The Most Common Causes of Knee Pain: A Physical Therapist’s Perspective on Movement Impairments and Muscle Imbalances
When it comes to knee pain, many people believe that it’s caused by arthritis, a torn meniscus, or other structural damage seen on an X-ray or MRI. But from a physical therapist’s perspective, knee pain often stems from movement dysfunctions and muscle imbalances that cause the knee to move excessively in ways it shouldn’t.
These faulty movement patterns create uneven wear and tear on the knee joint, leading to pain, inflammation, and an increased risk of long-term joint damage.
Here are three of the most common knee dysfunctions we see in practice that cause knee pain and how to fix them.
1. Tibiofemoral Rotation Syndrome –The Twisting Knee
What It Is:
Tibiofemoral Rotation Syndrome occurs when the tibia (shinbone) and femur (thighbone) rotate excessively in opposite directions during movement. This rotational misalignment puts uneven stress on the knee joint, particularly on the ligaments, cartilage, and meniscus.
This condition is often caused by muscle imbalances between the quads, hamstrings, and glutes, as well as poor foot and hip mechanics.
Common Causes:
- Weak gluteus medius, which leads to poor hip stability
- Overactive hamstrings
- Overpronation of the foot, which causes internal rotation at the knee
How It Causes Pain:
- Puts excessive stress on the ACL and other knee ligaments
- Causes wear and tear on the meniscus
- Leads to patellofemoral pain syndrome (pain around the kneecap)
How to Fix It:
- Strengthen the glutes and hip stabilizers to improve knee alignment
- Improve foot mechanics to prevent overpronation and reduce knee rotation
- Correct movement patterns during exercises like squats and lunges to reduce twisting forces on the knee
2. Hip Knee Hyperextension Syndrome (HKE): When the Knee Extends Too Much
What It Is:
Hip Knee Hyperextension Syndrome (HKE) happens when the knee extends excessively beyond its normal range of motion, often before the hip extends properly during movements like walking, running, or squatting.
This dysfunction is caused by overactive hamstrings dominating over the quads and glutes, causing the knee to lock out prematurely. The result is excessive knee extension and instability, which can create pain and increase the risk of knee hypermobility.
Common Causes:
- Weak quads and glutes
- Overactive hamstrings
- Lack of ankle dorsiflexion mobility
- Poor neuromuscular control in the hip-knee-ankle chain
How It Causes Pain:
- Increases stress on the knee joint and ligaments
- Leads to chronic knee instability
- Causes excessive wear on the cartilage, increasing the risk of osteoarthritis
How to Fix It:
Hip Knee Hyperextension Syndrome (HKE) happens when the knee extends excessively beyond its normal range of motion, often before the hip extends properly during movements like walking, running, or squatting.
This dysfunction is caused by overactive hamstrings dominating over the quads and glutes, causing the knee to lock out prematurely. The result is excessive knee extension and instability, which can create pain and increase the risk of knee hypermobility.
3. Lack of Inferior Glide of the Patella (Superior Glide Syndrome): The Stiff Kneecap
What It Is:
This dysfunction happens when the patella (kneecap) doesn’t glide downward properly during knee flexion (bending). Instead, the patella remains stuck in an upward position because of tight quadriceps muscles.
The quadriceps tendon pulls the patella upward, and when it doesn’t glide down as it should during movement, it causes friction, irritation, and pain in the knee joint.
This is often seen in individuals with tight quads and poor knee mobility.
Common Causes:
- Tight quadriceps muscles
- Weak hamstrings and glutes
- Poor patellar mobility
How It Causes Pain:
- Leads to patellofemoral pain syndrome (pain around or behind the kneecap)
- Causes inflammation in the patellar tendon (patellar tendinitis)
- Increases the risk of chondromalacia patella (cartilage damage behind the kneecap)
How to Fix It:
- Stretch and release the quadriceps to improve patellar mobility
- Strengthen the hamstrings and glutes to balance muscle forces around the knee
- Work on improving knee flexion mechanics with manual therapy and patellar mobilization techniques
What Do All These Knee Dysfunctions Have in Common?
All of these knee dysfunctions stem from muscle imbalances and movement impairments that cause hypermobility at the knee joint.
When the knee becomes the “victim joint”, it moves excessively to compensate for poor movement patterns in the hips, ankles, or feet.
Over time, these compensations cause pain, inflammation, and long-term joint damage.
Why These Treatments Work (and Why Most Traditional Treatments Don’t)?
Traditional treatments for knee pain—like painkillers, injections, or even surgery—often focus on managing symptoms rather than fixing the root cause.
At Back In Motion, we use our Gray Method™ to address knee pain by:
- Detecting the underlying cause of knee pain through movement assessments
- Fixing the dysfunction with targeted exercises, manual therapy, and movement correction
- Getting you back to being active and pain-free without relying on surgery or medications
Final Thoughts – Stop Treating the Symptom, Fix the Cause
If you’re struggling with knee pain that just won’t go away, it’s time to address the root cause. Whether it’s Tibiofemoral Rotation Syndrome, Knee Valgus and Hyperextension Syndrome (HKE), or Lack of Inferior Glide of the Patella, a physical therapist can help you identify and correct the movement impairments that are causing your pain.
At Back In Motion, we specialize in helping active adults get back to doing what they love—pain-free and without risky treatments.
Take the Next Step Toward Knee Pain Relief
- Book a Free Movement Assessment to find the root cause of your knee pain.
- Learn more about our Gray Method™ for treating knee dysfunctions.
- Contact us today to inquire about costs and appointment availability.
Don’t let knee pain slow you down. Fix the cause, not just the symptom—and get back to your favorite activities!