Knee Pain

What knee pain is

Knee pain is pain in or around the knee joint, most often from how the knee is being loaded by structures above (hip, trunk) and below (foot, ankle) — runner’s knee, ITB syndrome, jumper’s knee, and similar overuse patterns dominate in active patients. Most knee pain is mechanical, responds well to assessment-driven exercise and hands-on care for the hip and foot drivers, and doesn’t need imaging or a specialist visit to start improving.

What’s actually going on

The knee is a hinge joint that has to handle the loads delivered to it from above (hip and trunk) and below (foot and ankle). When the hip is weak, the foot collapses inward, or the trunk is poorly controlled, the knee ends up absorbing forces it wasn’t designed to absorb in directions it doesn’t move well. The result is the constellation of overuse knee issues we see in active patients — runner’s knee, ITB syndrome, jumper’s knee, and others.

Some specifics on the most common presentations:

• Patellofemoral pain syndrome (“runner’s knee”) — pain at the front of the knee, especially with stairs, squatting, or sitting for long periods. The kneecap isn’t tracking well in its groove, often because of weakness in the hip or foot mechanics that load it unevenly.
• Iliotibial band (ITB) syndrome — pain on the outside of the knee, classically worse with running (especially downhill) and longer distances. The ITB is a long fascial band running from the hip to the lateral knee; tension in the structures it connects to creates friction at the knee.
• Patellar tendinopathy (“jumper’s knee”) — pain at the bottom of the kneecap, especially with jumping or rapid direction changes.
• Meniscus issues — often after a specific twisting injury, with localized pain, sometimes catching or locking.
• Post-acute injury knees — sprains, strains, or injuries that haven’t fully resolved.

A useful framing: knees rarely fail because of the knee. They usually fail because of what’s happening above and below.

When to see someone

It’s worth coming in for knee pain when:

• Pain has been present for more than two weeks
• It’s affecting your training, work, or daily activities
• It’s recurring after previous episodes
• You’re avoiding movements because of it

Urgent medical care is warranted if:

• Significant swelling immediately after injury
• Inability to bear weight after trauma
• A clear “pop” or “give way” sensation during injury
• Locking that prevents the knee from straightening
• Suspicion of fracture or ligament tear after a fall or collision

How we treat it

For the typical biomechanical knee pain we see, treatment usually combines:

• Assessment — confirming the specific presentation, looking carefully at hip strength, foot mechanics, and overall lower-extremity loading patterns.
• Chiropractic care — for any joint involvement at the hip, knee, or foot/ankle. Knees often respond well to addressing the joints around them.
• Soft-tissue work — ART and Graston Technique® for the ITB, quadriceps, hamstrings, calf, and surrounding fascial restrictions.
• Registered massage therapy — for broader muscle tension and recovery support.
• Exercise rehabilitation — the main intervention long-term. Hip strengthening (particularly glute medius and hip external rotators), quad strengthening with attention to vastus medialis, foot intrinsic and calf work, and progressive loading back into the demanding activities.
• Custom orthotics when foot mechanics are clearly contributing — but used selectively, not as a default.

Most biomechanical knee pain responds well within four to eight weeks of a structured plan. Acute injuries (meniscus, ligament) often take longer and may need imaging or surgical consult — we’ll flag that when it’s appropriate.

What about prevention

For runners, cyclists, and other endurance athletes, the biggest knee-protective interventions are usually the unsexy ones:

• Hip strength — particularly the glute medius and hip external rotators
• Calf and foot capacity — these absorb a great deal of running load
• Gradual progression — increasing training volume slowly enough that the tissues can adapt
• Mixed training — adding strength work to a primarily endurance routine
• Running form basics — cadence and footstrike issues sometimes matter, but they’re usually a smaller piece than people think

The “knee-saving” gear and supplements industry is large and mostly unsupported by evidence. The boring, foundational work is what actually keeps knees happy.

Related reading

• What we tell our pickleball patients (you know who you are) — the typical knee, Achilles, and elbow patterns we see from playing five days a week.