For many weekend warriors and professionals alike, knee pain can mean an end to participating in a sport that brings joy, physical fitness and stress relief.  There are a variety of knee pain causes, but for this post I am going to focus on overuse injuries, as opposed to traumatic injuries.   Knee pain accounts for 42% of all overuse injuries and for runners knee pain is the number one cause of running cessation.  Considering the impact this one type of injury has on athletes we would think that a solution could be found, but still many athletes suffer from knee pain that keeps them from participating in the sport they love.  What have we missed and why can’t we seem to get a better handle on this extremely common condition?

The impetuous for this post came from a question that I was asked from a patient today as I was explaining why she was experiencing pain on her left side.  She seemed puzzled and asked me “why is their more stress on my left side when my right side takes the same amount of steps and holds the same amount of weight?” This question reminded me of a quote from the famous Notre Dame football coach Lou Holtz, “It’s not the load that breaks you down, it’s the way you carry it.”

For too long we have chased the pain and assumed that the pain is the cause of the problem.  This is akin to looking at your unevenly worn tires and saying that you have a tire problem, when you have an alignment problem.  To understand overuse injuries of the knee, we have to first understand why there is increased stress at the knee joint. To understand the stress that is placed at the knee we have to look outside of the knee, particularly above and below at the hip and the ankle.

In part 2 I will discuss the factors outside the knee that lead to overuse injuries.