Addressing Knee Pain Through the Kinetic Chain: Why Pilates Targets Hips and Feet for Relief

A student came to one of our teachers with complaints of medial (inner) knee pain. For those of you who have been engaging with our foot health discussions, you might guess what the teacher assessed first.

That’s right, the teacher started at the bottom of the kinetic chain, immediately assessing the student's static foot and ankle posture. She then observed his walking pattern, specifically looking for signs of over-pronation. However, everything appeared normal; his posture and movements showcased healthy and efficient dynamics.

So, what do you think the teacher checked next?

Consider what's located directly above the knee.

Yes, the hip!

Our teacher proceeded to evaluate the strength of this student's outer hip muscles, which turned out to be weaker than ideal. The solution? She guided him through gentle foam rolling techniques to release an overworked inner thigh, followed by targeted Pilates exercises to strengthen the outer hip muscles. The outcome? A grateful message from the student later that evening: "You seemed to help my knee. Good job!"

This scenario may lead you to wonder: why focus on the outer hip when it's the inner knee that's in pain? Or, why did the teacher start at the feet? 

Our perspective is holistic; we see the body as an interconnected system where each joint influences the others. Based on our experience, the site of pain is not always the source of the problem. More often, it's the dysfunction in a neighboring joint—either above or below—that leads to compensatory patterns in the joint experiencing symptoms. This is the rational behind our teacher checking her student's feet first. 

The knee, being a joint that requires stability, often suffers the consequences of problems originating from the foot, ankle, and hip. If you haven’t checked out our YouTube video on the feet, we highly recommend doing so, especially if you’re someone who deals with knee pain!

So, how can we leverage our Pilates expertise to deepen your understanding of the knee–the largest joint in the body–and uncover strategies to enhance its health and functionality?

Read on to learn more!

Knee Anatomy: Sandwiched Between the Feet and Hips

We're bringing back our fave graphic to do two things: 1) Show the position of the knee within the kinetic chain, and 2) Highlight the two bones that come together to form the knee joint. Why? We want to help you grasp why the knee frequently becomes a hotspot for aches and pains and to provide strategies for tackling these issues.

The positioning of the knees is more complex than it first appears. The knee joint is where the proximal end of the tibia meets the distal end of the femur. Interestingly, these bones also form part of the ankle and hip joints, respectively. The distal tibia connects with the talus's proximal end to form the ankle joint, which sits above the 27 bones of the foot. Meanwhile, the femur's proximal end joins the hip bones' acetabulum to create the hip joint. Are you a visual learner? Check it out:

Love anatomy and want to nerd out on the knees? Check out our blog post – Pilates Anatomy 101 – The Knees.

Anatomy of The Knee – So What?

Revisiting our kinetic chain graphic, a principle emerges: the foot, ankle, and hip joints need mobility, while the knees require stability. This balance is crucial for efficient and healthy movement. Mobile feet and ankles adapt to surfaces and absorb impacts (so that the knee doesn't have to), while flexible hips allow a wide range of motion (so that the knees can focus on stability). The knees, providing stability, support the body's weight and ensure an even force distribution across the kinetic chain, minimizing injury risk.

Imagine a tripod: the feet and hips are its flexible legs, adjusting to position our body, while the knees ensure stability, like a tripod's lock, critical for a steady focus.

A common issue we encounter is an imbalance in mobility. We often observe limited mobility in the foot and ankle contrasted with excessive mobility in the hips. This disparity places undue stress on the bi-articular muscles, such as the hamstrings and quadriceps, which support the function of the knee and the hip, and the gastrocnemius (one of your calf muscles), which supports the function of the knee and the foot and ankle. These shared muscles become strained under the imbalance, prompting compensatory movements that veer away from the knee's inherent need for stability. By addressing these imbalances with specifically designed exercises, we can mitigate knee pain and foster harmony within the musculoskeletal system, ensuring each component operates in sync within the body's dynamic equilibrium.

Sounds complicated, huh? Want to see this concept in action? Check out the video below! 

Written by: Destinie Slavich and Nicole Lancie

Wooden doll photo credit: Engin Akyurt