Finding the Cause to Your Knee Pain Through Integrative Manual Therapy

With a diagnosis of knee pain there are many things to consider. I’m going to go over some of the more basic things first and expand from there to a more detailed and whole-body assessment in looking at the knee.



One of the basic ideas in physical therapy in general and Integrative Manual Therapy in particular is that the knee is usually the “victim.” It is not usually the actual cause of the problem, but merely the area that took the big hit or injury.



Even in a traumatic injury, the knee is rarely the primary problem, but instead is the location of the patient’s pain. The reason the knee expresses the pain is that it takes so much of the stress, being at the end of two long levers, the thigh bone and the lower leg bone. Forces are accentuated where they meet, and in this case they meet at the knee.



How does this translate clinically? Say someone comes in with a recent onset of knee pain. Maybe they have started a new exercise routine, or they have been doing some extra walking or standing. Maybe they actually “blew out” the knee with a traumatic sporting injury. Maybe they have no idea how it started, but they have a few-months history of knee pain that is not clearing up on its own.



When I see this type of patient, I may find tenderness to touch in a tendon or a ligament or along the joint line of the knee. I have found that knee pain is usually caused by a hip problem and/or a foot problem. I will usually also see one or more of the following: an asymmetry in the pelvis, a lack of motion in the back and hip more on one side than the other, a foot that lacks motion in the ankle, or a foot that has too much motion, causing a flat foot.



The problems at the hip, back and foot are placing undue stress at the knee and making it more vulnerable to injury. The imbalances are also not allowing healing to occur in the knee. These are common findings when looking at a knee patient from an orthopedic physical therapy model. The forces need to be balanced above and below the knee to allow good mobility and stability at the knee. Specifically, treatment to correct the imbalances at the knee and allow healing of the tendon, ligament or joint of the knee would involve balancing the pelvis, hip, and foot through manual therapy, exercises, and orthotics.