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Cuyler Hudson, PT, DPT

Posted in Blog.

April 9th, 2019

Why Your Knee Hurts

The first thing people say to me when they learn my job is to rehab runners is, “a lot of knee problems huh?” And while I usually smile and say yes, the real answer is a firm NO. Do I see a lot of knee PAIN? Absolutely. Do I see a lot of knee PROBLEMS? Not so much.


Physical Therapy legend and Dean of the Gray Institute David Tiberio recently wrote an article based on Gary Gray’s analogy of the lower extremity to a railroad line, with the patella (kneecap) being the train, and the bones, muscles, and ligaments surrounding it being the track. It’s only logical, he states, that if the train is going off the track (i.e. the kneecap is not moving correctly and causing pain), that the problem is not the train itself…it goes wherever its led. It’s the track which is the problem and needs fixing to allow the train to safely get to where it’s going. This has been proven in research that has shown that patients with patello-femoral pain syndrome or “runners knee” demonstrated much different motion in their thigh bone when standing than those without pain.


The tricky part is figuring out why exactly the “track” is breaking down. The questions to ask are: Is the “track” moving too much? Is the “track” moving too little? Is there a lack of mobility at a joint (i.e. hip), or do you have the motion but can’t control it? This is where it becomes vitally important to get assessed by someone who understands how the joints of your lower body work together to move you forward. It may be that there’s not enough motion in your hip or ankle, and as a result, your knee is moving more to compensate. It could be that you have too much motion at your hip or ankle, and it’s dragging your knee along for the ride. The knee is only the victim, which is screaming. You need to find the culprit. Address the TRUE cause of the breakdown, and not just the symptoms if you want to get and stay pain-free.


If your knee problems in the past have been treated primarily by doing knee and hip “strengthening” exercises while sitting down or laying on your side, it’s about time you stop worrying about the train and start to figure out where your track is breaking down.

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