The Bane of Knee Pain in Sports – Overuse, Underuse, and Injuries

Knee pain is not an age-related problem – at least, not for me. It has been on-going, off and on, since my 20’s. According to the specialist I saw back then, these were the contributing factors…

The Female Anatomy

Apparently, being a woman predisposes us to knee pain because of the anatomical structure of our hips in relation to our knees. In order to be able to deliver a baby, we have wider set hips that give us a sort of “knocked-knees” appearance. Unlike men, whose hip joints sit more or less over their knees, the center of gravity of our hips falls on the outside of our knees, creating strain on the knee joint.

Knee Pain - Q Angles
Image Source: Pinterest

Anatomically, this hip-knee position is referred to as the Q-angle. Obviously there are variations in the Q-angle even among women and men. The larger your Q-angle, the more strain there is on your knees. So wider hips might make our job of delivering a baby easier, but it also predisposes us to knee pain. How terribly unfair.

Muscle Imbalances

To put it simply, muscle imbalances occur when you train one set of muscles more than another. When these muscles are connected to the same joint, they can exert unequal forces on that joint, pulling it out of alignment, potentially leading to injury and pain.

Image Source: Pinterest

According to the doctor, my knee pain was caused by an imbalance within my quads. At that time, a lot of the physical activities I was doing (mostly running and hiking) were all developing the three outer quads – rectus femoris, vastus intermedius, and vastus lateralis. These activities did little for the inner quad muscle – vastus medialis – so it remained largely underdeveloped, leading to a muscle imbalance. Every time my quads contracted, the three stronger muscles would pull harder on the knee cap, moving it out of alignment.

What makes it worse is that this problem exacerbates the first problem of having a large Q-angle.

Ankle/Knee/Hip Unit

Knee problems aren’t isolated at the knee. They also encompass our ankles and hips on the leg with the knee pain and even on the opposite leg.

In my case, I had repeated sprains on the my right ankle in the past that I never really rehabilitated. This resulted in a loose ligament that did not hold my ankle joint securely. The doctor demonstrated this when he wobbled first my right foot and then my left foot, revealing a lot more movement in the right foot compared to the left.

“But my ankle doesn’t hurt at all,” I said. The doctor explained that I had likely been unconsciously compensating for that weak ankle for years, placing strain on my knee. Because the ankle, knee and hip are all part of a unit, an injury to any part of that unit can affect the other parts. If left unmanaged, the entire unit can be affected and the opposing leg as well.

More Risk Factors for Knee Pain

Since that appointment with the doctor, I have been reading the Knee Crisis Handbook, which revealed other risk factors for knee pain. The individual anatomical structure of your femur and tibia, for example, can also affect your likelihood of encountering knee pain.

W-sitting position
Image Source: C–C.TOP

Apparently, if you can do the w-sitting position (see above), it means you have that anatomical structure that is predisposed to knee pain. This is the one of the few flexibilities that I actually have and now I discover it’s really not a good thing at all. Bummer.

According to the Knee Crisis Handbook, knee injuries and pain are on the rise because of our increasing activities. That said, joint pain can also be the result of underuse. The question of managing knee pain isn’t necessarily in exercising more or less, but in the strategies that we use, like muscle strengtheningstretching, and foam rolling (more about that last one next time). Oh, and don’t underestimate the power of a physiotherapist. I still remember how they rehabilitated my grandma into a whole new person I almost didn’t recognise.

I must confess that I am not the most diligent of people when it comes to doing the things need to do in order to get my knees back in order. The pain is a strong motivator, but once it’s gone, it is easy to stop. Unfortunately, even in the pink of health, stopping is not advisable.

After I was given the rehab exercises from the doctor, I asked, “How long must I continue doing these exercises for?”

His answer? “For the rest of your life.”


* This blog is not intended to replace the advice of your doctor. If in any doubt, please seek your doctor’s advice.

Published by Shen-Li

SHEN-LI LEE is the author of “Brainchild: Secrets to Unlocking Your Child’s Potential”. She is also the founder of (a website on parenting, education, child development) and (a website on Right Brain Education, cognitive development, and maximising potentials). In her spare time, she blogs on Forty, Fit & Fed, and Back to Basics.

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