Knee pain
The knee that hurts.
Usually starts somewhere else.
A painful knee is almost always a downstream problem. The hip stopped controlling rotation. The foot lost its arch. The quad and glute stopped sharing the load. The knee is the joint that pays the bill. We trace it back, treat the cause, and the knee stops hurting.
The condition
The knee is a hinge between two ball-and-socket joints. Its problems usually live in those joints.
Most non-traumatic knee pain comes from how the hip controls femoral rotation and how the foot controls ground contact. When the hip lets the thigh rotate inward under load, the kneecap tracks poorly and the patellofemoral joint gets irritated. When the foot collapses, the tibia rotates inward and the same thing happens from below.
Common presentations: patellofemoral pain (front of knee, worse going downstairs or after sitting), runner's knee (similar pattern with running), meniscus irritation, IT band pain on the outside, and post-arthroscopic recovery where strength and mechanics have to be rebuilt. Each has a different mechanical pattern. Each gets evaluated specifically.
How we treat it
Hands-on the knee. Then up the chain.
The session starts with manual therapy at the knee itself: patellar mobilization, soft tissue work on the surrounding muscles, joint mobilization where needed. This calms the irritation that is currently maintaining the pain cycle.
Then the upstream and downstream work: hip stability, glute activation, foot mechanics, and movement retraining. The exercises are specific to where your particular pattern is breaking down. Two or three targeted things, done consistently. Running and athletic return is built into the program when relevant.
Why it works here
Not a knee-only protocol. Hip, knee, and foot evaluated together.
Knee PT that focuses only on the knee misses the mechanism. You can strengthen the quad and stretch the IT band for months without addressing why the kneecap is tracking poorly in the first place. Here, the evaluation includes hip control, foot mechanics, and gait, because that is where the actual pattern lives.
One clinician, one hour. Hands-on manual therapy is the majority of the session. The home program is small and specific. Most patients are returning to running, hiking, or the sport that aggravated the knee within six to ten sessions.
Questions
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Do I need an MRI or imaging first?
Usually no. Most knee pain has a mechanical pattern that the clinical evaluation can identify. Imaging is helpful if there was a traumatic injury, if surgery is being considered, or if symptoms include locking, true instability, or fail to respond to conservative care. We will tell you if imaging would change the plan.
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My doctor mentioned my meniscus. Do I need surgery?
For most degenerative meniscus tears, research strongly supports PT as the first-line treatment, with outcomes equivalent to surgery for non-locking patterns. Acute traumatic tears with mechanical locking are a different category and may need surgical consultation. The evaluation can usually tell which you have.
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I keep getting knee pain when I run. Is running bad for my knees?
No. Knee pain when running is almost always a mechanical pattern that can be addressed, not the running itself causing damage. The goal is to identify what is breaking down in your running mechanics or load capacity and address that, so you can run again without symptoms.