Pain may be referred to the knee from the hip and pelvis, or caused by instability at the ankle.

Moderate exercise, like walking, should not cause knee problems. If it does, there is usually a problem at the pelvis or in the ankle which has adversely affected how weight is transferred through the knee joint.

If the knee is not injured, moderate exercise is good for the knee. Side stresses, which the knee is not engineered to withstand very well, cause most knee injuries. These can be caused by a twisting fall, being hit form the side, or even walking along one side of a road or a beach for an extended length of time due to the slope of the ground.

Researchers at the University of Georgia have found that females are more prone to knee injuries due to their form and muscle development. They tend to run, jump and turn on their knees with their legs straighter than males. Testing the strength of the major muscles of the leg uncovers inherent weaknesses. Therapy can then be recommended that will increase the strength and muscular coordination to help prevent injury.

A common area of discomfort is around the kneecap. This condition is called patello-femoral stress syndrome. Most of the cases show misalignment of the knee joint or improper muscle coordination around the joint. Muscle testing can be used to isolate the improper functioning muscles. These can either be over or under contracting, causing the patella (kneecap) to track abnormally, resulting in pain and tenderness. Imbalances in the muscles that support the lower leg or the pelvis cause abnormal stress to be passed through the knee joint, also causing pain and tenderness around the kneecap. This condition is common in runners, but can affect anyone after a long walk if the underlying muscle imbalances are present. This will usually first show up running or walking down hill. It is also found commonly as a consequence of a dropped arch.

Another common knee problem causing tenderness is chondromalacia or softening of the cartilage. Symptoms of this are knee tenderness, pain in front of the knee, and a grating sensation in the knee. The pain is worse after sitting for a prolonged period of time or when getting out of a chair. The knee cartilage is affected from overuse, trauma, and abnormal forces on the knee such as a misaligned patella.

In all of these conditions, the knee must be examined as part of the lower leg and pelvis. Seldom does a chronic knee problem not have an ankle and pelvic problem complicating the pain pattern. Proper care depends on an integration of muscle strengthening, stretching and coordination. Stabilizing the ankle and leveling the pelvis will support this. Nutritional support to decrease inflammation and to support healing of the soft tissues, especially the cartilage, must be integrated. Chronic or severe knee injuries will require a long-term commitment to reestablish the strength needed to have a properly functioning knee. But if you follow through, even knees with moderate ligament damage can be stabilized.