Knee Pain — Why the Knee Is Rarely the Only Problem

By Dr Don Kim · Chiropractor & Acupuncturist · TOP Chiropractic Acupuncture, West Ryde

Knee pain is one of the most common complaints I see in clinic — and one of the most frequently mismanaged. Not because practitioners don’t care about the knee, but because the knee is almost never the whole story.

The knee is a load-bearing joint that sits in the middle of a kinetic chain. Above it is the hip and lumbar spine. Below it is the ankle and foot. What happens at every one of those joints — how they move, how they load, how restricted or mobile they are — directly influences how the knee functions and how much stress it absorbs with every step.

In clinical practice, a patient who presents with knee pain almost always has contributing dysfunction somewhere else in that chain. Weak glutes that shift load to the knee. A restricted hip that alters the angle of force through the joint. A stiff ankle that changes the way the foot strikes the ground. A lumbar spine restriction that affects neural tension down the entire leg.

Treating the knee in isolation — without assessing and addressing what’s above and below it — is one of the primary reasons knee pain recurs. The pain settles temporarily, the patient returns to activity, and the same mechanical forces that created the problem in the first place recreate it.

At TOP Chiropractic Acupuncture in West Ryde, every knee presentation is assessed as part of the whole kinetic chain — and treatment is structured to address it that way.

Common Knee Conditions We Treat

Knee pain presents in many different ways depending on the structure involved and the mechanism of injury or overload. The most common presentations we see include:

Why the Knee Fails — The Kinetic Chain Explained

The knee is essentially a hinge joint — it flexes and extends, with a small amount of rotation. Unlike the hip or shoulder, it has very little inherent structural stability from its bony anatomy. It depends almost entirely on the muscles, ligaments and the correct alignment of forces from above and below to function safely.

When something goes wrong at another point in the kinetic chain, the knee compensates — and that compensation is what eventually produces pain.

A Note for Runners

Running-related knee pain is one of the most common presentations we see at TOP Chiropractic Acupuncture — and one where the kinetic chain approach makes the biggest difference. Runner’s knee, ITB syndrome and patellar tendinopathy are rarely caused by running itself. They are caused by running ON a body that has mechanical restrictions elsewhere.

A runner with restricted ankle dorsiflexion will overload the knee with every stride. A runner with weak glutes will allow the knee to collapse inward during the stance phase. A runner with poor thoracic rotation will compensate through the hips and knees during arm swing. These are subtle biomechanical faults that only become symptomatic after enough kilometres of accumulation.

As an Ironman and ultra-endurance athlete, Dr Don understands these patterns first-hand. His running patients receive a gait and loading analysis alongside their knee assessment — because treating the knee without addressing the running mechanics is treating the symptom, not the cause.

Common Chains We See in Clinic

In practice, the most common patterns we identify include:

The hip-driven knee: Weak or inhibited glute muscles fail to control femoral internal rotation during single-leg loading (walking, running, stairs). The knee collapses inward with each step, overloading the medial compartment or the patellofemoral joint. The patient feels knee pain, but the problem is hip control. Strengthening the knee without addressing the hip produces temporary relief at best.

The ankle-driven knee: A restricted ankle — often from an old sprain that was never fully rehabilitated — limits dorsiflexion. During a squat, step-up or landing, the body compensates by increasing knee flexion angle or shifting load laterally. Over time this creates patellar tracking problems or ITB overload. The patient has been stretching their ITB for months without improvement because the ITB is the victim, not the cause.

The spine-driven knee: Lumbar or sacroiliac joint dysfunction alters neural tension through the sciatic nerve and its branches (tibial and common peroneal). This can change muscle activation patterns in the quadriceps and hamstrings — producing anterior knee pain that has no local knee pathology on examination. The knee imaging is normal because the problem is not at the knee.

Identifying which pattern — or which combination of patterns — is driving your knee pain is the starting point for effective treatment. Without this step, treatment is guesswork.

How We Treat Knee Pain at TOP Chiropractic Acupuncture

Assessment comes first — always. Before any treatment is applied, a thorough evaluation identifies the specific structure involved, the contributing factors from the hip, spine and ankle, and the stage of the condition. Treatment is then structured around what the assessment finds.

In most cases, we use a combination of four approaches — each targeting a different layer of the problem, in a sequence that makes each one more effective.

What makes our approach different is that we don’t just treat the area where the pain is — we assess the entire biomechanical chain. A patient with neck pain may have a thoracic spine restriction driving it from below. A patient with knee pain may have a hip or ankle dysfunction changing how the knee loads with every step. A patient with sciatica may have a postural pattern from their occupation that’s been overloading the disc for years. Identifying and addressing these contributing factors — not just the symptom — is what prevents the problem from coming back after treatment ends.

