Potential Causes:Anatomy of the Knees: Function & Issues

The underlying causes for knee issues include:

  • Muscular imbalance
  • Mobility issues
  • Patello-Femoral Syndrome (PFS)
  • Osteoarthritis
  • Injury or overuse

Muscular Imbalance

  • One cause of knee issues is an imbalanced pull of muscles on the kneecap, causing cartilage to wear down. This can be related to improper tracking of kneecap, knock-knees or being bowlegged. (Doug Keller)
  • “Because people with bowlegs tend to bear weight unevenly on their hips, knees and feet (the outer sides of these joints bear more weight), uneven stress and wear on those joints could lead to the early onset of arthritis.” (Nina Zolotow)

Postural Imbalance Linked to Hip, Knee and Foot Symptoms

All of these problems [bunions, plantar fasciitis, patello-femoral knee syndrome and hip bursitis] can derive from the same postural imbalance,” according to Bill Reif, physical therapist and author of The Back Pain Secret… namely “the exaggerated anterior [forward] tilt of the pelvis, the internal rotation of the thighs, hyperextension of the knees or poor knee tracking, and overpronation of the feet — the inward drop of the ankles and the flattening of the inner arches. This pattern can cause symptoms at the hip, knee, or foot, and often, in more than one of these places.” – Amber Burke

Mobility Issues

  • Limited mobility in any hip movements can cause compensation that harms the knee.
  • Hypermobility in hips, also, can lead to knee issues. (Marla Apt)
  • Knee pain can be caused by instability in the foot, ankle or pelvis. (Ray Long MD)

Instability in Pelvis

While instability in the foot or ankle can contribute to knee pain and dysfunction, it’s a less likely culprit than instability in the pelvis—which is where a strong core, hip abductors, and glutes come into play. – Ray Long MD

Patello-Femoral Syndrome (PFS)

  • PFS “is caused by femur cartilage rubbing against kneecap cartilage when the knee is bent” and is usually caused by overload or poor knee alignment. (Olga Kabel)
  • “This condition can be a precursor to arthritis at the joint and is almost always associated with overuse… Depending on how much cartilage you start off with (this is genetic), what seems like overuse to one person may be different for another.” (David Keil)


  • When the cartilage of the knee degenerates and gradually wears away, it is known as osteoarthritis. (Larry Payne MD)
  • Risk factors for developing osteoarthritis of the knee include trauma, body weight, sedentary lifestyle, repetitive use, bone abnormalities and some diseases. (Baxter Bell MD)

Injury or Overuse

  • Other reasons for knee pain include tears to ligaments, tendons and cartilage (such as a torn meniscus or patellar tendinitis) due to injury or overuse.