The Number One Cause of Knee Pain


What’s the number one cause of knee pain?

Take a guess. Is the main cause of knee pain due to old age? ACL/PCL injury? Medial meniscus tear? Lateral meniscus tear? Collateral ligament strain? Patellar tendon tendinopathy? Iliotibial band (ITB) syndrome? Lower-crossed syndrome? Patella tracking issue? Hamstring trigger points? If any of those were your guess, you’d be wrong.

The Number One Cause of Knee Pain

This guy obviously needs to find out soon!

If you guessed any of those, you would be wrong.  That is, at least according to a recent article published by Sanshiro Hashimoto, MD[i].  Dr. Hashimoto is an orthopedic surgeon who specializes in the knee and is also trained in Mechanical Diagnosis & Therapy (MDT), which is the major assessment and treatment system we use at Active Health KC.

Dr. Hashimoto looked at his previous 101 patients that had a chief complaint of knee pain for at least one month.  He, along with two other trained MDT clinicians, assessed and treated the patients over the course of one month.  Of the 101 patients, he found that 44.6% of the patients had knee caused by one issue: lumbar spine derangement.

What is a lumbar spine derangement? Basically, that is when a joint or disc in the lumbar spine (low back) is not working correctly.  This issue can refer pain anywhere from the low back to the toes.  Since it involves the movement of the joint or disc tissues, it cannot be seen by an x-ray or MRI, only with a movement assessment by a trained clinician.

Now, you probably think that if an issue is being caused by your low back, you should have low back pain.  You would be kind of right, but also kind of wrong.  Of the 45 patients that had knee pain caused by a lumbar spine derangement, 31 did have low back pain.  However, the other 14 patients did not have any low back pain at all!

So, if you suffer from knee pain and also have low back pain, there’s roughly a 60% chance that your knee pain is being referred from the spine.  If you have knee pain without low back pain, then there’s about a 30% chance that the pain is referred from the spine.

However, if you walk into any clinic where the clinicians are not trained in Mechanical Diagnosis & Therapy, no one would ever look at your back.  They would probably give you a diagnosis from the list above and/or take an x-ray or MRI of your knee.  This means they would miss the true cause of the knee pain roughly half the time.  This is why knee surgeries are often no more beneficial than “fake” knee surgeries as I wrote about in a previous blog post.  It is also why, in our clinic, we see 3-4 patients a year who failed to get better with knee surgery (or hip surgery or shoulder surgery) and respond rapidly when we assess spine movements.

This is why it is very important to find a clinician trained in Mechanical Diagnosis & Therapy for your initial assessment.  Once the spine is ruled out, then treatment can be focused on the knee.

Assessing the spine as the cause of knee pain only takes a few minutes usually, but may take 1-2 visits at most.   But spinal issues can cause a lot more than just knee pain.  Another recent study[ii] assessed patients with extremity issues that ranged from carpal tunnel syndrome to shoulder impingement to hip bursitis and this study also found that 46% of the issues were referred pain from spinal derangements.  So, if you’re dealing with pain and haven’t been assessed by an MDT trained clinician, visit our office or find one near you at the McKenzie MDT Website.

Jeff Remsburg DC, MS, DACRB, Cert MDT

[i] Hashimoto et al. The most common classification in the mechanical diagnosis and therapy for patients with a primary complaint of non-acute knee pain was Spinal Derangement: a retrospective chart review. JMMT 2018

[ii] Maccio et al. Directional preference of the extremity: a preliminary investigation. JMMT 2018