Is Your Knee Talking Back? Here's What You Need to Know
- Dr. Lucas Marchand
- Jul 1
- 7 min read
Knee Pain and Chiropractic Care — What's Actually Happening and When It Helps
By Dr. Lucas Marchand, DC — MyChiro Mobile Chiropractic, Sioux Falls, SD
The text came in on a Tuesday afternoon: "Hey, question — my knee, I know it's not back, but it has been hurting the last three or four days and aspirin hasn't really helped. Should I have an X-ray or something to see if it is bad? I do notice, not every time I move it, but it will click or feel like something rubbed it. Not every time, but it does have sharp pain. It's dull pain, but it's annoying and has lasted a while now."
This is one of the most common clinical questions a chiropractor gets about a joint that isn't the spine. And the answer to almost every question in it — do you need imaging, what's causing the click, why isn't ibuprofen helping, what does a chiropractor actually do for a knee — is more specific and more useful than "it depends" or "you should probably get that looked at."
Here's the actual answer.
What Knee Pain Usually Is
The knee is a hinge joint with some rotational capacity, designed to bear load and absorb force across a wide range of activities. When it hurts, the pain is almost always mechanical in origin — meaning something in the movement pattern, load distribution, or tissue tolerance has changed, not something structurally catastrophic.
The most common presentations in clinical practice fall into a few categories.
Patellofemoral pain — pain at or around the kneecap — is the single most prevalent knee complaint in people who are active but not athletes, and in desk workers who sit for long periods with knees bent at 90 degrees. The patella tracks in a groove at the bottom of the femur, and when the muscles that control patellar tracking — primarily the vastus medialis oblique on the inner quad and the hip abductors — are weak or imbalanced, the kneecap shifts laterally under load. That shift creates compression and friction between the undersurface of the patella and the femoral groove. The result is a dull, aching pain around the kneecap that worsens with stairs, squatting, and prolonged sitting. The aspirin-doesn't-help pattern is consistent with this — it's not primarily an inflammatory process, it's a mechanical one.
Iliotibial band syndrome presents as lateral knee pain that worsens with repetitive flexion-extension, particularly in runners and cyclists. The IT band doesn't cross the knee joint itself but creates friction over the lateral femoral epicondyle at approximately 30 degrees of knee flexion — which is the angle the knee passes through repeatedly during running or cycling. The pain is often sharp and can feel like something is rubbing, which matches the description in the patient text above.
Meniscal irritation — not a tear, just irritation of the meniscal tissue — produces the clicking or "something rubbed it" sensation that many patients describe. The menisci are C-shaped fibrocartilage structures that sit between the femur and tibia and act as shock absorbers and joint stabilizers. Minor meniscal irritation from repetitive movement, a small positional shift in tibial tracking, or overloading during daily activities can produce clicking, a sensation of catching, and diffuse knee achiness without the swelling or locking that would indicate a structural tear.
Hip and foot contributions. The knee doesn't function independently. It sits between the hip and the ankle, and biomechanical problems at either end translate directly into altered knee mechanics. Weak hip abductors allow the femur to internally rotate under load, changing the angle of force through the patellofemoral joint. Flat feet or excessive pronation alter tibial rotation, which affects how the menisci are loaded. Many knee pain presentations that don't fully respond to local treatment are actually hip or foot problems with the knee bearing the consequences.
When X-Ray Is Actually Indicated
The patient asked whether they needed an X-ray. The honest clinical answer is probably not — but it depends on specific features.
X-ray images bone. For a patient with four days of knee pain that clicks occasionally, aches persistently, and isn't improving with over-the-counter anti-inflammatories, an X-ray would primarily tell you whether there is significant joint space narrowing (suggesting advanced degenerative change) or a fracture. Neither of those is a likely finding in someone who developed knee pain gradually over a few days without trauma.
The Ottawa Knee Rules — a validated clinical decision framework for determining when knee imaging is warranted — indicate imaging when any of the following are present: age 55 or older, tenderness at the fibular head, isolated patellar tenderness, inability to flex the knee to 90 degrees, or inability to bear weight for four steps. If none of those apply, X-ray is unlikely to change management and can reasonably be deferred.
MRI is a different question. If there's genuine concern about a structural meniscal tear — a locked knee, significant swelling, a clear mechanism of injury like a twisting fall — MRI is the appropriate imaging. But for the presentation described above, the clinical examination is usually more informative than imaging, and the management would be the same regardless of what the image showed.
What Chiropractic Actually Does for Knee Pain
Chiropractic care for knee pain doesn't work the same way it works for back pain, and it's worth being specific about why.
