Knee Pain: How to Find the Root Cause & Fix It
Knee pain: the 60-second answer
- Knee pain does not always originate at the knee. Hip, ankle and lower-back function can influence how the knee moves and is loaded.
- Common contributors include reduced hip strength or mobility and limited ankle movement. These factors can alter lower-limb movement.
- A simple movement assessment can provide useful clues. Look at your squat, ankle movement and lower-back mobility rather than focusing only on the painful area.
- Treatment should match the cause. Depending on the presentation, this may include mobility work, strengthening and progressive functional exercise.
What is the most common cause of knee pain? There isn't one single cause. Knee pain can arise from the knee itself, but it can also be influenced by how the hip, ankle and lower back function together.
This matters because simply resting the knee, strengthening the quadriceps or treating the painful area may not address every factor contributing to the problem.
In clinical practice, I often assess the entire lower limb rather than treating the knee in isolation. The goal is to identify what may be contributing to the pain, then restore the mobility, strength and movement capacity needed to get you moving confidently again.
On this page
Does Knee Pain Always Come From the Knee?
The short answer: no. The knee can certainly be the source of pain, but its function is closely linked to the hip, ankle and lower back.
During walking, running, squatting and other movements, the knee sits between the hip and ankle. If movement or strength is limited elsewhere, it can change the way the knee is loaded.
The bigger picture: Knee pain is a symptom, not a diagnosis on its own. Conditions such as patellofemoral pain, patellar tendinopathy and iliotibial band syndrome can have different causes, so treatment should be based on the individual presentation rather than the location of pain alone.
Hip Strength and Mobility
Your hip muscles help control the position and movement of your knee during walking, running, squatting and landing.
- Why it matters: Poor hip strength or altered hip movement can change lower-limb mechanics and knee loading.
- What you may notice: The knee may move inward during a squat, step-down or landing, although this does not automatically mean there is a problem.
- What may help: Depending on the individual, improving hip strength, mobility and movement control can form part of a rehabilitation program.
Worth remembering: Hip weakness is not a universal explanation for knee pain. It is one factor that may be relevant, particularly in some presentations of patellofemoral pain and iliotibial band syndrome.
How to permanently loosen tight or stiff hips
Can a Stiff Ankle Contribute to Knee Pain?
Yes, it can. Your ankle needs sufficient dorsiflexion - the ability to move your shin forward over your foot - for activities such as walking, squatting and lunging.
When ankle dorsiflexion is restricted, the body may compensate elsewhere. Clinically, we need to check whether a lack of range below the knee is having an impact on the health and function of the knee.
A lack of ankle range can present in the following ways:
- The heel may lift earlier during a squat.
- The foot may pronate or flatten more.
- The knee may move inward to accommodate the available range.
- Feet pointing outward when standing or walking.
The important point is not that a stiff ankle automatically causes knee pain. Rather, ankle mobility is worth assessing when the movement pattern suggests it may be contributing.
Could Your Lower Back Be Contributing?
The lower back forms part of the mechanical and neurological system that controls the lower limb. Changes in spinal movement, strength, sensitivity or neural mobility can influence how the hip, thigh and knee function.
- Mechanical role: The trunk provides the foundation from which the lower limbs move.
- Neurological role: Nerves supplying the lower limb originate from the lower spine and pelvis.
- Clinical relevance: In some people, restrictions or sensitivity around the lower back and associated neural tissues may influence how the leg feels or moves.
This does not mean that lower-back dysfunction is the cause of every knee problem. It means the back is worth considering when the clinical picture suggests a connection.
A 3-Minute Self-Assessment for Knee Pain
These simple movement checks can provide clues about factors that may be contributing to your knee symptoms.
1. The Squat Test
- How: Stand comfortably with your feet roughly straight ahead and slowly squat as far as feels comfortable.
- Look for: Do your heels lift? Do your feet turn out? Does one knee move markedly inward? Do you struggle to reach depth without losing balance or control?
