Knee Pain by Location: What Each Spot Usually Means

You're listening to the Restoring Human Movement podcast, where movement experts discuss the latest evidence-based practices to help you and your clients move with mastery. And now, your host. Hey everyone, this is your co-host Sebastian with the Restoring Human Movement podcast. Thanks for joining the movement movement. If you are new to the show, just know that if you are an active individual, a runner, a hiker, someone who likes to play sports, you're in the right podcast. We specialize in helping people get back to the thing that they love, the activity they love, despite age. Age doesn't really matter. You can play all these activities or go do all these activities and play these sports at any age. And as we say, age appropriate. I have people I play baseball with still recreationally on Sundays who are 60, some 70 years old. And I would love to say in the future that I would be able to play and be active just like them versus the other 70 or 60 year olds who are just doing nothing because they're scared that they're going to make themselves a little worse just because someone's been telling them wrong information.

So today, I am covering one of the topics that we're going to be doing on our YouTube channel very soon. If you don't know about our YouTube channel, we have literally thousands of videos which cover all these topics in more detail, such as porturnias, groin issues, hip impingement, diatica, low back, and so on. But we love lower quarter conditions, which is why we're talking about knee problems today. I saw a video recently on YouTube where somebody was showing the locations of knee pain in relationship to what the probable diagnosis is. I thought this was a great idea. They had this little picture. They had these little circles around the knee. But also, I didn't agree 100% with what they were saying because there are conditions in that location that aren't necessarily highly probable. They do happen, but there's other things that are more probable. So I apologize. I'm getting over a sickness. It's been like a month of being sick and coughing. So if I'm raspy, that's why. So I'm going to cover different locations on the knee to tell you what they may be. And if you want to see these, remember, log into our YouTube channel and just search knee location pain, knee pain location. You'll probably find the video.

So probably one of the most common types of knee pain is just under the knee cap. It feels like it's deep to the knee cap. This is going to be more of what we call probably condomalase patella or patellofemoral pain. The slang term is called runner's knee. Now, this is something that doesn't pop up with trauma. It usually happens slowly over time. Or if you start to do a lot of running mileage or different types of terrain when you haven't before, all of a sudden this will start to pop up. Most people who have had it have had it on and off for the last handful of years. Usually, if you've had it in the past, it's a predictor of future problems as well. Not to say future damage. I don't like to say future damage. But it's unreasonable to think that if you had that problem in the past, you're not going to have it at some point, decades even into the future. So normally this is solved with good old-fashioned rehabilitation structured exercise program that help target strengthening of the core and the hip area. There's a strong relationship to hip function or hip strength in relationship to knee extension strength. So if you're only doing things like squats and you're not doing exercises like deadlifting or hip thrusters or things like that, then you're missing a really simple part of the equation. And if you can't do those exercises because it hurts to do, then there's regressions to that. And that's kind of our job as coaches and people who treat problems like this is we're supposed to organize and scale the exercise so it doesn't hurt you. Exercises shouldn't really hurt. They should just be hard. And that'll go for all these conditions too. So runner's knee though is the most common one underneath the kneecap. But there is another variant, which if you're an older individual and you've had years and years and decades and decades of knee problems, then there may be a potential of having more arthritic change. Usually this happens under the kneecap, what the slang term is bone on bone. And this is where part of the cartilage of the undersurface of the kneecap, as well as onto the femur actually starts to wear itself down. A lot of times just feel very creaky, sometimes popping. It feels like it's grinding. Those are more common attributes associated to arthritic change. Arthritic change, it's funny, like when you talk to people who have the arthritis in the knee, they say, well, I don't know if I do stuff that it hurts to do. But when you look at what should be done, it's usually movement. They say movement helps it. But also movement under high load may not be a good thing to do. So doing heavy back squats and doing heavy mileage may not be the best thing for it. But we may have to be a little bit more creative about doing isometrics if we're doing squats and then picking the terrain type and then the break period associated to what type of mileage you may do. Even pace can change loads on the knee just a little bit as well. So there's ways to get around it as well. But usually doing nothing does make arthritis worse because arthritis is a process of stabilizing and building support around a structure which is not really doing its job. And so it's going to keep building. But you can't remove the process. You can just arrest it. Sometimes people end up needing knee replacements. If they end up having it too advanced, that is actually not a bad idea. I wouldn't jump to it too soon. I would do everything possible to not do a knee replacement. But knee replacements, even hip replacements, they've been very good at over the years. And we've met many people that we worked with that we can tell very quickly if things aren't going to be working well for them. And usually these arthritic cases with advanced arthritis can be very challenging.

The person gets frustrated. It may just be easier if they have the means to do so to replace the joint or parts of the joint and then rehab around it as well. The person can a lot of times do their activities again. And it's just less headache associated to it. Now, let's travel. We've done underneath the knee. Let's talk about above the knee, like kind of more to the hip region in the front side of the knee. Now, this is an area where a lot of people say they have quadriceps tendon pain. And this is what I disagreed with in the video. Actually, I'd say the most common complaint that I see in this area is actually fullness. Like when they bend the knee, it feels like it's tight in that area.

