Patient Question Friday. Knee Pain



I am going to start a regular patient question answer thing here on Fridays. I will take any questions if you have them, just post in the comments or email them in. Or I will take questions from people I see here in the clinic.

Jen from Edwards asked me ” I have knee pain when hiking, especially down hill, and riding my mountain bike uphill. What should I do?”

When I asked Jen a bit more about her pain, she described it as pain under her knee cap. In addition to hiking downhill and biking up hill, she notices it with squats and kneeling too.

This type of pain is often called anterior knee pain, or sometimes patellofemoral pain. There are different reasons we get it. But generally the surface of the patella or the femur where they contact each other becomes sensitized. All the things Jen describes her pain with increase load in this area.


To help the pain we need to figure out ways to decrease loads on this joint, at least for a while. Then we need to build up loads gradually to allow return to the activities that are an issue.

The first way is to look at activity management. Sometimes the issue is we ramp up activities to fast. We don’t do something much for a while then we jump in and do too much too fast. This gets things irritated and then we keep them irritated by trying to push our way through. Or we are sensitive enough that things like walking and stairs keep it going. The solution in these cases is to back down on the offending activities, as you feel better then gradually build them up. In Jen’s case we talked about hikes with less vertical descent and mountain bike rides with less steep climbs. As she is able to do this easily she can build up.

The second way to reduce load is to look at how your knee is loading biomechanically. The knee is caught between the hip and the ankle. Sometimes things happening above and below the knee can increase loads on the knee. By altering things you can make changes. A few examples are:

  • A stiff ankle may increase load on the knee. Improving ankle flexibility may help your knee.
  • Poor hip strength or endurance may cause increased rotation at the knee with downhill activities. Working on strength and endurance in our hips can alter these mechanics.
  • Poor balance can add stress at the knee every time we are in single leg stance. Improving dynamic balance can reduce these loads.

There are others also, but you can see there are different issues which load the knee. Changing these loads combined with progressive loading of the knee will work very well in reducing pain.

If you have tried dealing with your knee pain and are stuck, getting a physical therapist to look at your management plan and mechanics can be helpful getting you on the right track. If you have any questions about your knee or anything else, post it in the comments call me at 970-949-9966 or

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