.
The same principle applies below the knee. Excessive pronation at the foot and ankle, poor single-leg stability, and restricted ankle dorsiflexion all create compensatory forces that travel up the kinetic chain and load the knee in ways it wasn't designed to handle repeatedly.
The name of the diagnosis describes where the pain is. It does not describe what is causing it.
The three presentations we see most
Each has a different mechanism and a different treatment priority, which is exactly why the diagnosis matters.
Patellofemoral pain syndrome
Sometimes called runner's knee. Irritation at the joint between the kneecap and the femur, presenting as a dull aching pain around or behind the kneecap that worsens with running, squatting, stairs, and prolonged sitting. Contributing factors include hip abductor and rotator weakness, quadriceps weakness, poor patellar tracking, rapid training load increases, restricted hip or ankle mobility, and myofascial tightness in the IT band and quadriceps. Strengthening exercises targeting hip, knee, and core have strong evidence; passive treatments alone are much weaker.
IT band syndrome
One of the most misunderstood overuse injuries in running. The classic friction explanation has largely been revised: current understanding points toward compression and tension at a fat pad beneath the IT band. The drivers are similar, though, hip abductor weakness, training load spikes, restricted hip mobility, and poor running mechanics. The IT band is dense connective tissue that does not meaningfully lengthen with stretching, so load management, hip strengthening, soft tissue work to the lateral hip, and dry needling into the tensor fasciae latae and gluteus medius produce far better results than stretching it repeatedly.
Patellar tendinopathy
Sometimes called jumper's knee. Irritation and degeneration of the patellar tendon at its attachment to the lower kneecap, most common in athletes who jump, sprint, or load the lower body heavily. The key driver is excessive or poorly managed tendon load relative to what the tendon can currently tolerate. Treatment centers on progressive tendon loading through heavy slow resistance exercise alongside load management. Dry needling can reduce local pain and facilitate the rehab process, but passive treatment without loading progression rarely lasts.
How we approach knee pain
Every knee presentation at The Resilience Lab gets a full lower extremity assessment that includes the hip, knee, and foot and ankle. We look at single-leg squat mechanics, hip abductor and rotator strength, patellar tracking, ankle dorsiflexion, and the presence of trigger points in the surrounding musculature.
We also look at training load. A rapid increase in running mileage, volume, or intensity is one of the most common triggers for knee pain in active people. Understanding the load history is as important as the physical assessment.
Treatment combines chiropractic care to the knee, hip, and lumbar spine as indicated, dry needling into the quadriceps, IT band complex, and surrounding musculature, soft tissue work, and progressive functional rehab that rebuilds hip strength, movement quality, and load capacity. The goal is to address both the immediate pain and the mechanical reasons it developed so the knee can handle the demands you're placing on it.
Knee pain that keeps returning?
Book an appointment and we will assess the hip, knee, and ankle together, plus your training load.