Dr. Reed Jarvis, DC | Owner & Chiropractor, The Resilience Lab | Louisville, TN
The knee is one of the most frequently treated joints in musculoskeletal care. It's also one of the most frequently treated in the wrong place. The knee is where the pain shows up. But in a large portion of cases, the knee isn't where the problem originates.
Understanding what's actually driving knee pain changes the treatment approach entirely. And getting that wrong is one of the main reasons knee pain keeps coming back after treatment.
The knee is a victim of what's above and below it
The knee is a hinge joint. It flexes and extends. It's not designed to control significant rotation or side-to-side movement on its own. The hip above and the foot and ankle below are responsible for controlling those forces. When either of those areas isn't functioning properly, the knee absorbs the mechanical consequences.
Hip abductor and external rotator weakness is one of the most well-documented contributors to knee pain, particularly patellofemoral pain syndrome, which is the most common knee complaint in active and athletic populations. When the gluteus medius and hip external rotators are weak or poorly coordinated, the femur internally rotates and adducts under load. That shifts the position of the kneecap relative to the groove it tracks in, creating abnormal contact pressure and irritation. The research is consistent: runners with patellofemoral pain demonstrate significantly lower hip abduction strength than pain-free runners. Strengthening the hip is one of the most evidence-based interventions for front knee pain.
The same principle applies below the knee. Excessive pronation at the foot and ankle, poor single-leg stability, and restricted ankle dorsiflexion all create compensatory forces that travel up the kinetic chain and load the knee in ways it wasn't designed to handle repeatedly.
Patellofemoral pain syndrome: the most common knee diagnosis in active people
Patellofemoral pain syndrome, sometimes called runner's knee, involves irritation at the joint between the kneecap and the femur. It presents as a dull aching pain around or behind the kneecap that worsens with loading activities like running, squatting, stairs, and prolonged sitting. It's one of the most common conditions in recreational runners and active adults.
The name describes where the pain is. It doesn't describe what's causing it. The contributing factors include hip abductor and rotator weakness, quadriceps weakness, poor patellar tracking mechanics, overtraining or rapid training load increases, restricted mobility through the hip or ankle, and myofascial tightness in the IT band, quadriceps, and lateral retinaculum.
Strengthening exercises targeting the hip, knee, and core musculature have strong evidence for reducing pain and improving function in people with patellofemoral pain. The evidence for other passive treatments alone is much weaker. Load management matters as much as the treatment itself.
IT band syndrome: a tension problem, not a friction problem
IT band syndrome is one of the most misunderstood overuse injuries in running. The classic explanation, that the IT band rubs against a bony prominence on the outside of the knee, has largely been revised by more recent research. The current understanding points toward compression and tension at a fat pad beneath the IT band rather than simple friction. But the underlying drivers are similar: hip abductor weakness, training load spikes, restricted hip mobility, and poor running mechanics.
Treating IT band syndrome requires addressing those drivers, not just stretching the IT band repeatedly. The IT band is a dense connective tissue structure that doesn't meaningfully lengthen with stretching. Load management, hip strengthening, soft tissue work to the lateral hip musculature, and dry needling into the tensor fasciae latae and gluteus medius produce better and more durable results.
Patellar tendinopathy: a load problem
Patellar tendinopathy, sometimes called jumper's knee, involves irritation and degeneration of the patellar tendon at its attachment to the lower kneecap. It's most common in athletes who do a lot of jumping, sprinting, or heavy lower body loading. The key driver is excessive or poorly managed tendon load relative to what the tendon can currently tolerate.
Treatment for patellar tendinopathy is centered around progressive tendon loading through heavy slow resistance exercise, alongside load management of aggravating activities. Dry needling can reduce local pain and facilitate the rehab process. Passive treatments alone without loading progression rarely produce lasting results.
How we approach knee pain
Every knee presentation at The Resilience Lab gets a full lower extremity assessment that includes the hip, knee, and foot and ankle. We look at single-leg squat mechanics, hip abductor and rotator strength, patellar tracking, ankle dorsiflexion, and the presence of trigger points in the surrounding musculature.
We also look at training load. A rapid increase in running mileage, volume, or intensity is one of the most common triggers for knee pain in active people. Understanding the load history is as important as the physical assessment.
Treatment combines chiropractic care to the knee, hip, and lumbar spine as indicated, dry needling into the quadriceps, IT band complex, and surrounding musculature, soft tissue work, and progressive functional rehab that rebuilds hip strength, movement quality, and load capacity. The goal is to address both the immediate pain and the mechanical reasons it developed so the knee can handle the demands you're placing on it.
