An overlooked cause of knee pain

Posted on August 15, 2012

(Last Updated On: March 9, 2018)

I’ve written a bit about how the predominant issue for people with knee pain is their knee(s) cave inward too much.

I wrote extensively about how the TFL (and IT band) is one of the main muscles causing this issue. You can find that on The best damn it band stretch. 

One element I haven’t touched on much is what movements cause the knee to cave inward, or what movements cause the TFL and IT band to tighten up. Because in actuality, the tight TFL is a symptom of excessive movements (that use the TFL) throughtout the day.

In other words, what common activities do most people partake in causing them to move in a way that elicits a tight TFL/ITB, and subsequently causes knee issues.

In some ways this is pretty straightforward. Pay attention to yourself during the day, when is your knee caving inward? Boom, there’s a movement that’s causing your knee pain.

The most common time I see this mentioned is when people try to correct squat form.

Cause of knee pain

Again though, is this really the cause of the issue? Put another way, is squatting an activity you regularly perform? Something you perform everyday, tons of times per day? I doubt it. Therefore, crappy squat form is more often a symptom rather than a cause.


Here is a cause I’m not sure I’ve ever seen cited: Driving.

We often get caught up looking at the knee and it’s valgus (caving inward) movement. Back to the squat example, I always see people talking about “Knees out!” but I never see them talk about where the feet should be. It’s equally important to look at the feet and each tibia. Movement here affects the knee as well.

For instance, you could have your knees be out but still have the feet turned too. Which means there is still rotation going on at the knee, which the knee does not like. (Too much rotation is often what causes knee injuries.)

So, valgus and internal rotation of the femur is important, but so is LATERAL/EXTERNAL rotation of the tibia.

it band syndrome

You may have the knee in good alignment, but have the tibia in crappy alignment.  Like when you are….driving.

Knee pointing straight, but foot / tibia pointing out.

And what pulls the tibia into external rotation? Among other things, the IT Band.

it band anterior and posterior portions

Credit to Anatomy Trains and Tom Myers

Therefore, however long it is you spend in a car each day is how long (at least) your IT band is sitting in a tightened position.

Furthermore, because you get so used to sitting in this position it’s likely you sit with your foot / tibia in this fashion even when you’re not driving. Like while typing at your desk:

The left knee isn’t caving, but the left foot is still turned excessively outward.

And then when you go to get up, you start from this position. So what do you do? You perform a crappy squat pattern.

That’s a lot of time to have your knee in a twisted position. No wonder it doesn’t feel well.

Get rid of it. Get your foot straight, get your knee straight, and make sure the foot and knee are facing the same direction.

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Posted in: Knee Pain, Pain