29 Feb 2024

For many runners, knee pain is a frustrating and seemingly inevitable part of their exercise routine. Traditional physical therapy offers common exercises like knee extensions, clamshells, and foam rolling, but what if these methods don't bring the relief you seek? It's time to delve deeper. In this article, we uncover an often-overlooked cause of chronic knee pain that has perplexed even the most experienced PTs specializing in runners.

The Hidden Factor: Knee Rotation

A common misconception is that the knee only bends forward and backward. However, a critical aspect of knee function, frequently missed in pain diagnoses, is knee rotation. Understanding the importance of both internal and external rotation at the knee joint is crucial, as its absence can lead to significant mobility issues, affecting everything from walking and squatting to running.

Why Knee Rotation Matters:

Pivoting Limitation:

Without healthy knee rotation, pivoting during daily activities or sports becomes difficult, if not impossible.

Restricted Knee Bending:

Initiating a bend in the knee becomes challenging, hindering basic movements like walking, squatting, climbing stairs, or running efficiently.

Inability to Fully Extend the Knee:

This leads to weakened quadriceps and muscle atrophy, further compounding running difficulties.

Case Study: "Jimmy's" Journey to Recovery

Let's consider "Jimmy," a long-time runner suffering from chronic right knee pain for six years. His journey to recovery began with a comprehensive assessment at our new location in Cary, specializing in runners and active individuals. The findings were eye-opening:
  • Limited ability to straighten or bend the right knee due to past trauma.
  • Significant disparity in knee rotation range between the left and right knees.
  • Reduced right hip range of motion and overactive hip flexors.
  • Atrophy in the right quadriceps and weakness in the right glutes.
  • An abnormal hip drop observed during running gait analysis.
Our Approach and Jimmy's Transformation: Restoration of Knee Rotation: Through targeted self-mobility exercises, we successfully restored Jimmy's right knee rotation. Performance Dry Needling and Shockwave Release: These techniques were employed to release the overactive right TFL muscle and treat the side of the right knee. Blood Flow Restriction Therapy: This innovative method rapidly improved the strength and size of Jimmy's quadriceps without overburdening his knee.


After just nine sessions, Jimmy achieved remarkable improvements:
  • Full, unrestricted knee range of motion.
  • The ability to perform deep squats and lunges with weights.
  • A return to fitness classes without restrictions.
  • Most importantly, he was a happy runner again, free from the chronic knee pain that had plagued him for years.
Break Free from Chronic Knee Pain: Discover the Key Role of Knee Rotation with Next Level Physio Chronic knee pain doesn't have to be a life sentence. If you're struggling with persistent discomfort and traditional treatments haven't worked, it might be time to consider the role of knee rotation in your condition. At Next Level Physio, we're dedicated to uncovering and addressing these overlooked causes, helping runners like you return to the activities you love, pain-free. Contact us for a specialized assessment and begin your journey to a more active, fulfilling life without knee pain.

Unlocking the Mystery of Persistent Knee Pain: The Overlooked Cause Runners Need to Know