Knee pain is one of the most common complaints I see in clinic. Runners, gym-goers, HYROX athletes, and even people who simply stand all day often assume the knee itself is the problem.
But in many cases, the knee is just the victim.
The real issue is often coming from the hip and ankle.
Let me explain.
The Knee Is Caught in the Middle
The knee is a hinge joint. Its job is relatively simple: bend and straighten.
It is not designed to handle large amounts of rotation or sideways movement.
The hip above it and the ankle below it are designed to move in multiple planes. When those joints stop doing their job properly, the knee is forced to compensate.
Over time, that compensation becomes pain.
Common Pattern I See in Clinic
A typical presentation looks like this:
• Medial (inner) knee pain
• Gradual onset over months
• Pain with running, lunging or squatting
• History of high training volume
• No single traumatic event
On assessment, I often find:
• Femur internally rotated
• Tibia externally rotated
• Weak lateral hip (glute med)
• Poor control in single-leg stance
• Ankle stiffness or limited dorsiflexion
The knee is being asked to manage forces it was never designed to absorb.
How the Hip Contributes to Knee Pain
The hip controls the position of the femur.
If the gluteus medius and deep hip rotators are not doing their job, the femur collapses inward during running or squatting. This is known as dynamic valgus.
When that happens:
• The medial compartment of the knee is compressed
• The meniscus is overloaded
• The MCL is stressed
• Patellofemoral tracking changes
How the Ankle Contributes
Limited ankle dorsiflexion is another common driver.
If the ankle cannot move forward over the foot properly:
• The foot may pronate excessively
• The tibia rotates abnormally
• The knee collapses inward
• The load shifts medially
Again, the knee absorbs the consequences.
Why Rest Alone Doesn’t Fix It
Many people are told to “just rest.”
While rest may reduce symptoms temporarily, it doesn’t address the underlying movement pattern.
As soon as training volume increases again, the same problem returns.
That’s why some people have knee pain for months or even years.
The Real Goal of Rehab
The aim is to:
• Improve lateral hip stability
• Restore ankle mobility
• Reduce medial knee compression
• Improve control under fatigue
For athletes training for events like HYROX, running or high-intensity functional fitness, this is critical. The knee must tolerate repeated loading without collapsing inward.
The body works as a system. Treating one joint in isolation rarely produces lasting results.
If your knee pain keeps returning despite physio exercises or rest, it may be time to look at how your hip and ankle are functioning.
Because sometimes the best way to treat knee pain…
is to stop treating the knee.