These observations can provide clues about ankle mobility, hip control and overall movement strategy, but they do not identify a single cause of knee pain.
How to Do a Squat Assessment
2. The Back Ball Test
- How: Place a tennis ball or lacrosse ball between your back and a wall. Gently explore the muscles either side of your spine, starting around the lower ribs.
- Look for: Noticeable differences in stiffness, movement or sensitivity from one side to the other may be worth discussing with a clinician.
Avoid pressing directly onto the spine or using excessive pressure. Stop if the exercise causes significant pain, numbness or other concerning symptoms.
How to assess back mobility with a ball
How to Treat Knee Pain: A Practical Framework
What is the best treatment for knee pain? It depends on the cause, but rehabilitation commonly combines symptom management, mobility where needed, strengthening and gradual return to normal activity.
Step 1: Restore Useful Mobility
If restricted movement is contributing to your symptoms, improving mobility can help restore more efficient movement. This might include the ankle, hip or lower back depending on the individual.
- Ankle mobility: Calf stretching, banded ankle exercises and other mobility techniques may help improve dorsiflexion.
13 ways to improve your ankle mobility
- Hip mobility: Hip extension and rotation exercises may be useful when restricted hip movement is affecting function.
5 simple hip stretches for those who don't want to get down to the ground
- Back mobility: Where appropriate, improving spinal and surrounding soft-tissue mobility may help restore comfortable movement.
Learn how to use a lacrosse ball to mobilise hidden back restrictions
Step 2: Build Strength
Strength training is an important part of rehabilitation for many knee problems. The exact exercises should match your symptoms, goals and current capacity.
- Gluteal strength: Clamshells, side-lying leg lifts and banded exercises can be simple starting points for building hip strength.
- Knee strength: Progressive quadriceps and lower-limb strengthening is also important for many knee conditions.
Step 3: Integrate Strength Into Movement
The final step is to use your improved strength and mobility in movements that resemble real life.
- Squats: Build controlled lower-limb strength through a comfortable range.
- Step-ups: Develop single-leg strength and control.
- Deadlifts: Build hip, hamstring and trunk strength while practising efficient bending mechanics.
Frequently Asked Questions About Knee Pain
Can I exercise with knee pain?
Often, yes. Exercise is commonly part of knee rehabilitation, but the right amount depends on the condition and severity of symptoms. You may need to reduce load, range, speed or intensity temporarily rather than stopping completely.
How long does knee pain take to improve?
There is no single recovery time. It depends on the diagnosis, duration and severity of symptoms, training load and other individual factors. Some people notice changes within weeks, while rebuilding strength and returning to higher-level activity can take considerably longer.
Can knee pain improve without surgery?
Many common knee problems can be managed without surgery. Exercise, education, activity modification and other conservative treatments are important components of care. However, some injuries and advanced joint conditions may require surgical assessment.
Can I still have knee pain if I have arthritis?
Yes. Knee osteoarthritis can cause pain, stiffness and reduced function, but an arthritis diagnosis does not mean you have to stop moving. Strength training, aerobic exercise and self-management are important parts of conservative care for symptomatic knee osteoarthritis.
What causes IT Band Syndrome?
IT Band Syndrome is an overuse-related source of pain on the outside of the knee. Training load, movement patterns and individual factors influence it. Hip strength and control may be relevant in some runners, but there is no single cause or treatment that applies to everyone.
Knee pain is rarely as simple as finding one weak muscle or one tight structure. The most useful approach is to understand the individual presentation, identify the factors that may be contributing, and progressively rebuild strength and movement capacity.
If you'd like to learn more about knee pain, movement and rehabilitation, visit the Your Wellness Nerd YouTube channel.
- Grant
One key takeaway
"Knee pain can be influenced by more than the knee itself. Looking at the hip, ankle and lower back can sometimes reveal important contributors to the way the knee moves and is loaded."
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