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Knee Pain Assessment - Why it is so Important for finding the cause of pain

Written by: Nick Jack
Category: 2014
on 30 May 2019
Hits: 6790

Apart from lower back pain the most common injury I come across in our studio each week is knee pain. It affects people of all ages, with many young sporting athletes suffering with patella-femoral problems and more severe ACL injuries. But it also greatly affects sedentary people and can become a much bigger problem if not resolved at the source and eventually begin to create injuries at other joints of the body. According to the current study by Nguyen and colleagues, frequent knee pain affects 25% of adults, and osteoarthritis is the most common cause of knee pain in adults 50 years and older. In recent years, the rate of knee replacements has surged. Rates have tripled in women in the United Kingdom and have increased 8 times in the United States among those 65 years and older. Is this due to aging or is there someone much bigger at play behind the cause of this? I would argue it is due to two things. Lack of movement and poor movement. What you will find with most knee injuries it is nothing to do with the knee itself! To find out what is behind the problem we need to use a series of tests and assessments to find where the leaks are coming from. This article we will show you how.

Our approach to treating pain is that it is a real inconvenience and that there must be some kind of pill, tablet or medical intervention to just get rid of it. Surgery by the way should always be a last resort. After every other option has been exhausted. Yet often you find today, this is almost the first option, in particular with sports in the off season. For example having your ankle operated on or a knee scrape.

There has recently been countless books and articles written by well-respected surgeons questioning the benefit of many of the most common surgeries being performed. Below is a quote from the book "Surgery The Ultimate Placebo" by Dr Ian Harris an orthopaedic surgeon in Australia.

“For knee arthroscopy, the bottom line is that if you have knee pain and degenerative changes in your knee (like mild arthritis or an undisplaced meniscus tear), then regardless of the kind of symptoms you have (mechanical or not), regardless of what x-rays look like, regardless of where the arthritis is, regardless of how bad your pain is, and regardless of whether or not the MRI scans show your meniscus to be torn, and of whether or not you have an MRI at all, having arthroscopy will not increase your chance of getting better, compared to a sham surgery. Nor will it reverse the degenerative changes in your knee.”

What is the better solution then?

The answer is to find the source of the problem and not just treat the symptoms. Learning how to move efficiently is where the secret lies, but what does this really mean? How do you test yourself to see what your ability currently is and what it should be? The only way to know the answer to these questions is to use an assessment.

If You Are Not Assessing You Are Guessing

This is such a great quote to keep in the back of your mind when trying to find an answer to your problem. Over the past 14 years record keeping is essential when helping clients overcome injury and pain. It allows us to find energy leaks and expose patterns specific to the person that is contributing to the problem. The best tip I can give you is to let the assessment guide you on what to do.

What I mean by this is never follow a template or assume that everyone needs to do a certain exercise. Most people with knee pain will have weak glutes and tight hips, but not always. I had to learn this the hard way many years ago when many of things that had always worked were making things worse. It was only after my failures did I learn to adapt and use the tests to guide me, even when they didn't make sense to me. This is where our weak VMO and knee pain video and ebook was created to help people understand there is not one single way to fix their injury, only the way that is specific to you. Sometimes people have knee pain from overly flexible hips or excessively tight glutes. The only way to be certain of what to do is let the tests tell you where to start and what to do next.

Okay so where do you start?

Step 1: Find Out Previous Injuries & Medical History

Before doing anything it is important to take a look at any previous injuries and any existing problems elsewhere in the body. This information is very important in helping you find the root cause of the problem and is often a step that is missed in many treatments and examinations. The site of pain is often not the cause of the pain, it is merely the effect of a cause somewhere else.

Vladimir Janda a pioneer in the development of postural correction and movement assessment states, that "these two anatomical systems cannot be separated functionally". Therefore, the term “sensorimotor” system is used to define the functional system of human movement. In addition, changes within one part of the system will be reflected by compensations or adaptations elsewhere within the system because of the body’s attempt at trying to maintain optimal homeostasis.

Red flags to me with previous injuries are any ankle or foot problems and any hip related problems. More on this later.

Obviously any official diagnosis from a health practitioner and imaging results like MRI and X-ray are important in determining the exact area in pain and to what extent it is damaged. The thing that this does not tell you is HOW it was injured. If your injury was from an accident then treating the symptoms will be fine to begin with and you may be fine once the body has done its healing. However, if you are someone who developed this problem gradually and not from a specific accident then your problem is to do with how you move. If you want a lasting solution to your knee pain you MUST find out what is the cause and there is no imaging that can do that for you.

