I Treated 10,000 Knees & Learned THIS
Key insights: 60-second read
- Stop thinking of your knee as a knee – it's just one structure that sits within the rest of your leg and is governed by your lower back. Knee pain is usually a consequence of something else, somewhere else.
- Hidden back dysfunction is the most missed connection – stiffness in your lower back can affect the nerves and muscles that control your knee, altering how it functions.
- Tight hips affect your knee from above – restrictions in your hip flexors and thigh muscles change the resting tension through your knee, which can contribute to the onset of pain over time.
- Ankle mobility is crucial – if your ankle can't move properly, your knee has to compensate, which may lead to pain during squats, lunges, and walking.
- Test and retest to find your issue – perform a painful activity, do an exercise, then recheck. If it feels better, you've found a key piece of your puzzle.
If you've clicked through to this article, there's a very good chance you've been dealing with persistent knee pain. You've probably also bounced around a few health professionals, doctors, or even scoured YouTube for other videos on how to help.
I'm hopeful this is the resource you've been looking for. My name is Grant Frost, and I'm an Australian musculoskeletal physiotherapist who, over the last 20 years, has treated close to 10,000 sore knees.
I'd like to share what I've come to understand is ultimately helpful in resolving knee pain – distilled down to some important concepts and a few important exercises. These consistently apply to my patients and help resolve the broader dysfunction that is causing their knee pain.
On this page
A New Perspective on Knee Pain
The first and most important thing to understand is what knee pain ultimately represents for most people. There are many different types of knee pain – meniscal injuries, ACL tears, arthritis, bursitis, tendonitis, kneecap problems, fat pad impingements, Baker's cysts, among so many other issues. However, for this article, the labels don't matter.
I'd like to put the labels aside for a moment, for two reasons:
- They are a consequence, not a root cause
- It narrows our focus too much
Conceptually, we need to stop thinking of your knee as a knee. Instead, think of your knee as just one structure that sits within the context of the rest of your leg, and is governed by your lower back.
"Knee pain is best thought of as a consequence of something else. The tissue that's failed or become irritated is just a part of the broader machine that hasn't tolerated how that machine has been functioning."
For most people – especially those who randomly wake up one day with knee pain – there's often a hidden, underlying mechanical dysfunction going on throughout your leg. The part of your knee that's become sore is just one part of a bigger machine that hasn't tolerated how it's currently functioning.
The most limiting perspective I see is treating your knee as an isolated structure, divorced from your ankle, your hip, and your lower back function.
And if we just focus on the damaged or irritated part, we can easily miss the bigger picture - which is crucial to understand if we are to completely resolve this issue long-term.
Key Concept: I challenge anyone to tell me where your knee starts and finishes. There are so many structures that cross your knee, attach to your knee, and influence your knee from somewhere else that we can't think of it as an isolated structure.
Over 20 years, I've found three common issues consistently contribute to the onset of all knee pain I treat: unsurprisingly, it's poor ankle flexibility, restricted hip mobility, and lower back dysfunction. When we improve one, if not all three, of these areas, we can see consistently genuine results in how the knee feels and functions.
Exercise 1: Lower Back Mobility
This is probably the most missed aspect of knee pain that I see day to day. If you're dealing with knee pain, it can sound wild to suggest that your knee pain is a consequence of poor back function - especially with no back pain to speak of. But clinically, this is easily the most missed connection.
The base of your rib cage and the top of your lower back have direct and indirect connections to the function of your knee. The nerves that tell your knee muscles what to do reside in your lower back. If you get stiff or dysfunctional here, it can "short-circuit" the function at the other end. Muscles can tighten, muscles can weaken, and your knee can suffer the consequences over time.
How to Do It
- Setup: Grab a foam roller, lacrosse ball, or tennis ball. Work from the base of your rib cage down to the base of your spine, on either side.
- Find the spots: Recline back onto the roller/ball. Gently roll to one side, then the other. Go looking for where you feel stiffness, tightness, or restrictions – not just tenderness. Feel for areas that feel thicker versus softer.
- Hold and release: Stay on a stiff spot for 30 seconds to a minute. Allow the soft tissue and joints underneath to give. Then move up or down and hunt for the next tight spot.
- Test & retest: After doing this, immediately recheck your lunges, squats, steps, or kneeling. If anything feels different straight away, you've found an important layer to your puzzle.
An important note: if the consequence at your knee is local dysfunction - injured tissue or inflammation - it's unrealistic to expect that freeing up your back will instantly resolve that. It may still need time and care to settle. But if you have any surrounding tightness, restriction, or weakness, you may see an immediate improvement.