It's not always super painful. It can feel like pressure. But this is actually where, and we're going to show this in the video, this is where we call the superior recess of the knee. It's like a dumping zone for fluid, extra fluid of the knee. I remember I saw this with somebody who had an ACL injury a long time ago. They bent their knee and it just feels really full and tight and achy up here. And so I had a diagnostic ultrasound at the time and I put the probe on it. And you can see the quadriceps tendon was right there. The quad muscle was right there. And deep to it was this big black mass. Black in ultrasound is fluid. You can actually see particles of the synovium floating around in there. And so it was a drainage point. And so there's nothing really to treat from a musculoskeletal perspective right there. It may need to be aspirated or drained, or we need to take away some of the other irritation to whatever structure inside the knee is creating that fluid to become present because it's more of an inflammatory aspect. It's building up fluid. And once you stop the cause, it should stop the swelling as well. Now, I know I mentioned ACLs are associated to this. I'm not saying it's exclusive to ACLs. Like meniscus is really common or chronic irritation from poor knee mechanics is actually common as well. On the note of ACLs, because I won't be covering it later based upon location, ACLs are associated to a pop. Like you almost always will feel a pop and it will follow by immediate swelling. Like within like an hour, it'll be very full. Like you won't see your kneecap anymore. And it will be followed by disability. Like you cannot move your knee very well. So that is the ACL. It hurts in various locations because the body tries to find workarounds to it. But usually an ACL is going to be some type of replacement or surgery as well, especially with full tear. Let's move on to pain on the inner side of the knee. And then if you grab your own knee and you kind of move up and down, you can find what we call the medial joint line. And so there's a gully there. It's a soft spot amongst two bony spots because there's a tibia below it and the femur above it. And then you have the joint line. And the joint line is kind of horizontal. It's kind of points towards the kneecap. And this is an area of tenderness for people who have meniscal injuries. It doesn't have to be a large meniscal injury. It can just be a fray or an irritation to it. A large one like a bucket handle, it would actually leave you with so you're unable to unlock your knee. Your knee will be locked in place. And that's usually a surgical type of meniscal injury. But a lot of meniscal injuries are not surgical at all. You can actually spare the meniscus and decrease chronic irritation to it by normalizing mechanics of the knee, usually from a hip or an ankle perspective. We used to say with rehabilitation of the knee that good old-fashioned knee exercise, like resistance training exercises or corrective exercises can help out with knee pain because the knee is the circuit breaker of the leg. It's usually not its fault. It does get direct trauma sometimes. But most people, majority of people with knee problems are like, you know, it just started to kind of hurt. And it's because the mechanics of the knee are starting, are being altered because of a change of function or strength above or below it. So usually rehabilitation requires you to look above and below, even all the way up into the core, even all the way up down into the toes. So those are parts that need to be addressed. And usually creating a specific program around the deficiencies that you have is a big part. I'm not going to say everybody needs to do toe stretching and hip strengthening and so on, because it's incorrect. If you have a deficiency of hip strength, you need to do hip strengthening.

If your toes are stiff, you need to get them stretched out. If you have weakness in the hamstring, some don't, then you need to strengthen the hamstring and so on. So it's based upon your unique deficiencies and range of motion deficiencies that we may end up having to structure your program around. By the way, if you guys do want some help, we do offer something called a discovery session. It's very affordable. You spend about almost 30 minutes with us for a very low price. And we have telehealth options for license in different states as well, in case you ever want to talk to us about your problem as well. Now on the inner part of the knee too, they're just below the joint line.

There's a gully that sinks down and it's what most people will call the peasant serine. And so if there's actually a swelling there, which there rarely is, it's called a peasant serine bursitis because the bursa swells up. Now the peasant serine is where three tenets attach into from the upper part of the thigh. I'm not going to mention what those are at this point, but the area down there, if it really is swollen, it's peasant serine bursitis. Now, if it's still painful down there and it's not swollen, a lot of times it's actually a nerve entrapment from a distribution of the femoral nerve, which is called the saphenous nerve. And so it's interesting on some of these cases that they've been told they have peasant serine bursitis, but there's no evidence of swelling. There's no evidence of the pez being irritated at all. There's no tendinopathy involved.

There's no tendon irritation. And so it just hurts to move it. And this a lot of times is neglected. People neglect to look at the possibility of overlying structures like neurological compression in the area. And so simple things like skin rolling can help. The soft tissue work can help. Even things like stretchy tapes, like KTTs can help out with this. Now, rehabilitation also helps with those too, because unless there's direct contact to the knee, which does happen. I met a guy the other day who fell onto his knee and he had more of a irritation of this distribution of the femoral nerve called the saphenous. But not everybody has that. And so altered mechanics over time puts more load onto that area. And again, just like the other conditions, we got to look at the hip, look at the ankle, look at the foot, look at the core, and look at strength overall of the leg. Is it present or not?

