Knee pain has a way of being loyal to no one. It troubles runners and desk workers, the young and the older, the very active and the barely active. What most knee pain has in common is that the joint is rarely acting alone.
The knee is essentially a hinge that depends on the hip above it and the foot below it to line up and share the load. When they don't, the knee pays. That's why treating it in isolation so often falls short, and why we look at the whole chain.
Why the knee hurts
Most knee pain is mechanical, a matter of how the joint is being loaded, not a sign of serious damage. Problems like patellofemoral pain (runner's knee), patellar or quadriceps tendinopathy, and IT band pain all come down to the kneecap and joint being loaded in a way they don't like.
And the direction of that load is often set from above and below. A hip that can't control the leg lets the knee cave inward; a stiff or flat foot changes the angle it works at. Find and fix that, and the knee usually settles, which is far better news than it often feels at first.
Common causes of knee pain
- Runner's knee (patellofemoral pain): front-of-knee pain from how the kneecap tracks, tied to hip control.
- Patellar & quad tendinopathy: overloaded tendons above or below the kneecap.
- IT band syndrome: outer-knee pain, common in runners and with mileage spikes.
- Hip weakness & foot mechanics: the upstream and downstream drivers behind much knee pain.
- Osteoarthritis: wear-related knee pain, which responds well to strengthening and movement.
Symptoms to look for
- Front-of-knee pain with stairs, squatting, or sitting for a long time
- Outer-, inner-, or below-the-kneecap pain with activity
- Aching after exercise, or stiffness the next morning
- Swelling, grinding, or a sense the knee isn't quite stable
- Pain that makes you avoid stairs, hills, or kneeling
When to seek care
If knee pain is limiting stairs, exercise, or daily activity, or keeps returning, an assessment can find the driver, often up at the hip or down at the foot, and treat it before you build compensations.
Seek urgent or emergency care for any of these
Some knee problems need medical evaluation before conservative care:
- A knee that locks, catches, or repeatedly gives way
- Inability to bear weight, or the knee looks deformed after an injury
- Significant, rapid swelling, or a "pop" at the moment of injury
- A hot, red, swollen knee with fever (possible infection)
When something is clearly wrong, get it checked. Screening for these is part of a responsible first visit.
How Dr. Daniel evaluates your knee
Your visit begins with your story: where and when the knee hurts, what activities trigger it, and how it's affecting your day. That pattern narrows the likely source before any testing.
Then comes a thorough exam of the whole chain: the knee itself, but also hip strength and control, foot mechanics, and your gait, because the cause is so often above or below the joint. Dr. Daniel screens for anything needing imaging or an orthopedic opinion, then targets the true driver.
You'll leave understanding what's driving your knee pain and what the plan is. It's the same four steps every time: Listen, Assess, Treat, Teach.
Our evidence-informed treatment approach
Care treats the knee and rebuilds the chain that supports it, because for most knee pain, strength is the medicine:
- Soft-tissue therapy: to release the tight structures around the knee, hip, and thigh.
- Joint mobilization & adjustment: for the knee, hip, and foot where motion is restricted, when appropriate.
- Hip & quad strengthening: the targeted work that most reliably resolves knee pain.
- Load management & movement retraining: adjusting activity and fixing how the leg loads.
This reflects the evidence for most knee pain: hands-on care plus progressive strengthening, with surgery a last resort.
Ready to sort out your knee?
An unhurried assessment checks the whole chain (hip, knee, foot), then you get a clear explanation and an honest plan.
Exercises & prevention tips
These habits help keep knees healthy and resilient. They're general guidance, not a substitute for an individualized plan. If the knee locks or gives way, get assessed first.
- Strengthen your hips & glutes: better hip control keeps the knee tracking well.
- Build quad strength: strong thighs protect and offload the knee joint.
- Progress load gradually: increase squatting, running, or hills in steady steps.
- Mind your feet: supportive, appropriate footwear changes how the knee loads.
- Keep moving with arthritis: gentle, regular activity generally helps an arthritic knee.
Why patients choose Alem for knee pain
Patients across San Francisco describe the same three things, again and again, in their own words, in their public reviews:
- Never rushed: a full, one-on-one visit and an exam of the whole leg, not just the knee.
- Root-cause care: the hip and foot drivers behind the knee pain.
- Real, measurable progress: care that moves the needle visit to visit.
"After just one session I feel insanely better! I still definitely have a ton of pain, but it was at an 8 before seeing Dr. Daniel, and right now as I type this, it's at about a 5." — Nadim R., verified 5-star review
Frequently asked questions
What is causing my knee pain?
Very often the knee is where the pain shows up, but not where the problem starts. Weak or poorly-controlled hips and stiff or flat feet change how the knee tracks and loads, driving issues like runner's knee, tendinopathy, and IT band pain. The exam looks at the whole chain — hip, knee, and foot — to find the real cause.
Can a chiropractor help with knee pain?
For most common knee pain — patellofemoral pain, tendinopathies, IT band, and mild osteoarthritis — yes. Dr. Daniel treats the knee and, crucially, the hip and foot mechanics driving it, then rebuilds the strength that supports the joint. Care is hands-on plus progressive exercise, which is what the evidence supports.
Is my knee pain coming from my hip?
Frequently, yes — at least in part. Weakness or poor control at the hip lets the knee collapse inward under load, which is a major driver of runner's knee and related problems. That's why treating only the knee often disappoints, and why the hip is a routine part of the assessment.
Do I need surgery or an MRI for knee pain?
Usually not. Most knee pain improves with conservative care, and imaging or surgery is reserved for specific injuries — a locking or unstable knee, or pain that doesn't respond. Dr. Daniel will tell you honestly if he believes you need imaging or an orthopedic opinion.
How long until my knee improves?
Many people notice progress within a few weeks of consistent care and rehab, with tendinopathies and stubborn cases taking longer as the tissue rebuilds. You'll get an honest timeline for your situation and a plan with a defined finish line.