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4 Reasons Why You've Got Chronic Knee Pain

author image Kyle Arsenault
Kyle Arsenault is a performance coach, author and former intern of the renown Cressey Performance. Now working with Momentum PT, he specializes in combining principles of physical therapy with strength and conditioning to enhance overall performance for his competitive athletes as well as his general population athletes.
4 Reasons Why You've Got Chronic Knee Pain
Knee pain is often caused not by the knee itself, but by surrounding muscles. Photo Credit iStock/acostamedia


A significant number of Americans experience some sort of chronic pain during their lifetime. In a 2010 study, it was estimated that approximately 100 million American adults had common chronic pain conditions (about 43 percent).

Of the 100 million Americans experiencing chronic pain, 19.5 percent of those reported chronic knee pain, second only to chronic back pain.

Although knee pain is a common complaint and a common site of injury for many people, the mechanisms of pain and injury are still highly debated among many professionals. This doesn’t help the cause when individuals are trying to stay free of pain, live an active lifestyle and gain strength and size.

A common misconception is that knee pain is actually caused by an issue with the knee itself. The truth is that the knee is often a victim of a problem with the muscles or joints above and/or below the knee. In order to better understand why you have knee pain and what you can do about it, let’s take a look at some of the most common causes of knee pain:

Approximately 100 million American adults suffer from common chronic pain conditions.

1. Glute Amnesia

When your glutes aren’t working, whether it’s because they’re not firing (contracting) at the right time or they’re not strong enough, that means you may have “glute amnesia.” Basically, the glutes are not working sufficiently enough, and this can lead to a host of problems, including knee pain.

The glutes play a major role in controlling the hip and femur (thigh). If control is lost, the femur is likely to rotate inward and deviate forward, which creates unwanted stress on the knee that can lead to pain (more on this later).

What to Do: You have to train the glutes to fire at the right time with adequate strength. Simple exercises like glute bridges and hip thrusts can help to target the glutes when performed correctly.

2. Quad Dominance

When you use your quads excessively for the majority of lower-body movements, you are said to be “quad dominant.” While we need to use our quads, if we rely on them to do more work than they should be doing (as a result of glute amnesia), the knee joint can be affected.

This is a result of the excessive force placed upon the knee when movements are quad dominant, as the quads have a direct pull on the knee. A quad-dominant person will often allow the knee to glide forward during movements, again placing more stress on the knee.

What to Do: Much like the first point, working away from quad dominance involves getting the glutes (as well as the hamstrings) to do more work. Replacing squats with deadlift variations, forward lunges with reverse lunges or step-ups and making sure to emphasize driving through the heels and fully pulling through movements are key to working away from quad dominance.

3. Stiff or Tight Quads and/or IT Band

Both the quadriceps and the IT band attach at the knee. When these tissues are stiff or tight, they can pull on the knee, causing it to track improperly. When the knee isn’t tracking in a proper fashion, pain can result as the joint components rub together and become compromised.

Also, when tissues are stiff or tight, trigger points can develop. Trigger points in these tissues cause pain to be referred down to your knee.

What to Do: Make sure to perform regular self-myofascial release work on the quads and IT band with a foam roller, and look into finding a good massage therapist or other manual therapists.

4. Knee Valgus, Forward Translation and Hyperextension of the Knee

If the knee joint is constantly working through compromising positions, the knee will be compromised. Knee valgus (cave-in), forward translation (going forward) and hyperextension (knee going back in an excessive lockout position) are common movement flaws that will cause pain. These movements can be the result of weak glutes and quad dominance and is why the above points are critical.

What to Do: Whether you’re in the gym, going up or down stairs or simply standing, focus on keeping your knees from caving in, going too far forward and being locked out. This will be hard because you will have to first be consciously aware of these movements and positions. Once you train these for long enough it will become subconscious, and if you are doing this in the gym, the muscles that help to avoid these will become stronger and result in subconscious movement and positioning conducive to avoiding knee pain.

Knee pain is often unrelated to the knee joint itself. It’s more often a result of weak hips (glutes), overactive quads, tight muscles that attach to the knee and faulty movement patterns. If your goals include being active and strong and living a healthy and fit lifestyle, preventing knee pain is a must.

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