Cause of Lateral Knee Pain

Lateral Knee Pain:

So, we’ve covered the typical treatments that don’t work. We’ve also reviewed the anatomy of the Proximal Tibiofibular joint. We have also discussed the primary function of the Proximal Tibiofibular joint. So now we are getting to the real meat and potatoes of the issue.

What is the real cause?

I’m sure you can guess at this point that it has something to do with the Proximal Tibiofibular joint. If that’s your guess, then you’re RIGHT! But why?

Source of Irritation

The Proximal Tibiofibular joint is designed to be a very stable and stationary joint. It is meant to allow little to no movement. Unfortunately, many of us have an unstable joint. This can be due to a sudden injury, such as a motor vehicle accident, or an ACL rupture. Or, it can be as simple as stepping off a curb funny. And, most people don’t even realize they have injured the area and created joint laxity. It can also occur as more of a chronic issue, with recurrent stresses being placed on the joint over and over. Finally, we can’t ignore a person’s DNA. Some people are just born with greater than normal laxity here.

If an athlete has or develops movement in this joint, everything around it will become irritated. This usually comes in the form of either lower leg neurological issues, or (more commonly) lateral knee pain. The lateral knee pain occurs when the IT Band gets irritated, because it is either trying to stabilize a joint that it isn’t designed to stabilize, or it doesn’t have a stable foundation to perform the jobs it is designed to do.

Biomechanics

But what causes the movement? Even a lax joint has to have some sort of outside force to make the joint move. In this case, it usually originates at the foot. But, the hip also plays a role.

As the body moves over the foot during the midstance phase of the gait, the foot naturally pronates and flattens out. Some people obviously pronate more than others, but in many athletes (many that “happen” to develop lateral knee pain) over pronate and flatten out excessively.

At some point, the the structure that usually supports the arch of the foot (i.e. fascia, posterior tibialis) can’t or don’t support the foot. As the foot continues to pronate, the talus will tilt inwards (valgus). At this point, the fibula is there to block the excessive motion to prevent over pronation. If the Proximal Tibiofibular joint is lax, the fibula will be pushed vertically, thus causing motion in that joint and creating irritation and pain.

It’s Almost Always About the Hips

To understand where the hip fits into the equation, it is pretty simple when you think about it. It is accepted that excessive foot pronation moves up the kinetic chain to lower leg internal rotation, knee valgum, hip internal rotation, and finally anterior hip rotation. This is why most people who over pronate also have tight hip flexors.

The hip enters into this equation because that same kinetic chain works both ways. Meaning, we know it starts at the foot and moves up the chain, but it can also start at the top and move down the chain. So, if an athlete has tight hip flexors and an anterior pelvic tilt, they may pronate more than they do if they had a neutral pelvis.

Learn more about how Lateral Knee Pain:

Typical Treatment

Proximal Tibiofibular Joint

The Solution