Chiropractor Chandler AZ

What Causes Pain on Outside of Knee when Kneeling?

Pain on the outside of the knee could be a wide range of possibilities, what we commonly see is caused by cartilage, meniscus, ligament, or iliotibial band tendon sprains. Bending and kneeling changes the parts of the body that are stressed, leading to lateral knee pain on the damaged tissue. Half the battle of relieving this pain is finding the location and position of the damaged tissue.

Let's think about this in a basic sense. When you are kneeling, you are flexing the quad muscle and the IT band, so injuries to either of these two components are a common cause of pain on the outside of the knee when kneeling, since they are so heavily involved in the process.

Causes Of Pain

Regular exercise can cause this pain, but certain types of exercises and training intensity can prolong the pain, or make it worse.

  • Increasing time exercising
  • Exercising with heavy weights and/or improper form
  • Especially a squatting or lunging-type exercise
  • Imbalance of the muscles surrounding the knee
knee model posterior labeled

With pain on the lateral knee, it is best to avoid any kind of activity or exercise that will involve squatting, kneeling or lunging. These types of exercises can put even more strain where it is painful, and possibly cause more damage to the injured tissue.

Knee tendinosis and tendonitis are common issues related to this type of pain. Think of a tendon like a rope tied to a tree. Each tug on the rope places tension and stress on the rope, especially where the rope is tied to the tree. With time and repletion this creates an area where the rope becomes damaged and frayed. With enough pulling and fraying the rope can become severely damaged. IT band tendonitis is often caused by a combination of gluteus medius weakness, lateral quadriceps spasms, and scar tissue limiting elasticity of the IT band fascia. All of these factors contribute to the IT band tendon rubbing and fraying against the outside of the knee.

When you think of fixing the problem, we can't just focus on the injured area. We must also focus on strengthening the areas surrounding the knee. Strengthening the knee and its surrounding muscles, tendons and ligaments is the key to proper recovery.

knee model lateral view labeled
Anatomy of Knee

The knee is a massive hinge joint which allows over 130° of flexion. A straight leg (extended knee) can be bent (flexed) to where the heel touches the butt. This tremendous range allows us to run, jump, and squat. Your entire body weight and its resistance against gravity strains the joint. When we are running, jumping, or squatting, the forces are greater and shift through the joint depending on the level of flexion.

Your knee also has a slight amount of rotation. This rotation locks and unlocks the knee when standing straight-legged. Many times, people will feel a pop as they extend or flex a knee; some of this feeling is from the rotation.

Your knee is a complex joint. A simple version to that statement is that it has a lot of stuff in it. This stuff includes the bones. The weight-bearing femur sits on top of the tibia and the smaller fibula that is on the outside of the lower leg. Most of the weight is transferred from the femur to the tibia.

If you are sitting with your knee bent, place your finger on the top of your kneecap. As you straighten your knee you feel the patella get pulled towards your hip. The contraction of the quadriceps muscles is shortening and pulling the patella towards the hip. The patella ligament is pulling the tibia and extending the knee. The quadricep is shortening to produce movement, or concentric contraction. Now slowly lower your leg back down by allowing the quadriceps to lengthen. The quadriceps muscle is slowly elongating, or going through eccentric contraction. Eccentric contraction places more strain on muscles and is more likely to cause muscle damage. Eccentric contraction is why you are more sore after running or walking downhill compared to flat ground.

knee model patella labeled
Bringing Your Knee Back to Normal Function is a Process

At our Chandler clinic, we use many different types of treatments and therapies to ensure you can return to what you love doing, or just get you back to a normal function. We start with the basics, then move on to more advanced techniques like Graston or our cold laser.

Treatment is a Progression

Our initial goals are always to:

  • Get you out of pain
  • Increase flexibility
  • Restore proper range of motion
  • Increase strength and endurance
  • Restore muscle coordination
  • Restore muscle and joint stability

The table below will briefly display the benefits of two of our major treatment techniques, Graston and the Cold Laser.

Graston Technique

Cold Laser

Reduce stress and strain to injured areas

Accelerate tissue repair and growth

Decrease inflammation

Reduced fibrous tissue formation

Increase blood flow

Pain relief

Break up scar tissue

Increased blood flow

Promote proper tissue repair

Nerve function and repair

Increase muscle flexibility and strength

Increased energy production

Accelerating fibroblast activity

Decrease inflammation


As you can see, these treatments have many of the same benefits, so when used in tandem they have the most beneficial effects. The cold laser will be more involved with nerve damage, whereas Graston will be more involved in muscular-type damage.

Pain on the outside of the knee is commonly the result of poor strength and flexibility in important parts surrounding the knee. We will work to improve movement and eliminate pain in a variety of methods and knee treatments. Many therapeutic exercises can help restore proper strength and endurance to the leg muscles. Isometric exercises are often the initial treatment exercises, followed by single plane rubber band exercises for the hip, knee, and ankle: flexion, extension, adduction, abduction, circumduction, inversion, and eversion.

wobble board squatting two feet

We also will engage a variation of dynamic knee exercises on unstable surfaces.

  • - Vibration plates
  • - Exercise ball
  • - BOSU ball
  • - Rubber discs
  • - Stability foam

The more unstable the surface, the harder your lower extremities work to provide stabilization. Vibration plates enhance neuromuscular learning throughout the foot, ankle, knee, hip and back.

Our Chandler Chiropractic and Physical Therapy clinic treats a variety of people coming from different backgrounds with muscle, tendon, joint and ligament injuries. We provide treatment for cyclists, runners and triathletes in addition to common to traditional neck and back patients seen in Chiropractic, Physical Therapy and Massage Therapy clinics. We work with all ages and abilities for residents in Phoenix, Tempe, Gilbert, Mesa and Chandler.