The middle child of the lower limb
The knee is a hinge caught between two far more mobile joints: the hip above and the ankle below. When either of those neighbours stops doing its job — lost mobility, weak control, poor positioning — the knee is forced to compensate with movements it was never designed to perform.
This is why so many people treat their knee for months with little result: the pain is in the knee, but the problem often isn't.
How the kinetic chain works
Your lower limb functions as a linked chain. Every step you take, force travels from the ground through the foot, up the shin, across the knee, into the hip and pelvis. Each segment influences the next:
- From below: a collapsed arch or overly rigid foot changes how the tibia rotates — and the knee absorbs the difference on every single step. That's thousands of small misloads per day.
- From above: weak hip abductors and external rotators allow the femur to fall inward (dynamic valgus). The kneecap no longer tracks in its groove, and the patellofemoral joint becomes overloaded.
Research by Powers (2010) demonstrated that abnormal hip mechanics directly alter knee loading — and that patients with patellofemoral pain often show hip weakness rather than any structural knee deficit.
The classic patterns we see in clinic
1. Dynamic valgus — the knee that dives inward
Watch someone with this pattern do a single-leg squat: the knee collapses towards the midline. The cause is almost always proximal — gluteus medius weakness and poor pelvic control — yet the pain shows up at the front or inside of the knee.
2. The rigid foot — no shock absorption
A high-arched, stiff foot doesn't pronate enough to absorb impact. That impact has to go somewhere: usually the knee. These patients often present with anterior knee pain after running on hard surfaces.
3. The flat foot — too much rotation
Excessive pronation drags the tibia into internal rotation for too long during stance. The knee, trying to extend while its foundation is still rotating, suffers torsional stress — a common driver of medial knee pain.
Why a proper assessment changes everything
An MRI shows structure — cartilage, menisci, ligaments. It cannot show movement. Most recurring knee pain is a movement problem, which is why imaging so often comes back "normal" while the pain is very real.
Our assessment maps the entire chain: digital foot scan to quantify your foundation, biomechanical video analysis of gait and squat mechanics, thermography to locate the actual inflammation, and strength testing of the hip complex. Only then do we know whether your knee needs treatment — or protection from what's failing above and below it.
What treatment actually looks like
Depending on findings, a programme may combine MLS laser to settle the inflamed knee tissue, targeted hip strengthening, foot posture correction (sometimes with custom insoles), and movement re-education so the corrected pattern becomes automatic. Treating all links — not just the painful one — is what stops the cycle.
Persistent knee pain? Book a full-chain biomechanical assessment at Bruno Physical Rehabilitation, Ipswich.
References
- Powers, C.M. (2010) 'The influence of abnormal hip mechanics on knee injury: a biomechanical perspective', Journal of Orthopaedic & Sports Physical Therapy, 40(2), pp. 42–51.
- Barton, C.J., Lack, S., Malliaras, P. and Morrissey, D. (2013) 'Gluteal muscle activity and patellofemoral pain syndrome: a systematic review', British Journal of Sports Medicine, 47(4), pp. 207–214.
- Neal, B.S., Griffiths, I.B., Dowling, G.J. et al. (2014) 'Foot posture as a risk factor for lower limb overuse injury: a systematic review and meta-analysis', Journal of Foot and Ankle Research, 7, 55.
- Dye, S.F. (2005) 'The pathophysiology of patellofemoral pain: a tissue homeostasis perspective', Clinical Orthopaedics and Related Research, 436, pp. 100–110.
- Souza, R.B. and Powers, C.M. (2009) 'Differences in hip kinematics, muscle strength, and muscle activation between subjects with and without patellofemoral pain', Journal of Orthopaedic & Sports Physical Therapy, 39(1), pp. 12–19.