The spine responds to chiropractic adjustment because restricted spinal joints can be directly mobilized — the thrust creates a cavitation in the joint and restores its range of motion. The knee can be adjusted directly in some cases, particularly when the proximal tibiofibular joint (where the fibula meets the tibia just below the knee) is restricted, or when the patella is laterally displaced and needs mobilization. These are useful techniques but they're not the primary intervention for most knee complaints.
What matters more for most knee presentations is what happens above and below the knee.
Hip adjustment and hip mobility work directly addresses the femoral rotation and abductor weakness that contribute to patellofemoral dysfunction. The treatment sequence at MyChiro for knee presentations typically starts with percussion therapy to the lateral hip and IT band, PIR stretching of the hip flexors and external rotators, and adjustment to the lumbar spine and sacroiliac joint where movement restrictions are affecting hip mechanics. Many patients are surprised to find that a knee complaint responds to treatment directed at the hip and lower back — but it makes mechanical sense once the chain is explained.
Foot and ankle mobility work addresses the tibial rotation contribution. A restricted subtalar joint or limited ankle dorsiflexion changes how the knee tracks during squat and stair patterns. Improving ankle mobility is often the missing piece in knee presentations that have plateaued with other treatment.
Soft tissue work to the quadriceps, IT band, and posterior chain reduces the chronic tissue tension that's mechanically loading the knee beyond what it can tolerate. This doesn't require aggressive deep tissue work — percussion therapy and directed stretching are usually sufficient and significantly more comfortable.
The Hip Connection Most Patients Don't Know About
It's worth expanding on the hip contribution specifically because it's the most commonly missed piece of the clinical picture in knee pain.
The gluteus medius — the primary hip abductor — fires during the single-leg stance phase of every step you take, preventing the opposite pelvis from dropping and controlling the degree of femoral adduction. When it's weak or inhibited, the femur drops inward under load, the knee moves into valgus alignment (the classic "knee caving" pattern), and the patella is pulled laterally out of its groove by the relatively unopposed pull of the lateral quadriceps and IT band.
This pattern is extremely common, particularly in people who sit for most of the day. Prolonged sitting inhibits the gluteals through a process called reciprocal inhibition — the hip flexors (which are shortened and compressed during sitting) neurologically inhibit their antagonists, the gluteals. After years of predominantly sedentary work, the glutes simply don't fire the way they should, and the knee pays the price.
In nearly a decade of mobile chiropractic practice in Sioux Falls, the most consistent finding in knee pain presentations is not a knee problem — it's a hip problem that the knee is being asked to compensate for. The clinical implication is significant: treating the knee alone without addressing the hip rarely produces lasting relief, while addressing the hip alone often resolves knee symptoms that seemed unrelated to the hip.
What to Expect From Treatment
For a presentation like the patient text above — four days of diffuse knee pain, intermittent clicking, dull ache that aspirin isn't touching — the realistic treatment arc with chiropractic management looks like this.
The first visit involves a full assessment. Where exactly is the pain? When does it click — flexion, extension, weight-bearing? Does stairs make it worse, better, or irrelevant? Any history of prior knee injury? Full lower extremity orthopedic screen including hip mobility, patellar tracking, and tibial rotation assessment. This takes fifteen to twenty minutes and shapes everything that follows.
Treatment at the first visit focuses on reducing the irritation before loading the tissue further — percussion therapy to the quadriceps, IT band, and hip, followed by PIR stretching of the hip flexors and hamstrings, followed by relevant spinal and hip adjustment. Home exercise: glute bridge and terminal knee extension as a start.
Most straightforward presentations respond meaningfully within two to four visits. Presentations that have been present for months or years, or that have significant degenerative component confirmed by imaging, take longer. The goal in either case is to restore as much mechanical function as possible, reduce the pain signal, and give the patient the specific exercises that maintain what was gained.
When to Refer Rather Than Treat
Knee pain that warrants referral rather than chiropractic management includes significant joint effusion (swelling that fills the joint space and makes the knee feel boggy), a locking sensation where the knee cannot fully extend, significant instability suggesting ligamentous injury, pain that is constant and severe rather than activity-related, or any neurological symptoms — numbness, tingling, or weakness — that suggest nerve root involvement from the lumbar spine rather than a local knee problem.
None of these presentations were described in the patient text above. But naming them is part of answering the question honestly — a good chiropractor recognizes the limits of their scope and refers when the presentation warrants it.
Getting Assessed in Sioux Falls
If your knee has been bothering you for days or weeks without improvement, the most useful next step is a proper assessment — not imaging, not ibuprofen, not waiting to see if it gets worse.
MyChiro serves Sioux Falls, Brandon, Tea, Harrisburg, Renner, Canton, and the surrounding area. The clinic comes to you. Same-day appointments are usually available.
Book your visit here. Or call or text (605) 201-4862.
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