Exercise 2: The Couch Stretch
Once you've explored your lower back, it's time to hunt for restrictions through your hips – more specifically, tightness through your hip flexors and thigh muscles. Mechanically, if you're tight through the tissues that anchor to the top of your knee, that tightness changes the resting tension through your knee and how you load up all the structures within it.
How to Do It
- Setup: Get your knee back into the corner of a wall. Bring your other leg up into a high position (like a kneeling lunge).
- Position: Keeping your back straight, extend up as far as you feel comfortable until you find tightness through the front of your hip and down through your thigh.
- Modify if needed: If kneeling is uncomfortable, put a cushion or towel under your knee. If the position is too aggressive, do the same stretch up on a chair or couch – you can work your way down over time.
- Contract-relax: Once you find your tightness, squeeze your glutes and tense up your thigh muscles for 5-10 seconds. When you relax, everything should give a fraction, allowing you to go further. Repeat this process until you stop making change.
- Test & retest: Recheck your knee pain-producing activity. If something feels different, you've found another important layer.
"This isn't a terribly awesome gymnastic feat – it's just bending your knee and trying to extend your hip at the same time. But you may have drifted away from normal long enough that your knee is starting to tell you about it."
You may need to start down low or do this up on a chair. It can be a brutal stretch depending on how tight and stiff you are. Progress yourself from a chair down to the floor as your mobility improves.
Exercise 3: Banded Ankle Stretch
Much like the restrictions above your knee, restrictions below your knee (at the ankle) can also ask your knee to compensate as it works around the problem. This can be seen best when squatting. As you squat down, if your feet turn out, your heels lift, your knees cave in, or you feel like you're going to fall backwards, it may indicate a lack of normal ankle flexibility. And it could be a leading cause of why your knee hurts as it suffers the consequence.
How to Do It
- Setup: Grab a band and place it just below your ankle. Stretch it out as far as you feel comfortable, keeping your foot straight.
- Movement: Bend your knee as far as you feel comfortable, just before your heel wants to come up off the ground.
- Stay straight: If you feel your knee caving in toward your big toe, refocus. Keep everything straight, or even rotate outward slightly to go through the stiffness, not around it.
- Oscillate or hold: Gently oscillate in and out of your end range, or hold it for 30 seconds to 2 minutes.
- Test & retest: After spending a couple of minutes doing this, recheck your knee pain-producing activity. If anything has changed, you've found yet another important layer.
It's worth noting that this exercise is not a squat or a lunge – you can almost sit back on it a little and direct the movement through your ankle, not through your knee.
After treating thousands of sore knees over decades, I can't stress enough that you need to think of your knee more holistically. Direct blunt knee trauma aside, it's highly likely to be a consequence of something else.
While the banded ankle stretch, the couch stretch, and using a ball or foam roller to free up your spine are exercises I've found genuinely successful, there will be nuance to your specific symptoms. You may also need to improve your quad, calf, gluteal, and core strength. Arch dysfunction, although outside the scope of this video, is another piece of the puzzle.
I urge you to keep looking at this as a lower body problem, not just a knee problem. All the strength exercises, injections, surgeries, braces, and taping in the world can be good symptomatic treatments. But if we don't take a step back and realise that this modern world is really good at robbing us of basic flexibility and function through our back, hip, and ankle, your knee pain may have permission to persist despite your best efforts.
- Grant
Frequently Asked Questions
Can back problems really cause knee pain?
Yes. The nerves that control your leg muscles originate in your lower back. If your back becomes stiff or dysfunctional, it can alter the way your muscles control and influence the function of your knee, opening the door to pain over time. This is one of the most missed connections clinically.
How long should I do these exercises before seeing results?
You may see immediate changes in how your knee feels during a test movement after just one session. For lasting change, aim to incorporate these mobility exercises into your daily routine for at least 2-4 weeks. Consistency is more important than intensity.
What if these exercises make my knee pain worse?
Respect your pain. If an exercise significantly increases your knee pain, ease off or modify it. For the couch stretch, do it on a chair or couch instead of the floor. For the ankle stretch, reduce the band tension or range of motion. If pain persists, consult a physiotherapist for a personalised assessment.
Do I need to do all three exercises?
Not necessarily. The "test and retest" approach is designed to help you identify which areas are contributing to your knee pain. If you do the lower back exercise and your knee feels better, that's likely a key area for you. If not, try the next one. Many people find that two or even all three are relevant.
One key insight from treating 10,000 knees
"Knee pain is best thought of as a consequence of something else. The tissue that's failed or become irritated is just a part of the broader machine that hasn't tolerated how that machine has been functioning. Stop thinking of your knee as a knee – it's governed by your lower back and directly affected by your hip and ankle."
Want personalised guidance for your knee pain?
If you would like help making sense of your knee pain, injury, or general musculoskeletal dysfunction, you can book with Grant either in Port Macquarie or via an online telehealth consultation.