Here is an example of forms I use to help me find out more about the client and where I may need to look during the further tests to come.


In addition to this information I also use a simple questionnaire to establish what repetitive movements and activities that use throughout the day. In most cases these are the triggers that provoke the compensation and mechanism for pain. By identifying and understanding what your pain trigger is you can begin to understand how to get rid of it for good or even avoiding more damage to begin with.

This simple questionnaire can reveal a lot for it is trying to magnify things that are performed repetitively and give you clues as to what corrective methods you may need to use. Where the last two questionnaires tell me about things that have already happened this one is telling me about how they may have been created.

 

If you have a job where you are seated all day, what hobbies or even the sports you play can help to narrow down what specific position or movement is used repeatedly that could be contributing to their problem.

Sometimes we can get caught up in prescribing exercises and thinking of all the corrective strategies and forget to really drill home to the client that they must change how they move in life. Many times we go through intense assessments, provide home exercises, stretches, stability drills for the client to do and after a few weeks the person has not changed much with their pain. Why?

The reason is that in 99% of these cases the trigger that is causing their pain is still at play and has not been changed. And this trigger is usually a DAILY ACTIVITY they think nothing of. Any of the corrective work we complete in the gym is instantly wiped out when the person continues to move with poor postures, motions, and methods they used to create the injury.

For example the damage that sitting causes to the knee is astounding (see video below). If someone sits for 8-10 hours a day, and just does 2 or 3 corrective exercise sessions of 30 minutes per week they are unlikely to change anything.


Dr Stuart McGill one of the world's leading researchers on back pain refers to this as "picking the scab". A great analogy to use to explain why so many people never respond well to their treatment, even when the treatment or exercise program is exactly the right thing. For the minute they get home or go to work they move exactly the same way that created the injury in the first place.

Main things I am looking for here are:

  • Previous injury to feet, ankle or hips
  • Repetitive movement where hips are in flexion, eg sitting or cycling
  • How often they exercise
  • If they are a runner I will need to assess running technique later
  • If they use Yoga too often or use excessive stretching I might suspect hypermobility

Step 2: Postural Assessment

Assessing your posture is critical in the beginning to determine where to start. Posture is defined as the position with which movement begins and ends. With all cases of injury we have found in 95% of these was significant postural malalignments across the body.

The other reason a postural assessment is good to do as it gives you many clues as to the areas to focus on first. Whenever I do this with a new client I have never met before, I begin to see things that set off alarm bells of where potential problems might be hiding. This helps me complete the rest of the assessment as I now look more intently in the areas of suspicion. You can request the help of a skilled therapist to do this, or you can also get easy to use apps these days you can use with IPADs that are very effective. See video below of this in action.

The problem with the posture assessment is similar to the imaging results. It might not look good but it does not tell you why it is that way and it also does not look at your posture while you move. I have had many clients look amazingly perfect on a static posture examination yet have extreme pain when they move.

All this does is give you clues of things that do not look right and help you highlight areas you want to investigate further.

Main things I am looking for here are:

  • If knees are valgus (knock kneed)
  • If feet are turned out
  • If knees are hyperextended
  • The degree of Pelvic tilt and lumbar curve

Step 3: Mobility Assessments

Many injuries can begin at the bottom and work their way up, or at the top and work their way down the kinetic chain and it is very common to see knee, hip, and lower back injuries caused by the feet or the thoracic spine.

Take a look at the picture below. This shows you how a person with feet instability will create a series of compensatory movement right up the kinetic chain that leads to problems at other joints. The feet may not have any pain but in this case they are the cause of the problems.

This is what is known as the "Joint by Joint" approach which was invented by Gray Cook and Mike Boyle. This gives great insight into how many movement problems are often created somewhere else and to correct the problem using this approach can help identify the right course of action.

What you will see is that every second joint needs flexibility and mobility, and the other joints need the exact opposite being stability and strength.

Here is how it works.

