What to do when physical therapy isn't healing your knee pain

Have you been to a physical therapist for knee pain? Then you’re familiar with this routine. The therapist will evaluate how well your knee bends or straightens at different angles. Then s/he will help you work on making your leg muscles stronger. You’re given exercises to do at home to strengthen the area around your knee. Your therapist might even add weights to make your muscles work harder. In short, strength training is a key part of a physical therapy workout. 

In this approach of treating knee pain, the knee joint is viewed as a mechanical hinge that simply bends and straightens. We know that there are muscles around it, like the quads and hamstrings, and it’s easy to diagnose knee pain as a sign of muscular weakness. However, when we consider everyday activities—walking, running, squatting, lifting onto our toes, sitting, standing—we can start to see the knee as part of a larger system of movement.

Importance of Whole Body Awareness in Knee Pain Treatment

Let’s take walking as an example to demonstrate how treating knee pain effectively requires looking beyond muscle strengthening.

1. Weight Transfer During Walking May Cause Knee Discomfort

When we walk, we bend our knees to step forward, simultaneously shifting our weight from one leg to the other. Imagine a relay race: the way the runner passes the baton can either be smooth and help maintain momentum and eventually win the race, or it can slow them down. Our legs work similarly when walking. If they work well together, the back leg smoothly transfers our body weight onto the front leg. But if one leg isn’t skillful in transferring the weight, it causes strain and discomfort, eventually leading to wear and tear on the joints—the knee, hip, and ankle.

2. Imbalance in Pelvic Movement Can Cause Cumulative Strain in Knee 

Another aspect of walking that affects the knee is the movement of the pelvis. If you observe yourself walking, or watch someone else, you'll notice the pelvis swings and swivels from side to side. Most people have a bias in this movement, swinging more to one side. This asymmetry can create micro-strains due to unequal pressure on different parts of the knee joint. When this happens, the knee’s role in propulsion and springiness is compromised, turning it into a point of strain.

3. Stiffness or accumulated habits in chest can strain one knee.

Walking is a contralateral activity, meaning our legs and hips move opposite to our arms and shoulders. We swing our shoulders and chest as we walk. Habits in our chest and shoulders can either support or hinder the weight transfer from one leg to the other. For instance, a stiff chest that feels like a brick can become a dead weight on the lower body pulling it down. As another example, excessive imbalance in the use of one's arms can create or accentuate a scoliosis that affects the first two traits of good walking outlined above and hence creates disproportionate strain in one knee.

The Need for Customized and Whole Body Treatment for Knee Pain

Every person performs these actions a little differently, giving each of us a unique walking style. While walking is a universal human function, our individual ways of moving mean that knee pain can vary significantly from person to person. A Feldenkrais practitioner can observe these unique patterns and tailor treatments accordingly.

Consider these differences in how they affect your walk and therefore your knee pain.

• We each have a leg we tend to rely on more.

• Some of us support more body weight on the front of our feet, while others lean back on their heels, hyperextending the knees. 

• Some roll their ankles inward, collapsing arches and causing knees to knock together.

• Many hold their chest in a particular way that affects their overall posture.

This means that treatment for right knee pain shouldn’t be limited to strengthening the muscles around the right knee itself. It should also treat the left leg and its capacity for weight transfer. A Feldenkrais practitioner, for example, would focus on improving the left leg’s ability to transfer the body weight over the right leg. When this is done well, not only is knee pain relieved, but there’s also a feeling of strength and solidity in that whole leg.

If you support more weight on the front of your feet, we may work on improving the glide in your ankles to lengthen your achilles which would reduce the strain in your knee joint. 

If you collapse your feet, we would expand the range of leg rotation to open your hip joints, thus allowing you to balance your weight proportionally between the outside and inside edges of your feet. This would address the compression on the inside of the knee. 

We would also work to bring suppleness and greater participation of the chest in walking that would bring a light and uplifting sensation in the knees as opposed to a heavy or stiff chest that becomes a dead weight on the knees.  

These variations show how each person’s knee pain is unique in that it reflects their unique style of walking. This is another reason why general exercises and formulaic solutions often fall short. As a Feldenkrais practitioner, I can not only evaluate your knee pain through the lens of a day to day function like walking, but also see your unique patterns within these everyday movements. By addressing individual movement patterns and habits, we can create more effective and personalized treatment plans, leading to better outcomes for knee pain relief.

In essence, cookie cutter treatments for knee pain aren’t effective because your pain is as unique as your body habits 

Knee pain treatment must consider the knee as part of the entire body’s movement system. By focusing on how we move in everyday activities and addressing issues holistically, we can find more effective solutions to knee pain that go beyond simple muscle strengthening. This holistic and personalized approach ensures that treatment is tailored to each person’s unique needs, offering a more effective path to healing.

If you’re ready to address your knee pain with a customized, holistic approach, schedule a 1:1 session with me. Together, we can work towards a pain-free and stronger you.