The knee bone is connected to the spine!!

The Knee Bone Is Connected to The… Well a lot!!!

Question: Did you know that stiffness in your upper to mid back could be the cause of your knee pain?

Truth: Pain is very misleading, but if we can learn to understand it’s true origin, then we can also learn how to treat it to live a more productive life.

The Story: A middle-aged man that also happens to be a tri-athlete came to me with complaints of knee pain while cycling and running. If you have every watched professional cycling, the typical posture is one that includes being hunched over with the arms tight to the body, very focused on the road ahead.


The Problem: If there were even a minor restriction in the mid back (causing a rotational shift to one side), that restriction could cause a compensatory rotation in the hip or the knee, especially when clipped in.

For example, if you are sitting in a little bit of rotation to the right, due to perhaps a fall onto the rib cage or maybe even because you sit to the right while working, in order for you to keep your gaze directed forward while cycling, you must rotate somewhere else to achieve this. And that could happen anywhere in the kinetic chain, even the knee.

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The source of your low back pain may not be where you think it is!

Golfers did you know that your low back pain can be coming from a restriction in your opposite shoulder?

Your back hurts after playing a round of golf. A very common scenario, I must admit.

One of my patients has chronic low back pain, is an avid golfer and has a sedentary job. Most activities are pain free except when she plays a long round of golf. After which she is sore for a couple of days.

A swing evaluation revealed that during the follow through she had difficulty rotating her torso to the left. So she compensated through her low back, which took the brunt of the rotation.

Why did she have this difficulty? Was there a restriction in her thoracic spine (mid back, thorax)?   Was there a restriction in her left or right shoulder? Were her hips not rotating during the weight shift?

weight shift2


The shoulder, thorax, and the hips as well as the feet are all joints that rotate. As you can see from the above photo, when this golfer is rotating to the left, both shoulders and forearms are rotating as well, in addition to his thoracic spine (torso), hips and feet.

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Does your low back hurt when you sit?

Does your low back hurt when you sit? 

This is a fairly common scenario not only because many people sit all day, but because back pain can be felt in the same place by many people, but you all could have different sources to your problem. Many times the back is the victim.

Consider a patient scenario: Left sided low back pain, worse with sitting and driving.

You are fine for years and then one day out of the blue, your back hurts after a long meeting. Was it the chair? Was it because you started doing the stationary bike more? Or was it because you had a long drive the weekend before?

Such was the case for one of my patients. In order to get to a sitting position, you have to squat first. So I assessed her squat.   Every time she squatted, her whole body rotated to the right. The body takes the path of least resistance. And her path was right.


sit to stand

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Golfers -did you know knee pain can come from your pelvis?

Does your knee hurt when you play golf?

The knee is usually the victim in most of these scenarios. I wanted to write just a short snippet about why you should consider other sources of your knee pain.

Yes, your knee hurts but is it the cause of the problem? Sometimes yes, more often no.

Consider a patient scenario: Long standing knee pain on the right, aggravated by the downswing.


As you see above, the right hip is turned in (internally rotated) and the clubface is ready to make impact. There is weight transfer from the right to the left leg and the pelvis stays level. Continue Reading…

Explaining Pain

How Do You Explain Pain to Patients?

The healing power of touch is well publicized but how about the healing power of speech?  When patients come to me, they hurt, they are in PAIN.  As physical therapists, we employ a great deal of clinical reasoning to come up with a diagnosis as to where their source of pain lies.   But patients always ask me,  “but why do I have pain?” Continue Reading…


Do you know what’s Really Causing your Running Injuries?

Preventing injuries while running may seem difficult even at the best of times, especially if you are putting in heavy mileage, adjusting to new shoes or just running on new terrain.

Recent studies estimate that between 19% and 79% of runners sustain an overuse injury in a 1 year period.  Recurrence of injuries is also common.  20 – 70% of injuries will come back.  Continue Reading…

Laptop Posture

Is your laptop causing you injury?

This post arose out of a need to answer all of my patients’ questions regarding their laptops and the best way to position them, especially when they are not sitting at the same desk all the time or when they are not in the same place all the time.

Is your laptop causing you injury?

The use of laptops for home, work and school has increased dramatically over the past decade. The US has the highest percentage of mobile workers in its workforce at almost 72%! Continue Reading…