The Runner Who Kept Treating the Wrong Thing
She was a 34-year-old who ran three to four times a week along the coastal path from Rose Bay to Nielsen Park. Lateral knee pain, consistently worse after about the 4-kilometre mark. She’d been told it was her IT band. She’d foam-rolled it religiously. She’d had two cortisone injections. She’d taken six weeks off running twice, and both times the pain returned within days of getting back on the road.
When I assessed her properly, the real problem wasn’t in her knee at all. Her left hip was measurably weaker than her right, her pelvis was dropping on the right side with every step, and her lumbar spine had a functional asymmetry that had been there, unaddressed, for years. The IT band was reacting to a biomechanical problem upstream. This is the most important thing I can tell you about exercise physiology for knee pain: the knee is almost never the whole story.
The Most Common Knee Pain Presentations I See
Patellofemoral pain syndrome (runner’s knee) — pain around or behind the kneecap, driven by altered patella tracking. Almost always a consequence of hip abductor weakness, tight hip flexors, or foot and ankle mechanics.
IT band syndrome — lateral knee pain common in runners and cyclists. The root cause is almost always hip-related, particularly weak glutes and hip external rotators.
Osteoarthritis (OA) of the knee — degenerative joint disease. Knee OA responds well to appropriately dosed exercise; it is one of the conditions where exercise physiology has the strongest evidence base of any intervention.
Post-surgical knee rehabilitation — whether after ACL reconstruction, meniscus repair, or knee replacement. Return-to-sport timelines and progressive loading protocols fall squarely within the exercise physiologist’s scope.
How Exercise Physiology Builds the Strength Your Knee Needs
Phase 1: Hip activation without stressing the knee — clamshells, side-lying hip abduction, glute bridges.
Phase 2: Progressive functional loading — step-ups, split squats, Romanian deadlifts. Hip-dominant patterns that teach the body to load through the hip rather than defaulting to the knee.
Phase 3: Sport or activity-specific conditioning — progressive return to running with gait retraining, or building the capacity to manage daily activities with less pain for older patients with OA.
Exercise Physiology for Knee OA: A Special Note
There is a persistent and damaging myth that people with OA should rest and avoid loading the joint. The evidence is clear in the opposite direction: graduated, supervised exercise is one of the most effective interventions available for knee OA — more effective than many medications, and without the side effects.
Book with Dr Gordon: Call Gordon Chiropractic & Exercise Physiology on (02) 9371 7774 or book at gordonchiropractic.com.au.