  • Feet - The feet have a tendency to being lazy, and easily losing strength and motor control. From poor footwear, to sitting too much, and even the lack of barefoot walking, the feet need exercises to make them stronger and more stable. The big toe is very important here and it needs incredible mobility as much as stability.
  • Ankle - The ankle tends to develop stiffness very easily and needs more focus on mobility and flexibility. Again another risk factor with ACL injuries.
  • Knee - The knee like the feet becomes weak and sloppy easily, (VMO for instance completely shuts down with as little as 10ml of fluid present). This in turn creates severe knee injuries and if left untreated eventually chronic stiffness in an attempt to stabilize it. Stability and strength work is needed for this joint.
  • Hip - This joint is often the cause of many knee problems. The hips have a tendency towards stiffness and as a result benefit from flexibility and mobility work.
  • Lumbar Spine - The lumbar spine needs stability to pre-vent unwanted flexion or extension.
  • Thoracic Spine - Needs mobility to provide extension and rotation of the ribcage
  • Scapula & Glenohumeral Joints—Needs stability with some degree of controlled mobility.

Why do we start with mobility assessment first?

The simple answer is that tight muscles will prevent you from moving into the correct position to begin with so it makes sense to try and restore optimal mobility first and it is the easiest and least painful thing to start with. The more complex answer is that tight muscles inhibit weak muscles otherwise known as muscle inhibition.

Not all muscles are designed the same way. In Vladimir Janda’s book “Assessment & Treatment of Muscle Imbalance” he explains great detail how this system works, but in simple terms tonic system muscles are prone to tightness or shortness, and the phasic system muscles are prone to weakness or inhibition.

A common example we see with most hip and knee injuries is a tightening of the hip flexor and quadriceps muscles that inhibit the ability of the posterior chain of the glutes to fire leading to poor alignment of the knee and weakening of the VMO. This lengthening and weakening of the Glutes & VMO occurs due to their Phasic nature. The tonic muscles begin to develop a method of overworking and dominating all movements and in essence “shut down” the phasic muscles completely. Even when we use the right exercise to correct the problem the wrong muscles take over and ruin it. Our first job is to shut these tonic muscles down and restore optimal mobility first and the best way to do this is using mobility drills and stretching.

I mentioned earlier that the ankle and foot is always high on my list to rule out. Below is a very simple test to see if there is a loss of ankle mobility.

How To Do The Wall Test

  1. Kneeling on the floor in front of a wall with the stiff ankle the (front) leg
  2. Slowly try to move your foot back as far as possible, while still being able to dorsiflex with the heel on the ground so the knee touches the wall in front.
  3. The foot should point directly ahead and the knee should move directly over this.
  4. The distance from great toe (the end of the big toe) to wall is measured. You should be able to reach at least 8cm with 10cm being ideal.

Things to correct this may vary considerably but one of my favorite drills is featured below.

When it comes to hip mobility the stretch featured below with the swissball is one of the first things I will look at, and it is amazing how often a person with knee pain cannot do this. This particular stretch will become a big part of their initial program and eventually evolves into the mobility drill featured in the second video to the right.

It is important that you do not stop here and think your job is done. You must assess your mobility at all joints and pay close attention to the ankle and hip. Make no mistake if you skip this stage you will never be able to squat or deadlift correctly and you will soon see that these are critical to the long term solution.

I also suggest reading these articles to see more detailed examples and explanations of how to complete your own mobility assessment.

Main things I am looking for here are:

  • Knee flexion & quadriceps length tension
  • Loss of ankle mobility
  • Loss of hip mobility
  • Loss of thoracic mobility

Step 4: Basic Stability & Gluteal Function

Now that I have some background information about what this person does, I have also observed the posture and assessed their mobility I am already starting to get a feel of what my program is going to be. A person with mobility restrictions we are more than likely going to be stuck in the previous stage for some time. But what about the person who passes the mobility tests easily?

This always tells me there is a stability and movement problem that is the main concern.

Many people who easily pass the mobility tests, and even the isolated strength tests will often fail these simple stability assessments. This tells you there problem is more to do with weakness than tight muscles.

The very first thing I look at is foot stability and in particular the big toe function.

It makes sense to start at the feet as they are the first part of the body to touch the ground when we move. Our feet and ankles are meant to withstand incredibly high forces and should provide more in terms of shock absorption than perhaps any other body part. Unfortunately, we begin to gradually lose this ability once we start wearing shoes. Over time, the feet, ankles, and toes become inhibited. And as we expose our feet to some trendy shoes with all types of padding and support, this only make matters worse and exacerbates the lazy and weak feet muscles.

