Most people have the completely wrong idea when it comes to the causes of knee pain. They talk about ACL tears, tendonitis, arthritis, etc. and how those cause pain in your knee. Well duh. But those aren’t the real cause. What caused those to occur? Just treating the ACL injury isn’t going to make your knee pain all better if you don’t figure out what allowed that injury to happen in the first place.
That’s like getting ecoli poisoning, treating it and then re-exposing yourself to ecoli. It makes the treatment completely pointless.
With that said, let’s talk about what causes of knee pain.
(I apologize in advance for some of the geek speech – I’ll try to keep everything as simple as possible)
Improper Biomechanical Alignment
Did you know that ACL injuries are almost 10x more likely in female athletes than their male counterparts? This is likely due to the biomechanical alignment difference between males and females. Stick with me here – I know I’m already getting technical but I promise it’ll be worth your while to keep reading (and if you have any questions, leave a comment and I’ll help you understand whatever you’re having difficulty with).
If you look up “q angle” in Google, you’ll probably notice that many of the results mention females specifically as this is usually more of an issue with females than men. The q-angle refers to the relationship between the hip and knee.
When females hit puberty, they generally get a wider pelvis, which can cause this angle to become excessive, which increases risk of injury. The wider pelvis in females is the main reason they have such a high risk of ACL injury compared to males.
So in this case it’s not the ACL injury that is the cause of the knee pain, it’s the biomechanical misalignment that caused the ACL injury that is really the root cause of the knee pain. So when recovering from an ACL injury (or trying to prevent ACL injury), you should remember to take into account biomechanical aligment. (I’ll talk about treatment in a moment).
Poor Muscle Function and Strength
This is kind of obvious, yet a lot of people don’t realize that their muscles are not functional. Many people go to the gym without a plan, without a trategy. Or they do something just as bad and go with a terrible plan or strategy.
They go to develop “beach” muscles or try to look like a model or something and they create all sorts of problems in their body without knowing it. This is especially the case with every one of those infomercial gadgets.
They force your body to move a certain way, developing a certain set of muscles and none of the supporting muscles. This makes you look “good” by Hollywood’s standards, but the muscle you get is not functional at all, and when you start trying to use it in real life, you’re very likely to injure yourself.
Essentially, due to a lack of effective training protocols, a lot of people have suboptimal muscle function and even though they may look good, the muscle isn’t useful and is an injury waiting to happen.
When you train, you should be training for functional muscle and for health, not for good looks. (The good looks will come with the functional muscle but the functional muscle doesn’t necessarily come with good looks)
Poor Joint Mobility
If you have poor hip & ankle mobility, guess which joint tries to move when it shouldn’t? That’s right, your knee joint. Unfortunately, most people have poor hip & ankle mobility due to sedentary lifestyles and only paying attention to flexibility while ignoring mobility (if they even pay attention to flexibility at all).
If you don’t ensure that your ankle and hips are mobile, your body WILL try to recruit your mobility from your knee, and you will likely get hurt.
Luckily it’s not difficult to work on mobility (more on that later), so this is easy to deal with.
Weak Surrounding Muscles
You have two types of stabilizers around your knee – active & passive. Your muscles are your active stabilizers. They are meant to be the primary source of stabilization in the knee, and it’s their job to give stability in the knee area (and other areas of your body as well).
So if your active stabilizers (musculature surrounding the knee) are weak, your body is forced to recruit your passive stabilizers (your ligaments), which are not meant for the job. And if your ligaments are having to make up for your weak muscles, you can see why an injury would occur.
This also applies to shock absorption. When your muscles & tendons are weak, your joints take all the force and it causes some serious wear and tear. But in a healthy body, your muscles and tendons absorb the shock, keeping your joints from wearing out and keeping you pain free.
If this is a problem for you, I’ve got a “secret weapon” for dealing with this that I’ll tell you more about shortly.
Too Much Tension in Muscle & Fascia
This is common in runners & cyclers. Have you heard people complain of lateral knee pain? This is not generally a problem with knee, it’s a problem with the tense tissue surrounding the knee (unless they’re arthritic or have had knee surgery).
An easy solution for this is self myofascial release or SMR, which is commonly performed with a foam roller. SMR combined with stretching & mobility exercises will release a lot of the muscle tension, dealing with this cause of knee pain.
Overuse
This is common in runners, cyclers and anyone who performs repetitive movements for extended periods of time.
What happens is each tissue has a certain amount of “load” it can handle. When you consistently overload the tissue, it causes degeneration and pain.
Patellar tendinosis is a common example of an overuse injury in the knee.
The above are the real causes of knee pain – not the injuries that result because of them. Deal with these, and you’ll drastically decrease your risk of knee pain and you’ll be able to treat your own knee pain more effectively.
As a former struggler of knee pain, I’ve done a lot of research into knees and how to prevent and treat knee injury.
In my research I discovered an exceptional guide for identifying the cause of your knee pain and effectively treating your knee pain and that guide is Bulletproof Knees by Mike Robertson.
I know, I promised some information on treating knee pain, and so I’ve written a separate post on knee pain treatment.
However, I want to admit up front that everything I learned about treating knees (and most of what I learned about the causes of knee pain) I learned from Bulletproof Knees. It is the most comprehensive, most effective guide to knee pain I have come across, and after I found it I stopped looking because I don’t think you can make a better guide.
So if you’re serious about preventing or treating your knee pain (or if you’re a trainer wanting to treat your clients knee pain), I think Bulletproof Knees is a must.
And I’d like to give you a little incentive. Remember above I mentioned that I have a secret weapon that I use for strengthening the surrounding muscles quickly? Well when you buy Bulletproof Knees through any of the links I share, I’ll be credited for the referral and in return, I’ll send you a quick guide revealing what my secret weapon is and how I use it to build up the surrounding muscles and relieve knee pain FAST.
All you have to do is click any of the links on this page to get Bulletproof Knees and then forward your receipt to shawnhorwoodfitness @ gmail.com and I’ll take it from there. 
If you have any questions, just leave a comment below and I’ll do my best to answer your questions.
Shawn Horwood
P.S. If you’d like more information on Bulletproof Knees, I’ve put something together for you here.
