6 Common Causes of Knee Pain and How to Fix Them: Part 2

By dpope2020

January 7, 2013

anterior knee pain, chondromalacia patella, Crossfit, genu valgus, knee exercises, knee injury, knee pain, knee physical therapy, knee problems, knee symptoms, patellofemoral pain, patellofemoral pain syndrome, PFPS, runner’s knee

Knee pain sucks, especially if you’re an athlete.  Unfortunately runners, cross fit athletes and weightlifters commonly have knee pain.  Terms like chondromalacia patella, patellofemoral pain syndrome, runner’s knee and osteoarthritis have become commonplace.  Despite the complexity of each syndrome they all share a common theme.  They all come from poor movement.  Poor movement strategies over time lead to pain and degeneration in our knee joints.  It’s easy to blame this on genetics and some of this is probably hereditary but a large portion of it is not.  If we can fix our movement (our technique and the way we move) we can come away with a permanent cure to the root of the problem.

Like discussed in Part 1:

The only way to get permanent relief to knee pain is to fix the movements that caused the problem in the first place.

To reiterate: As with most injuries, once you’re hurt you’ll probably have to take some time off from exercises that bother your knees.  This is a great time to see a physical therapist or chiropractor.   Some soft tissue work and manual therapy is sometimes exactly what the doctor ordered to get this area to calm down and stop hurting.  While the area heals up and your knee pain starts to decrease you can get to work on fixing your movement.

Obviously, each person is different.  This is the internet and I’m not saying that everyone is going to have the same problems with the same solutions.  However, I see a lot of the same things over and over again with knee pain in this athletic population, and applying these principles have been successful.  If you’ve ever been diagnosed with chondromalacia patella, patellofemoral pain syndrome or IT band syndrome then this article is for you.

Fix #1 – Promote Ankle Mobility

If you lack flexibility in the ankle (Dorsiflexion) then whenever you challenge the end range of your joint, you’ll end up compensating to complete the motions.  Think about performing a deep squat or stepping down a step.  If you lack ankle mobility it could be the cause of a compensation at the knee which is commonly called dynamic genu valgus.  In lamen’s terms that means your knees travel inwards.   This puts you on the fast track to knee pain city.

Unfortunately this applies to every exercise that challenges the flexibility of your ankle (end range dorsiflexion in sciency terms).  That means the same thing goes for running, lunges, pistols, jumping and landing!  So let’s fix this.

Fix your Ankle Mobility:

Stretch your soleus

Fix #2 – Promote Foot Stability

What’s important to keep in mind is that our knees are slaves to our feet and hips.  If you’ve got poor movement (poor stability in this case) at the foot, you’ve got poor movement at the knee.  When I refer to stability it means being able to support your foot in the proper position.  This is known as the short foot posture.

The research supports this too, those with a flatter foot (more pronation) are more at risk for knee pain.  We’ve been wearing shoes to help support our feet our entire lives, is it any surprise that our feet are weak and lack stability?

Understanding the short foot position (creating foot stability)

Training the short foot for stability

The basic progressions to applying the short foot to your fitness routine.

***The biggest issue with retraining the foot is that it takes a lot of time, dedication and effort to build foot intrinsic strength and promote stability in the foot.  As discussed previously we’ve been babying our feet and inadvertently weakening them over time by wearing supportive shoes.

Fix #3 – Promote Hip External Rotation and Abduction Strength

Since our knees are a slave to our hips it makes sense to attack the hips in order to promote efficient movement at the knee.  I like to approach the hip with exercises specific to what we’d encounter in the gym.

Squatting Patterns

Lunging patterns

Single Leg Patterns

Notice how Pat does a great job of keeping his lower back and pelvis in a neutral position.  All of the movement is coming from his hips.  Ie: he isn’t letting his lower back round or rotate.

Fix #4 – Promote Hip Mobility

If we are tight in our adductor (groin) musculature and limited in hip external rotation and flexion then we’re going to run into some problems.  Limitations here will bring us right back into genu valgum at the bottom of a squat and that’s bad.  If we’ve got issues here we’re also opening ourselves up to hip pain and problems like femoral acetabular impingment (FAI) and subsequent hip labral tears.  So what’s the fix?

Mobilize your hip flexors and adductors

Working on hip external rotation mobility and mobilizing the hip’s posterior capsule

Fix #5 – Promote Core Stability

PFPS 6 Common Causes Of Knee Pain and How to Fix Them Part 1This picture beautifully sums up the problem at the pelvis, hip and foot that leads to a poor knee position.  Take note of what’s going on with that big bowl shaped bone in the person’s hips called the pelvis.  It’s tilting to the person’s left.  If we want to fix everything that’s wrong with this picture, we need to address the core and we’re going to do this by promoting stability.

Fix: Strengthen the Glutes, Hamstrings and Trunk musculature to reset the pelvis in a neutral position and keep it there while we move (exercise).

In this article we went over Lower Crossed Syndrome.  Our goal is to fix lower crossed syndrome to regain control of the pelvis.  We’ll also have to select exercises that challenge our core to combat rotation and lateral flexion, the specific forces that will lead to knee pain.

From the picture you can see that strengthening and therefore shortening) the rectus abdominis (6-pack muscles), glutes and hamstrings will help us stay in a better pelvic position.  A neutral position of the pelvis will help keep things downstream aligned better, including the knees.

Fortunately for us the exercises described to strengthen the hips have already started the process of strengthening the core.

In addition to strengthening the glutes and hamstrings (hips muscles), you’ll need to hit a few additional exercises  to challenge core stability.  I’m a big fan of certain plank exercises and dead bug variations because they challenge our core to resist rotation and that’s key for keeping our knees in proper alignment during exercise.

Dead Bug:  Make sure to keep your lower back flat against the floor, or atleast in a neutral position.

Around the World Plank Variation

The Chop popularized by Gray Cook.  We’re integrating all of the musculature that helps put our pelvis in the correct position.  We’re also challenging our ability to maintain this position by chopping with a band or cable.

Fix #6 – Fix your technique

So when we’re looking to correct knee pain we’ve got to take a total body approach.  I said it before and I’ll say it again.  I love foam rolling and other forms of soft tissue work, manual physical therapy and taping techniques as much as the next guy but…

The only real solution to the problem is going to be fixing the movement that caused the problem in the first place.

Treat each exercise you do in the gym as a skill.  Keep the weights heavy enough to get a training effect (build some strength and muscle) but light enough to ensure perfect technique.   Be honest with yourself.

Next time we’ll go over how to put all of this together in a program.  Until then remember, knee pain sucks.

Happy Knees,

Dan Pope