Besides minimizing the ability to withstand intense ground reactive forces, the body gradually begins sending fewer and fewer signals to the feet, leading to distortions in pro-prioception and loss of innervation all the way up the kinetic chain. This is where poor stability evolves and injuries are born!

I have seen countless ACL injuries that began with poor foot stability. But how do you assess this? Firstly I start with the BIG TOE! Since power during propulsion is dependent upon the foot’s ability to become a rigid lever, making sure you can flex your big toe is the key to achieving full foot supination. When you walk, the entire body is advancing past this single joint, the ability to dorsiflex, and then be able to raise the heel as you move through the various stages.

If this mechanism fails, compensation will be forced to occur at ALL joints from this point onwards.

The simple tests I use to identify weakness here is to do 3 things.

  1. Can you SPREAD your toes? This drill is so simple to do and very important in mobilizing all the bones and muscles in your feet to provide you with a wider base to stabilize. It is amazing how difficult this can be to do if you have weak feet, and you will most likely need to use your fingers to do this.
  2. Can you LIFT the BIG TOE ONLY?
  3. Can you LIFT all the toes except the big toe?

Failing to do any one of these simple tests indicates you have some degree of foot instability.

The other area to look for instability is at the pelvis. This is where we see hips trying to become stabilizers and inhibit the abdominal muscles. Two great tests to determine this are featured below in the videos. The first is testing the lower abdominal muscles ability to maintain the pelvis in neutral and the second video is more of a reflex stability drill.

Lastly I will look at glute function in an isolated exercise. The simplest test to use is the hip extension or bridge as it is also known. The glutes get a great deal of attention when it comes to knee injuries as they are so important to maintaining optimal alignment at the hip by providing external rotation of the femur. This is where I may suspect weakness here if I found knock knees on the posture assessment.

It is important to perform this exercise as a holding position because this mimics the stabilising role of the gluteal muscles more closely. Building up the length of time you can position will improve strength-endurance of the gluteals in the inner range position.

What I am looking for here is where the person feels the contraction. If they feel it strongly in the hamstrings or lower back, the gluteals are not doing their share of the work. If they start to feel the exercise moving out of the gluteals into the hamstrings, and maybe even cramping the hamstrings, I know they have weak glutes as they have fatigued. I also observe if they try to push their hips up too far and arch the lower back too much indicating poor abdominal control. I also assess how they position their knees and feet which may give me more clues as to how they are going to move.

I suggest getting a copy of our Glutes Checklist below that takes you through everything you need to know about this stage.

Great articles to read with more detail are below

Main Things I Am Looking For Here Are:

  • Foot stability and big toe function
  • Abdominal control over hips
  • Hamstring cramping during glute isolation drills
  • Reflex stability ability

Step 5: Movement

So far everything we have looked at has been at a specific region of the body and most of the tests we have used have been lying or kneeling down. If we were to use a computer as an analogy think of the assessments in step 1-4 as assessing the hardware of our body such as bones, muscles, ligaments and tendons of the body. Now we are up to assessing movement which is equivalent to the software and is the motor programs that coordinates all these pieces of hardware.

Motor programs are ways the brain stores information about movement, and these are stored in the spinal cord as engrams. From picking up a pen off the floor, to riding a bike or throwing a ball, your brain develops a motor program that allows you to do this activity again without having to relearn all the mechanics involved. This way the brain can save storage space and energy and avoid the time consuming task of trying to put together all the individual parts of the movement each time you want to do that activity.

This is by far the most critical stage. You can spend all the time mobilizing and working on isolated glute strength as you want and you will make no difference to how you move. For if the body only knows how to move in poor positions anything you do in step 1-4 will be automatically erased the minute you move.

The more a motor program is used the more efficient it becomes. But this is where it gets interesting. For the brain does not question if it is good or if it is bad, it only wants to perform the movement in the most efficient way it can using what it has learned.

We must assess all of the fundamental movement patterns of the body to see how well you coordinate movement but for the sake of this article I will break this down to the big 3 for knee pain.

  1. Squat
  2. Deadlift
  3. Single Leg Stability

The Squat

This movement is usually the most painful for people with knee pain to perform for it requires a large degree of knee movement. For this reason it is why it is so important to learn.

