The Victim is Not the Culprit
Knee pain can suck. Much like low back pain, it can be debilitating and knock you out from doing things you love, like training, or playing, or just simply walking up stairs. When we experience any kind of pain, our minds usually run to the worst case scenario, and with the knee, the mind turns to the ligaments and menisci and what kinds of damage is there.
But if there's one thing to keep in mind, it's that body is all connected.
Look Above & Below
There have been countless times with clients where they have complained of knee pain while doing "insert exercise." And more likely than not, it usually has nothing to do with the knee at all. It's usually coming from somewhere else.
When it comes to pain, my thought process is to look above and below for the root cause. In most cases, the pain we're feeling is coming from another source. It just manifests itself in a vulnerable area. In this case, strength, mobility or stability issues at the hip or ankle can cause pain at the knee. The hips and ankles are meant to be mobile. If this is an issue, the body will compensate and find that mobility elsewhere. *cough, cough, the knee, cough*.
Remember, the victim is rarely the culprit. Search for clues as to why the knee hurts. Avoid automatically assuming something is wrong with the knee.
"The victim of pain (knee) is rarely the culprit (hip/ankle).
Assess and Test"
The first place we recognize knee pain is when we go to squat to do something, or when we go upstairs. However, in order to perform both of those movements, it's important to have an optimal range of motion in the ankle, specifically dorsiflexion (pointing your toes/foot to your shin). If this happens to be restricted in some way, then the knee has to take on some of the force.
One way to test to see if you have a good amount of dorsiflexion is the "Knee to Wall" Test. In this, you'll set up in a half kneeling position with your front foot 3-5 inches from the wall. Push your knee towards the wall while trying to keep the heel down on the ground. If you can do this with no issues, then rock on. If not, then we may have to do some work with regaining dorsiflexion.
This can be accomplished through different corrective exercises utilizing some banded distraction, stretching, and SMR for the calves.
Weakness and/or tension in the hips can cause the knee to get a little cranky as it contains many big strong muscles of the hips, but also equally important stabilizing muscles. Most of us sit a fair amount of time, and this can cause many of the muscles in the hips to tense up and not have access to as much mobility. When this is the case, the link between the foot/ankle and the hip doesn't work as well. And what ends up happening is the knee gets treated like Cinderella by her two evil step sisters.
In order to combat this, we're going to start off with SMR using a lacrosse ball or foam roller on the glutes, TFL, and the quads. I'd throw in IT Band as well, although when you foam roll your IT Band, you're really only affecting the lateral part of the quad at best. But it does feel "nice," so go for it.
Follow this up with strength-based movements like squats (if you can tolerate it) and various hip-hinging exercises like deadlifts and hip thrusts. You can also incorporate isolated exercises like hamstring curls, and corrective/activation exercises like band walks, monster walks and posture ups to help strengthen some of the smaller stabilizing muscles. With those banded exercises, make sure the movement actually comes from the glutes. It is very common for the hip flexors and TFL to take over.
Band walks happen to be a particular favorite as they target a little muscle called Glute Medius, which can control the hips from shifting side to side, which can lead to knee problems down the line, especially for runners.
Lastly, you can add in stretching exercises like the pigeon stretch. I'd recommend doing it off a bench as it is easier to control the depth and intensity of the stretch.
Pain sucks and our typical reaction is to address the site of pain. But if we take the time to find the root cause of the pain, we can often take care of it for good. When it comes to knee pain, look towards the ankle and hip for clues on what to do.