Phase 1 — Reduce pain and restore joint environment

Phase 2 — Shockwave therapy for tendon and soft tissue involvement

Where the knee presentation involves tendinopathy — patellar tendinopathy, proximal IT band or fat pad — shockwave therapy is introduced once the initial pain and joint restriction have been addressed.

Shockwave delivers focused acoustic pressure waves to the affected tendon or soft tissue — restarting the biological healing response that has stalled in chronically degenerated tissue. It stimulates collagen remodelling, new blood vessel formation, and the reduction of sensitised nerve fibres that are amplifying pain signals at the tendon.

Phase 3 — Rehabilitation and load management

Rehabilitation is the phase that determines whether recovery is permanent or temporary. Without it, the mechanical contributors that created the problem remain — and the knee pain returns.

The rehabilitation program is prescribed specifically for the diagnosis, the contributing factors identified on assessment, and the patient’s activity goals. For a runner, the goal is return to running. For an older patient with osteoarthritis, the goal is pain-free daily function and maintaining the strength that protects the joint long term. For a young athlete, the goal is return to full sport with reduced reinjury risk.

At the end of your treatment plan, we perform a full re-examination — retesting everything from your first visit and comparing the results side by side. This gives you a clear, objective picture of how much you’ve improved. There is no guesswork and no vague ‘how do you feel’ — we measure your range of motion, your strength, your pain levels and your functional capacity against your original baseline. Those results determine whether you’re ready for maintenance, need continued treatment, or should be referred for further investigation. The numbers make the decision.

The rehabilitation program typically progresses through three stages:

A Note on Knee Osteoarthritis

Osteoarthritis deserves particular mention because it is surrounded by a great deal of unnecessary fatalism. Patients are frequently told their cartilage is “bone on bone” and that nothing can be done until they are ready for a knee replacement.

This is not accurate — and it is not helpful.

We regularly see patients with significant osteoarthritis on imaging who achieve meaningful improvements in pain and function through a structured programme of joint mobilisation, targeted strengthening and activity modification — without surgical intervention. The research supports this: appropriate exercise is the single most effective intervention for knee osteoarthritis, producing outcomes that are superior to medication for long-term pain and function.

If you have been told that your only options are painkillers and eventual surgery, a thorough biomechanical assessment may reveal modifiable factors — hip weakness, ankle restriction, muscular imbalances — that are amplifying your symptoms beyond what the structural changes alone would produce. Addressing those factors does not reverse the arthritis, but it can significantly change your experience of it.

Cartilage cannot regenerate in a meaningful way once significantly degenerated. That part is true. But the experience of pain, stiffness and functional limitation from knee osteoarthritis is not determined solely by the degree of structural change visible on imaging. It is profoundly influenced by the mechanical environment the joint is loaded in, the strength of the surrounding musculature, the mobility of the hip and ankle, the neural sensitisation that has developed, and the patient’s activity levels.

The evidence is unambiguous: appropriate exercise and load management is the most effective intervention available for knee osteoarthritis — more effective than anti-inflammatory medication or corticosteroid injection for long-term outcomes, and producing meaningful improvements in pain and function in the majority of patients who complete a structured program.

The Combined Result

Knee pain treated as an isolated joint problem almost always recurs. Knee pain treated as part of the kinetic chain — with the hip, spine and ankle addressed alongside the knee itself — resolves more completely and stays resolved.

At TOP Chiropractic Acupuncture the treatment approach for knee pain combines:

Each approach addresses a different layer of the same problem. Together they produce outcomes that no single treatment alone consistently delivers — faster recovery, more complete resolution, and significantly lower recurrence rates.

When Should You Come In?

Book an assessment at TOP Chiropractic Acupuncture if you are experiencing:

• Knee pain with running, cycling or sport that is limiting your training
• Front knee pain with stairs, squatting or prolonged sitting
• Outer knee pain that develops after a set distance of running
• Knee stiffness that is worse in the morning or after sitting
• Clicking, catching or giving way of the knee
• Knee pain that has been present for more than 2 weeks without improvement
• Osteoarthritis that is limiting your daily activity or exercise
• A previous knee injury that has never fully resolved

About Dr Don Kim

Dr Don Kim is a dual-qualified chiropractor and acupuncturist at TOP Chiropractic Acupuncture in West Ryde. As an active endurance athlete competing in Ironman events, trail running, cycling and triathlon, Dr Don has first-hand experience managing the knee load demands of long-distance sport — and treats many runners, cyclists and active adults from the West Ryde and Ryde area who want to stay moving without pain.

Disclaimer: This article is for general educational purposes and does not constitute medical advice. Assessment and treatment recommendations are made individually based on clinical findings. Results vary between patients. Significant acute knee injuries should be assessed medically before beginning conservative treatment.