The saying goes “when there is pain, look at the joint above and below to find the root of the problem”.
This is a more modern approach to resolving injuries and pain, as opposed to simply looking at the knee.
In order for a global approach for long-term results, I’m concerned with three areas: The pelvis, the tibia, and even the ribcage.
This image effectively describes how joints should function in the body. The knee is a stable joint and there should be requisite mobility at both the ankle and hip. If either of those are out of proper position, the knee and surrounding bones are going to compensate to find stability.
HOW DOES KNEE PAIN DEVELOP?
When I hear “knee pain” I hear “torque”. It starts with either the thorax (ribcage) and/or pelvis.
When the pelvis is too forwardly tipped on one side, it causes the femur to slide forward and externally rotate in the hip socket. The femur has no choice but to follow the pelvis.
Let’s continue with that example.
When the femur externally rotates, or turns out, there’s a couple of things that can happen at the tibia. Either:
- It will internally rotate to try to straighten the leg out
- It will also be externally rotated.
Either situation can cause the foot to excessively pronate, putting potential stress on the medial knee.
When this happens, the knee is torqued. The muscles responsible for this are:
- An overactive hip flexor and glute max that is setting the pelvis forward
- Lack of hamstrings to pull to pelvis back
- Lack of gluteus medius (anterior fibers) and adductors to properly orient the femur in internal rotation
Improper shoewear is also often at fault, but that’s a different story for a different day.
The important thing is that it all starts at the pelvis, but the ribcage is also a significant player.
Notice the anterior tilt. This causes the hip flexors and low back to be short, tilting the pelvis forward. The anterior ribcage becomes flared up because of a lack of obliques holding the ribcage down.
Therefore, a ribcage that is out of position can potentially cause the anterior tilt of the pelvis, and then it all descends into the aforementioned compensations from there.
WHAT CAN I DO?
We need to focus on inhibition and facilitation. The hip flexors need to be balanced out by hamstrings to pull the pelvis back. The obliques, adductor, and gluteus medius muscles need to become active to orient the femur into a more neutral state.
Each case is individual. It needs to be determined if the problem originated at the pelvis or ribcage. If either of those are out of position, there can be no long-term solution.