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How Doing NOTHING Can Cause Knee Pain

Updated: Aug 16, 2023

Greetings everybody, Robert here again. Today’s topic is knee pain. Knee pain is almost as common as low back pain due to the two dysfunctions sharing a lot in common in terms of muscular imbalances. Often I’ll see patients walk in the clinic complaining of a COMBINATION of low back pain and knee pain. Not just one or the other. Both. What causes this phenomenon? Well, a big contributor is glute dysfunction. In other words, your butt is broken. It’s not working right. When that happens, your femurs fall into a combination of hip flexion, adduction and internal rotation relative to the tibia. That’s a kinesiological way of saying knocked knees. Here’s an example:

Picture credits:

In this picture, the leg is “less straight” and the knees come closer together relative to the rest of the leg. A major consequence of this is that instead of the knee being able to evenly disperse forces throughout a larger area, bony congruences decrease and result in a much higher, much more concentrated force in an unintended area of the knee joint. This is likely coupled with further inactivity – sitting down watching TV is a big one – which further facilitates the imbalance caused by weakness in the glutes. This begins a self-perpetuating cycle.

From standing, sitting, and doing other activities under load or even while carrying objects using poor knee alignment, is it

How do we fix this in physical therapy? We aim to strengthen the patient’s gluteus maximus and medius in addition to incorporating proper lower extremity (leg) posture into dynamic movements. One exercise I suggest is the lateral band walk. In this exercise, you place a resistance band around the knees and walk sideways. Here’s a great technique video by Bret Contreras, a S&C coach who received his Ph.D. in glutes. (Yes, he literally studied the glutes.)

Video credits: Bret Contreras, 2017

This technique of integrating specific hip and knee positions in a dynamic fashion forces the brain to create new neural connections that reinforces your new default posture. The final outcome? Your knee integrity is restored. The benefits would likely trickle up the kinetic chain into your low back if that is an issue as well.

Try this exercise out and reap the benefits.

Best of luck,


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