Knee Pain

Forward movement is associated with poorer muscle engagement in people with knee pain than in pain-free individuals. Knee pain should be approached by asking why the knee is not healing properly, rather than treating wear and tear as the whole explanation. One-sided knee pain can indicate an imbalance rather than simply mileage or aging. The primary cause of knee pain in training-active adults is forward movement dominance creating structural imbalance. Tendons are the actual site of most knee pain and have dramatically lower baseline blood flow than muscles. People with knee pain show movement-direction-dependent muscle activation patterns. Descending hills causes knee pain in older adults because unprepared tendons are overwhelmed by the knees-over-toes loading position. Chronic avoidance of the knees-over-toes position leaves tendons and muscles unprepared for the forces imposed by everyday activities. The first step for knee pain is to understand the knee as part of a larger functional and repair system, not automatically to pursue surgery, injections, or imaging. Backward training is described as useful for rehabilitation among knee pain sufferers.