Liam came in to see us with clicking and pain on the outside of his knee. He had been doing a lot of rowing at the gym and the knee seemed to be getting worse every time. On testing his knee was stable, had full range of movement and other than being tender to touch it was difficult to reproduce his symptoms. The ligaments and cartilage of the knee was fine with specific tests and he had good muscular strength in the quadriceps and hamstrings.
We decided to look further upstream and assessed his hip, where we found an obvious muscular imbalance (too much Tensor Fascia Latae, too little Gluteus medius) causing a tightening of the Iliotibial Band (ITB). The ITB is an important support of the lateral knee, but if it is overly tight, it can flick over the bony prominences of the knee becoming inflamed and painful. The TFL directly attaches to the ITB, so everytime Liam contracted his TFL, he was pulling on the ITB, causing it to become more restrictive around the knee.
We decided to leave the knee alone and focus our attention on correcting the muscular patterning around the hip. Over 3 sessions we released the soft tissue, taught Liam to preferentially contract the glute complex rather than the TFL (thus lessening the tension throughout the ITB and creating more space at the lateral knee) and re-introduced concurrent hip and knee extension (rowing specific). Liam is now back up to 10 minutes on the rowing machine with no pain!
It goes to show, sometimes the symptoms don’t directly relate to the cause. The body is a complex set of systems that requires many moving parts to be working efficiently. An alteration in one joint, can often lead to a downstream effect where another joint is affected. By correcting the hip, we were able to correct the knee.
If you have pain that isn’t responding to local treatment, we can look upstream and down stream and investigate!