When Knee Pain Isn’t a Knee Problem: A Kinetic Chain Perspective
One of the things we love most about our Therapy Thoughts series on our email newsletter is how often real clinical lessons come from real human experiences, NOT just textbooks or labs. A great example of this comes from Christian Hoban, one of our instructors at Great Lakes Seminars, who shared a story that perfectly illustrates why whole-system thinking matters.
A Familiar Story: When Knee Pain Isn’t a Knee Problem
Several years ago, Christian ran a marathon. Like many runners, his preparation wasn’t perfect. Limited training, less-than-ideal footwear, flat feet, and some underlying coordination challenges. By mile 24, he developed significant lateral knee pain along with symptoms that felt neural in nature.
He did what most people would do: sought out physical therapy. The treatment focus stayed local to the knee, including proximal tib-fib joint mobilizations. While that approach offered short-term relief, the symptoms never fully resolved.
For years afterward, running continued to provoke knee pain. The presentation was inconsistent and unclear, making it difficult to pin down a definitive cause.
The Missing Link: The TFL–Glute Max Relationship
It wasn’t until Christian worked with another therapist who’s taken lots of GLS courses in the past (someone trained to look beyond the site of symptoms) that the real issue became clear.
The driver wasn’t the knee at all.
His TFL was excessively wound up, pulling the IT band off track and creating inhibition and functional insufficiency in the gluteus maximus. That altered force relationship upstream was setting the stage for chronic knee symptoms downstream.
Functionally, this makes sense. The TFL and glute max both attach to the IT band and are meant to work together to create a stable, efficient system for power generation, especially during activities like running. When one part of that system dominates or loses balance, the consequences often show up somewhere else.
A Lesson Bigger Than One Runner
Christian’s story is a powerful reminder of something we emphasize repeatedly in our courses:
pain is often not the problem—it’s the signal.
When clinicians stay too local and don’t explore the kinetic chain above and below the area of symptoms, we risk missing the true driver of dysfunction. In Christian’s case, addressing the knee alone delayed meaningful change for years.
Once the focus shifted to the full system, and the TFL–glute max relationship was addressed, everything finally started to click.
Why This Matters for Your Patients
This is exactly why integrated, system-based assessment and treatment matter. When we take the time to understand how regions interact, rather than treating them in isolation, we give our patients a much better chance at lasting results.
That philosophy is at the core of what we teach at GLS: connecting anatomy, movement, and clinical reasoning so therapists can think more clearly, treat more effectively, and adapt to complex presentations.
Christian’s experience is just one story, but it’s one that highlights how powerful it can be when we zoom out and truly look at the whole person.
Questions? Check out these FAQs!
Because knee pain is frequently a symptom rather than the root cause. If contributing factors at the hip, pelvis, or foot are not assessed and addressed, local knee treatment alone may provide only temporary relief. Looking both up and down the kinetic chain is essential for long-term resolution.
A whole-system approach allows clinicians to identify upstream and downstream contributors to pain, such as hip strength, fascial restrictions, or coordination deficits. By addressing movement relationships rather than isolated structures, treatment becomes more efficient, durable, and individualized.
Kinetic chain assessment involves evaluating how different regions of the body interact during movement. Instead of focusing solely on the site of pain, clinicians assess joint mobility, muscle function, and coordination across multiple segments to determine where dysfunction is truly originating.
Therapists can improve outcomes by expanding assessment beyond the knee, incorporating movement analysis, proximal strength and control, and soft tissue relationships. Education in integrated anatomy and functional movement can significantly enhance clinical reasoning and treatment effectiveness.
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