The timing of the joints involved in a squat is the key. The ankle, knee, hip, and also the spine must all move in harmony with each other and importantly in the correct alignment in order to handle loads, force and braking or provide propulsion and movement. If the timing is off or the alignment is faulty there will be an "energy leak" that will compromise the efficiency and strength of the movement. This leads to poor performance and eventually injury as the body attempts to adapt to the poor alignment and correct it using a "plan B" strategy, otherwise known as compensation.

This is a perfect visual of what the optimal alignment would be like for a back squat. A back squat is where the bar is resting on the shoulders.

Take a look at where the knees are positioned, over the toes right? Take a look at where the bar is and the dotted line drawn down towards the foot. This is called the joint axis and is placed perfectly between the two moment arms, of the knee and the hips. A moment arm is simply the length between a joint axis and the line of force acting on that joint. Every joint that is involved in an exercise has a moment arm.

The critical things to take note of is that the perfect balance of work between the two moment arms creates symmetry and perfect timing of the body to handle loads. There is many great things happening here.

This is what happens when your knees go over your toes during the squat.

  • The Hip Moment Arm - comprises the workload being completed by the posterior chain of the glutes and hamstrings. The glutes are the powerhouse or the engine room for lifting loads and they are in great position here to work.
  • The Knee Moment Arm - still has enough work to complete if the knees travel over the toes. This is where the workload is completed by the quadriceps, especially the VMO muscle that is critical for healthy knee and patella tracking.
  • The Spine - is able to remain perfectly stable in neutral and avoid being compressed with either flexion or too much extension
  • The Neck - is easily held in neutral as there is no need to tilt the head back in order to look straight ahead.
  • The Ankle - receives great mobility to dorsiflex to provide the necessary angle for the squat to be completed.

This type of squat will be pain free and able to generate massive force to build strength and power.

Now compare that squat to the picture below of what I often see performed by a person with knee pain.

A great video about the squat is featured below.

I also suggest reading the articles below that provide you with many of the corrective exercises and various progressions and regressions we might use.

Deadlift

If the squat is the movement that creates the most pain with knee injuries, the deadlift is often the movement that feels the most comfortable and least painful for most.

It all has to do with pelvic positioning and being able to load the glutes effectively.

There are some people where the problem is so severe, or been there for so long that we must find ways to manage their pain and prevent any further aggravation of their injury. Anything that loads the knee too much like squats, lunges and even single leg positions are just simply too hard. We have to find other ways and the deadlift can be a great exercise that allows you to strengthen without pain. This is more common in the older adult who has been told they need a knee replacement or has severe osteoarthritis that impacts their daily movement. For more information on this see the article - Exercises for severe knee pain

If you were cramping quickly in the hamstrings with the glute drills earlier in step 4 learning to deadlift correctly will be invaluable.

All these hip loaded exercises are great strength choices for the person with minimal strength and pain because the demands on the knee are minimal, as opposed to the squat which places a high demand on the knee. Both the hip extension and deadlift are excellent for developing critical strength into the posterior chain of the glutes and hamstrings, my preferred choice is the deadlift. This is because it forces you to maintain an anteriorly tilted pelvis, allowing greater control for aligning the lower limbs and protecting the spine.

However…….. extreme caution is required with the deadlift as serious injury to your lumbar spine is the result of poor bending technique. See article about bulging discs for more on this.

There are many versions of the deadlift and I like all of them. But it is always wise to start with the easiest versions first that have more of a focus on timing and posture than brute strength. The video on the left is the version we use as the test. The trap bar deadlift is the version we might progress to if the technique is fine with the basic version.

Make sure you read the article – How to do the deadlift correctly for more tips and information

Single Leg Squat

At long last we up to assessing the single leg stance and more specifically the single leg squat as an assessment tool. I could also use the single leg deadlift if we have determined the squat is too difficult. This one movement puts together everything from steps 3&4 into one movement! For this reason it is the most important and useful test of all when it comes to knee pain. If I have not found anything useful from everything we have done so far I will most likely find something here.

All you have to do to appreciate how good this one exercise is as a test is to observe how many things are needed to get this right as seen in the picture below.

These are all the things that must happen within a blink of an eye in order to maintain perfect stability and timing with this exercise. The fact that the brain will use the timing from this exercise in walking, running and jumping means you have to become great at this to prevent injury and improve performance, no matter if you are a sporting athlete or an elderly person looking to remain mobile!

