3: The Knee in the Middle – Why It Hurts When the Real Problem Is Above or Below

Knees are one of the most common areas people complain about. Whether it’s a dull ache going up stairs or a sharp pain after a workout, discomfort around the knee can creep in quietly or hit all at once. But here’s the thing the knee is often not the source of the problem. It’s stuck in the middle, caught between two other joints that aren’t doing their job properly.

The knee is meant to be a stable hinge joint. It bends and straightens with each step, squat, or jump. But when the feet below or the hips above lose mobility or control, the knee ends up absorbing stress it was never built to handle. That’s when things start to go wrong.

The Knee’s Role in the Chain

Think of your body as a chain of joints, each with a primary role:

The foot: stable

The ankle: mobile

The knee: stable

The hip: mobile

The lower back: stable

When mobility is missing in one area, or when stability breaks down, stress gets pushed to the next joint. The knee is often the victim of that compensation especially when both the ankle and hip aren’t functioning well.

Common Movement Problems That Load the Knee

1. Collapsing arches or overpronation

When the feet roll inward, the lower leg rotates, pulling the knee into a knock kneed position. This puts strain on the inner knee and the structures that stabilise the patella and ACL.

2. Stiff ankles

If the ankle can’t bend properly when walking or squatting, the knee often shifts forward too much or collapses inward. This loads the joint in ways it’s not designed to handle.

3. Weak or inactive glutes

The hips play a big role in keeping the knees in line. If the glutes aren’t firing properly, especially in single leg movements, the knee often caves in. This can lead to IT band irritation, patellofemoral pain, or even meniscus problems.

4. Muscle fatigue and poor control

When the muscles around the knee fatigue or stop supporting the joint well, stability is lost. That lack of control is what leads to breakdown over time especially in dynamic movements like running or jumping.

A Real Example

A client comes in with knee pain during squats. They assume the issue is in the joint itself. But on assessment, we find flat feet, limited ankle mobility, and a complete lack of glute engagement. Every time they squat, their knees collapse inward and the load shifts forward right onto the structures causing them pain. The solution? Improve the system, not just the symptom.

How to Fix It

Step 1: Assess the full chain

Look at foot posture, ankle movement, hip control, and even how they breathe or brace during movement.

Step 2: Improve mobility where needed

Focus on unlocking the ankles and hips. Mobilise the calves, stretch tight hip flexors, and restore clean joint movement before loading it.

Step 3: Strengthen the system

Train the muscles that support and control the knee, glutes, hamstrings, quads, and the deep core. Use exercises like:

Step downs

Glute bridges

Controlled lunges and split squats

Single leg balance and control drills

Step 4: Rebuild movement patterns

Once the system is functioning well, focus on retraining clean squats, lunges, and gait. Teach the knees to track properly with strength and control.

Final Thought

Knee pain rarely starts at the knee. It’s usually a sign that something further down or further up the chain is not doing its job. When you restore mobility in the right places, build strength where it matters, and retrain quality movem

ent, the knee can finally do what it was meant to do, move smoothly and pain free.