Why my knee hurts?

A patient who had undergone knee surgery approximately 10 years earlier came to our office because of persistent knee pain. At the time of the original surgery, the patient had been diagnosed with a meniscus injury, arthritis, and abnormal patellar movement. However, when we reviewed the patient's history, an important detail stood out: there had been no significant direct trauma to the knee. Instead, the patient reported having experienced significant low back pain for many years before the knee problems developed. After the knee surgery, the patient underwent physical therapy. However, knee exercises repeatedly caused severe pain, eventually leading the patient to stop physical therapy. Ten years later, the patient continued to experience chronic knee pain. Walking for more than approximately 15 minutes would cause a sharp, stabbing pain that became severe enough that the patient had to stop and rest before continuing to walk.

Looking Beyond the Knee

Our examination began with the knee itself. Interestingly, the knee joint did not show an obvious structural misalignment on examination. However, the quadriceps muscles were chronically tight, significantly restricting the patient's ability to bend the knee. We then carefully observed the movement of the patella while the patient's leg was moved through its range of motion. The patella did not track straight. Instead, it tended to move toward the inside of the knee.

The quadriceps muscle is actually made up of four muscles that work together to extend and control the movement of the knee. Ideally, these muscles should coordinate properly during movement. When the muscles remain chronically tight or do not function in a balanced manner, they can alter the tracking of the patella.

In this patient, the chronic tension in the quadriceps appeared to contribute to abnormal patellar tracking, which could increase stress and irritation around the knee during walking and bending. But the examination did not stop at the knee.

Examining the Spine and Pelvis

Because the patient also had a long history of low back pain, we examined the lumbar spine and pelvis. Our examination revealed significant findings around the lower lumbar spine, including restricted movement at L5 and the right pelvis, along with substantial tension in the muscles of the right lower back and hip.

X-rays provided additional information about the patient's spinal and pelvic alignment. The L5 vertebra appeared to be positioned posteriorly, affecting the normal curvature of the lumbar spine. The right side of the pelvis was also positioned approximately 6 mm anteriorly compared with the left, and there was an apparent difference in leg length of approximately 7 mm. These findings suggested that the patient's lower back and pelvic mechanics were affecting the way the muscles of the right leg were functioning.

How Can a Back Problem Affect the Knee?

This raises an important question:

How could a problem in the lower back contribute to chronic knee pain?

The body does not function as a collection of completely independent joints. The spine, pelvis, hips, knees, ankles, and feet work together as a kinetic chain. Changes in one area can alter movement and muscular demands in another.

From a chiropractic perspective, when the lower lumbar spine becomes mechanically dysfunctional, the surrounding muscles may become tight in an attempt to stabilize and protect the area. Over time, this muscular tension can affect the position and movement of the pelvis. Changes in pelvic mechanics can then alter how weight is distributed through the legs. For example, if more weight is repeatedly placed on one leg, the muscles surrounding the hip, thigh, and knee may have to work harder to maintain balance and stability. Over time, this can contribute to muscular fatigue, altered movement patterns, and increased stress on structures around the knee. The quadriceps and other muscles surrounding the knee play an important role in controlling the movement of the patella and stabilizing the knee during walking, climbing stairs, squatting, and other activities.

When these muscles are chronically tight or fatigued, normal knee mechanics may be affected. Abnormal patellar tracking can then increase irritation and discomfort around the knee. In some patients, what appears to be an isolated knee problem may therefore be part of a larger spine–pelvis–hip–knee mechanical problem.

Why Knee Treatment Alone May Not Always Be Enough

When someone visits an orthopedic office for knee pain, the evaluation naturally tends to focus on the knee. Imaging may identify arthritis, meniscus damage, cartilage changes, or other structural abnormalities. Depending on the condition, treatment may include medication, injections, physical therapy, or surgery.

These treatments can be appropriate and helpful when there is a specific structural problem that requires them. However, treating the painful area alone may not always address the mechanical factors contributing to the patient's symptoms. This is particularly important when knee pain is accompanied by chronic low back pain, hip tightness, pelvic imbalance, altered gait, or muscle tension. For example, if the lumbar spine and pelvis remain mechanically dysfunctional, repeatedly strengthening or exercising the leg without addressing the underlying movement pattern may sometimes place additional stress on the muscles and joints. This does not mean that physical therapy or exercise is inherently harmful. Rather, the right treatment should be based on the individual's condition, examination findings, and ability to tolerate the exercises.

The Importance of Looking at the Whole Body

The human body is an interconnected system. The spine provides the central structural foundation for movement, while nerves, muscles, joints, and connective tissues work together throughout the body. Because of these relationships, a problem in one region can influence movement and function in another. That is why, when a patient has chronic knee pain—especially when the pain does not fully improve after knee-focused treatment—it can be valuable to examine more than just the knee. The key question should not always be:

"What is wrong with my knee?"

It can also be:

"Why is my knee being stressed in the first place?"

In the patient described above, the knee was only one part of a much larger mechanical pattern involving the lumbar spine, pelvis, hip, and leg muscles.

How Can Nova Gonstead Chiropractic Help?

At Nova Gonstead Chiropractic, we do not look at knee pain in isolation. We evaluate the spine, pelvis, hips, and lower-extremity mechanics to determine whether spinal or pelvic dysfunction may be contributing to the way the knee is functioning. Using a Gonstead-based examination, we assess spinal and pelvic alignment, joint motion, muscle tension, posture, and other clinical findings to develop an individualized treatment approach. If you have chronic knee pain, recurring knee problems, abnormal patellar tracking, or knee pain accompanied by low back or hip problems, it may be worth looking beyond the knee itself. Your knee may be where you feel the pain—but understanding why the knee is being stressed may require looking at the entire kinetic chain, beginning with the spine and pelvis. If you have persistent or worsening knee pain, especially after an injury or surgery, a comprehensive evaluation by an appropriate healthcare professional can help determine the underlying cause and the most appropriate treatment. 

NoVA Gonstead Chiropractic Clinic
9514 Lee Hwy (Route 29), Suite B
Fairfax, VA 22031
(703) 359-6262