Knee Pain

Lingering Knee Pain? Here are Four Hidden Culprits

Approximately 25% of adults suffer from chronic knee pain without any clear reason why.

For some, aging and arthritis are to blame, and it’s something to just “live” with. For others, they’re told it’s due to “wear and tear.” Yet despite one or more surgeries to “clean out the knee,” the pain lingers and persists. 

So why do some people age, develop arthritis, and put lots of wear and tear on their knees without any issues, while others suffer from chronic knee pain?

The answers may surprise you. 

Here are four hidden culprits that contribute to lingering knee pain that are often missed or overlooked:

1. It’s Actually Your Back

Did you know that 40% of the time, an extremity problem (such as in the knee or shoulder) originates from the spine, even when you don’t experience neck or back pain? It’s more common than you think for knee pain to be caused by issues in your lower back. When this is missed, it can lead to knee pain that never seems to resolve. True knee problems typically present with symptoms that are specific and localized to the knee joint. However, if your pain moves around your knee or travels up and down your leg, there’s a good chance it’s actually coming from your back. If you’ve been treating your knee for months or years without success, consider that the problem might be your back, especially if cortisone injections and various knee procedures have had little effect.

2. You Have a Weak Core

Most people associate core strength with preventing and resolving back pain, but it’s also crucial for good knee health. Your abdominals, low back muscles, hips, and glutes make up your “powerhouse,” or core, which greatly influences how well your lower extremities function. If your core is weak, your legs will have to work harder and overcompensate, often leading to knee pain. Although knees require some stability to function well, they aren’t designed to be stabilizing joints – that’s the role of your hips and ankles. If your core, particularly your hips and glutes, is weak and your knees start compensating as stabilizers, this could be why they keep hurting. If you haven’t had your core strength properly assessed, now might be the time – this could be the culprit.

3. Instability in Your Ankles

If your ankles aren’t strong enough to stabilize your foot and lower leg, your knees will compensate, which can lead to knee pain. When a joint lacks strength or stability, it will often stiffen up to compensate. If your ankles lack range of motion and are weak, your knees will bear the burden. This is particularly evident during activities such as running, hiking, or playing sports like pickleball or tennis. Good ankle mobility and stability are essential for these activities, or else your knees will suffer. If you have lingering knee pain and haven’t examined your ankles, it might be time to do so – they could be the overlooked issue.

4. You Lack “Hyper” Mobility

Early in my career, “hyper” mobility was often considered a bad thing. However, research and experience have shown that a joint that moves fully and freely functions better and allows the surrounding muscles to work optimally. Many people mistakenly focus on muscular strength as the solution to pain when they should be looking deeper. For knees, you need a bit of “hyper-extension” or more-than-straight flexibility. Most practitioners focus only on how well a knee bends. But it’s just as important to pay attention to how well a knee extends – and just getting to “straight” is often not good enough. I see this a lot with folks who’ve had surgery. If full knee extension (including hyperextension) wasn’t restored properly during your post-op rehab, knee pain will persist, or show up months to years later and you’ll have no idea why. Ensure you have full knee extension that includes a bit of hyperextension and that it matches your other knee – this could be why your knee pain isn’t going away.

Knee pain can be tricky to figure out, especially if it’s chronic. The key to successfully getting rid of knee pain starts with correctly identifying the cause. From my experience, arthritis, age, and wear and tear serve as “excuses” when a practitioner doesn’t know where to look. If you’re suffering from chronic knee pain and haven’t explored any of these four possible hidden culprits – talk to a specialist who understands how to look at the bigger picture. The true cause of your lingering knee pain might be elsewhere.

Dr. Carrie Jose, Physical Therapist and Pilates expert, owns CJ Physical Therapy & Pilates in Portsmouth and writes for Seacoast Media Group. To get in touch or sign up for her upcoming Masterclass for Knee Pain Sufferers – CLICK HERE.