THE 3 Major Reasons For Knee Pain


Tissues that suffer from persistent and recurrent pain are tissues that are suffering. For many of us the stubborn little aches and pains we suffer in the first half of our lives are the warning signs of the wear and tear that becomes more serious as we get older. This can be particularly important in weight bearing joints that are prone to pain like the knee and the hip. That said, our happiness and basic freedom to enjoy life are affected hugely at any age if we cannot move without pain in the foot, hip and knee pain. 

Ask yourself, which joints do you hear of people get replaced due to osteoarthritis most often?

Knees and hips are major weight bearing joints. While we do suffer massive amounts of neck pain, shoulder pain and back pain in our culture, it is the knees and hips that suffer most from wear and tear due to the combination of sedentary lifestyle, weakness, weight bearing, long lives (high mileage) and hard urban surfaces. 

to illustrate appearance of knee pain

Knee pain is an extremely common complaint in our society..but why?

Not only are our stats for knee injuries, osteoarthritis and knee pain sky high, so are our stats for dramatic knee injuries like ligament and meniscus tears. The US stats for anterior cruciate ligament tears alone are estimated at 200,000 tears annually. Believe it or not, the majority of these knee pains and knee injuries that come on suddenly have their basis in repetitive strain that weakens the connective tissue of the knee.

Most knee injuries are not as random as they might seem! 

Two decades of managing cases of knee pain and knee injuries have left me feeling very certain about the causes. I have come to believe that while there are many more subtle contributing factors, there are 3 major causes that underpin virtually all the knee pain and knee injuries out there. 

Muscle Weakness 

The cartilage and connective tissue of the human knee relies very heavily on the surrounding muscles for support. When your heel strikes concrete at speed it is essentially the bone and joint tissue that sustains the stress of the impact. The fibrous ligaments and muscles help maintain alignment of the joints and bones during movement and weight bearing. 

The supportive role that muscles play means that maintaining good muscle strength is absolutely essential for the prevention of wear & tear, injury and niggly knee pains.

a prime candidate for a case of knee pain

Without healthy muscle volume around the knee joint we face increased risk of knee pain, knee injury and knee degeneration.

Ask any physiotherapist, sports chiropractor or osteopath what the most visible physical change is that they see in virtually every instance of stubborn knee pain. The answer is wasting of the vastus medialis muscle. You can bet your bottom dollar that this says alot about the true cause of knee pain. 

Urban Terrain 

Your ancestors walked near constantly on soft ground, when you are truly in the big outdoors the ground is nearly always softer than the urban environment and almost never flat. When you are on the beach, in the forest and on grasslands the level of support and shock absorption your heel and arch receive is many many times what concrete offers. Natural ground hugs and supports the foot, this helps with knee alignment.

image showing the true cause of knee pain and hip pain in our society.

Hard flat urban terrain is a major cause of knee pain in our society.

The uneven nature of natural surfaces and also the sheer number of obstacles that must be navigated stimulate and work the muscles of the knee in a big way. Nature gives a constant daily workout to the knee muscles. If you get this constant stimulation for all the knees stabilising muscles the likelihood of you developing knee pain and knee injury is greatly diminished. 

Foot Mechanics  

Healthy foot mechanics are essential to prevent knee pain and knee injuries. Whether or not you have healthy foot mechanics is largely down to the shape of your bones, and in part related to the strength of the muscles that support those bones. Some of us are born with lovely straight teeth, others a born with less than perfect grills. Similarly, some of us were born with anatomically superb bones in our ankles and feet and others were born with club feet. Life is in some ways a genetic lottery that we play. 

foot anatomy image depicting flat feet

Flat feet are one of many possibly foot issues that can influence knee pain.

High arches for example, are determined by the shape of your bones and the natural level of tension you have in your connective tissue. If you were born with high arches in your feet and you live in the modern world with its hard flat surfaces it can create a world of chaos for your knees. High arches were designed to have some external support which prior to the industrial revolution came from soft natural surfaces like soil, sand and mud. Without this natural support from soft ground 

Many people with high arches at some point or another end up needing treatment for knee pain and knee injuries. People who pronate excessively also often get knee pain and knee injuries. People who have very flat feet are also quite prone to knee pain and knee injuries. These are the major foot patterns and tendencies that can create knee pain but there are others. 

Closing Thoughts 

We are healthily and wisely brainwashed to be proactive in looking after our teeth from an early age. No such wisdom is applied to our feet, knee’s and hips. This lack of ‘wellness culture’ around the subject of knee pain, knee injuries and other lower limb complaints is a major factor that ties all the other factors together. 

One of the things we value most as a species is ‘freedom’. When it comes to knee pain there is a threat to our basic freedom to move but also enjoy the movement that forms part of a normal active life. This ultimate fact is why I believe that understanding the causes of knee pain and knee injuries is a worthwhile topic, and one that hopefully forms a stepping stone towards effective action in overcoming the challenges knee pain presents. 


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