Are you deficient? And so those things can help out with identifying how to create a structured program and strength training program around it. Now, if we're talking about pain below the kneecap, not under the kneecap, but below it, more towards the foot, most of the time people call this patellar tendinopathy or jumper's knee. I would say that does happen. It does happen, but it has to have a mechanic involved. It has to have the history. Usually jumper's knee or patellar tendinopathy is associated to poor training programs or increase of workload. For example, I have not been jumping at all, but I decided to pick up jump roping. And now I'm jump roping for 20 minutes a day. And it's been two months and now I feel pain, pain below my kneecap. That would be more appropriate. Now you can't just wake up or do weightlifting and get jumper's knee. It doesn't match the mechanics. Patellar tendinopathy is something that can happen again with poor training. So in poor program design, if you've been doing too many jerks, so catches, snatches, or even things like squat cleans, squat cleans or power cleans, like these things have an impact on that structure. And if not scaled appropriately, like you're doing too many too fast for too long, then it's program issue. And so there are ways to address this from a rehab standpoint as well. Most people will think, Hey, maybe I got to get PRP on the knee or stem cell. And I'm not going to say it's a bad idea, but there's a standard of care involved, which is called isometrics.

They're long, hard isometrics. And this helps to condition the tendon again. So it becomes healthy as well. But you also have to take away some of the triggers too. So a lot of times we have to do activity modifications as well. And we call this management. Not everything's about treating the area. Sometimes it's about actually managing the person. Now, the last one that I'm going to bring up, actually two more I'm going to bring up is the outer side of the knee, just around that kind of joint line area. Like we talked about the medial meniscus, there can be, there's a tendon on the side there, which it's not a hamstring tendon, which is going to be the one that most pops it most prevalent, it's the one in the front. And this is where the tib, IT band inserts or the ilio tibial band inserts into the side of the knee, which creates lateral stability of the knee.

The glute max attaches into it from the upper part. And sometimes friction on this, on this structure can be increased over the course of doing too many miles. Like similar scenario as the last one, it's too many miles or too much workload too soon, which can create a friction syndrome in the area. Now, if you've been dealing with this and you have not gotten better and your mileage is really not a big jump, you need to consider strength of the hip again. The glute max inserts 70% of its fibers into the IT band and establishes lateral control of the knee very well. And so it's ridiculous to think that someone's going to survive a lot of mileage running if they have weakness of the glute max. Now, can you get IT band syndrome from doing weightlifting? No, it's not possible. It's a friction syndrome. And if you don't have the amount of reps involved, then it's impossible to get, but people will have problems on that side. Nevertheless, if they're in a different category, a different type of population, and that would be more of an L5 radiculopathy. It's a referral from the back.

And these ones are super easy to resolve. They use to resolve some core conditioning, some stabilization training, a little bit of focal treatment to the hip as well. And these things, they're more present than you think. We've seen them in running populations as well who have not responded to traditional good old-fashioned IT band care. And those people are candidates for just treating it from a low back perspective. Again, that can be done with virtual. It can be telehealth. There can be self versions. We have online programs that show a lot of these things as well. But most cases, the knee are actually the knee. But there are ones that actually are just referred from the spine. Now, the last one we're going to talk about is pain behind the knee. Not the kneecap, but behind the knee. And this usually presents itself more when you're trying to put your heel to your butt or sit on your knees and hips back to your heels. This is more of a meniscal presentation. Again, it's going to feel pinchy. And these are managed similarly to the other meniscal injuries we talked about, which are associated to more of a mechanical issue. And we need to normalize biomechanics. We need to get strength about us. We got to get better core strength, get better leg strength, and so on. It's the same type of protocol.

The treatment of it to try to decrease sensitivity of the meniscus is a little bit different than the other ones. Usually, we use something called McKinsey knee extensions, which work very well. Now, there's another condition that can be back there as well, which is called a Baker cyst. If you're a young individual, you don't have Baker cyst. Like, if you're 70 and you've had ongoing knee pain for years, like Baker cyst, yeah, you can totally have it. And it's where there's fluid that goes out the backside of the knee, similar to the presentation under the quad that we talked about earlier, but an exit point is behind the knee as well. So, the Baker cyst is very possible if you're an older individual. These ones are harder. We don't actually manage these here. We're very bad at them and in at least regards to, like, getting things better faster. Personally, I think these seem to be aspirated, but then they also will be a rehab and strength training case after the fact. But unless you aspirate it or find a way to get the fluid to decrease in the joint space, it is very hard to manage for a lot of people when they get frustrated. So, if you guys are looking for help, again, we have telehealth and we also have online training programs, which I put together personally. They're 12 weeks long. They include a lot of the things that I just discussed, but they're not personalized to you or your exact type of knee condition. That is what personalized care is about. So, if you want to jumpstart things, do a consultation with us and we'll see you guys next time. 714-502-4243. See you soon.