Clinical Conversations

Knee pain: The complete question and answer by Nick Rinard Physical Therapy

1). What is a surprising fact about knees that most people don’t know?


The most relevant misinformation about knees for patients is that radiologic findings (either x-ray or MRI) are what’s responsible for their pain.  On the contrary – something ‘wrong’ found in imaging is most likely NOT associated with pain!  In one study of 24 elite athletes NOT complaining of knee pain, “EVERY knee imaged had at least one structural anomaly” (  The rate of “false positives’ (what researchers call it when a positive test for a disease is incorrect because the patient does not actually have the disease) varied from around 50% to 80% in this study.  So, if your knee hurts, and you get a radiological diagnosis, you have a high chance of getting misdiagnosed.  Better to get a full examination to get a better clue as to the source of pain.


2.) How do your knees affect your stride?


Technically speaking your knees (the joint parts) do not affect stride since running is a “mid-range” motion.  Walking, on the other hand, does involve end range extension, so limited extension could have an effect – but not in running.  Pain in the knee is likely to affect your ability to tolerate a running stride, and your body will find ways to avoid pain – thus affecting your stride in varying ways.  There is no typical way this happens, so if you have knee pain, you need to have a good mechanical examination to find out how to best treat or manage it.


3).  Is ‘runner’s knee’ a real problem (and is it as big a one as people think?)


‘Runner’s Knee’ could be any one of many diagnoses, so, as a term, it is not really a diagnosis – it is a symptom.  Consider this:  Meriam Webster’s “Medical Definition of ‘Runner’s Knee: pain in the region of the knee especially when related to running that may have a simple anatomical basis (as tightness of a muscle) or may be a symptom of iliotibial band syndrome or chondromalacia patellae.”  It can be a real problem, and it can be a big one if not well understood by the patient or treating healthcare provider, like a physical therapist.  If your pain does not subside quickly after running, or is so bad that you cannot increase your running distance due to pain, then it is best to get a full mechanical evaluation from a trained provider (and given the answer to question 1 above, imaging should not be necessary first.)


4).  What are the most important things a runner can do to keep their knees injury free?


The body is amazing and can be trained to do almost anything.  Injury creeps in when your training load exceeds your body’s ability to adapt.  Progress your training in small increments and don’t underestimate the power of a rest day to give your tissues a chance to heal and catch up.


5).  Anything specific we didn’t talk about that you think I should mention?


Yes, over the years I have seen a high incidence of spinal problems being either the sole source, or contributing to, knee pain.  This rate is up to 40% or higher based on my anecdotal experience and confirmed by research in progress (presented at the 2017 McKenzie Institute International Conference in San Francisco).  Many runners have consulted with me right in the middle of training for an event (like a marathon, mostly), desperate to not interrupt their training due to knee pain.  I have helped them stay in training and complete the event by effectively screening for spinal issues that are masquerading as knee pain.  Often the patient dismisses this since they “always have a sore back, but the knee pain is new”.  Given the important role the spine plays in controlling everything in the extremities, it should not be surprising how relevant it can be in knee pain – and how important it is that your properly trained specialist can identify and treat it effectively!




Nick Rinard MPT, Cert MDT