When assessing this movement we start at the ground and work our way up, looking for clues as to where joints are not functioning correctly. We can assess the feet for stability, ankle for mobility, hip for mobility and pelvis for stability all at the same time. Even the thoracic region can contribute to faulty loading. Last but not least we cannot forget the brain. The most important factor to consider and the one thing that drives all movement. You could actually find that all of these joints with the corrective exercises and drills are very good and there is nothing wrong with them! The problem is that you just do not know how to squat, which is a brain and coordination problem.

Watch the video below as I show you exactly how to do this

Main Things I Am Looking For In Step 5 are:

  • Squat technique & what compensations are present
  • Deadlift technique and if good form can be executed
  • Single leg squat technique & what compensations are present

Make sure you read the article – How To Use The Single Leg Squat As An Assessment Tool

Running Technique & Change Of Direction Technique

This last set of tests is not relevant to all people and is not something I would do within the first few weeks. I will make sure I have already implemented any corrections based on the other steps before assessing these following tests. Usually I would look at this about 3-4 weeks after the initial assessment depending on the person.

These assessments come back to the information we obtained in step one where we looked at their lifestyle and exercise habits. If they are someone who runs or play sports I have to assess their ability to run correctly and also how the change direction for these two things may be the trigger behind their pain.

I have seen many people whose knees are fine as long as they do not run or play sport. They can cycle and even lift weights in the gym okay, but if they run or try to play sport knee pain is the end result.

This is where the problems we might have seen with the single leg squat are multiplied to much bigger problems when they run. Trying to evaluate a running technique is tricky at best and trying to change it is even harder. Having said that, there is a few simple things you can do that could make all the difference.

Below are 2 videos explaining how we to do this.

Cutting Technique (Change of direction)

Again this is not relevant to everyone, just the people who play sports. Also you need to understand that this is the exact movement we see the dreaded ACL tear occur in!

As with the running technique any compensations or mistakes seen in the single leg squat are greatly exposed here and there is 3 key factors for making this perfect.

First, you need to learn how to control what is known as “shoulder sway”.

This is important in maintaining balance during explosive change of direction and if you witness an ACL tear you will often see the person demonstrating shoulder sway right at the point the knee goes. When you plant your foot quickly to change direction but do not control the upper body by recruiting good stiffness through the core, the shoulders will move you sideways to the direction you are moving. As a result, you will have too much of your body weight heading in one direction and it to change back the other way will not only be slower but risky as you will need to twist over your knee to get back! There is many reasons why this may happen but knowing to avoid this mistake will already make you more efficient.

Secondly, you must learn to stay low by keeping your hips behind you. This is a common mistake we see at all levels and you fail to stay low during a cutting move, your ability to effectively brake the movement is compromised. If the body is not loaded well, it certainly cannot explode concentrically as well. The athlete must learn to reposition the feet from a low athletic stance so that proper loading occurs.

Lastly, the previous 2 mistakes often occur as a result of improper plant foot angle. Stutter steps or poor balance often stem from this error. The plant foot angle is intended to provide an optimal base for eccentric control of deceleration and concentric force production during the subsequent acceleration or push-off movement. If the foot plant is correct, the deceleration and the push-off movement become smoothly linked.

Main Things I Am Looking For In Step 6 Are:

  • Running technique - specifically over pronation or excessive heel strike
  • Cutting technique – shoulder sway, being too upright and foot turned out on foot plant

Summary

There is many other assessments I may use depending on the person in front of me but the ones featured in this article I would use with almost every person. When you know what good form and pain free movement looks like it is easier to work backwards and see where people are compensating and energy leaks are hiding. Everything we have discussed in this article could be a factor and it is your job to find the underlying cause or trigger of the problem to find the long term solution.

The next question is what do you do once you have all this information?

And the answer to that is impossible for me to say as it will vary a lot from person to person. Many of the tests will become great exercises to use and that would be my starting point much of the time. However there is many things you will need to do to pull all this together and teach your body more efficient patterns of movement.

But at least now you a clear direction of what is needed and the exercise selection will be very specific to your needs.

You will find our complete assessment process and the detailed online knee pain programs to rectify your injury in our program below you can download instantly. This includes a 60 minute video and instruction manual to guide you on creating your program.


And if you live in Melbourne and would like to know more about our personal training or knee rehabilitation programs you can request a free consultation by clicking here.