Knee pain – thinking beyond degeneration: a systematic review

Knee pain is the most common and challenging pain, that affects the performance and activities of daily living. Apart from the bones, the surrounding neuromuscular structures too are an integral part of the knee joint. The development of knee pain due to these surrounding neuromuscular structures, i.e. hip joint and ankle-foot complex is studied in this literature review. This systematic review was done for the purpose to summarise the literature mainly related to various neuromuscular factors related to neuro-muscle imbalances that affect knee pain other than degeneration. Observational studies related to knee pain published up to 2020 were reviewed in this paper. Strength of hip muscles and foot alignment were included in the study. We searched electronic database online for articles on ‘muscular imbalance that causes knee pain’ from Google scholar & PubMed the quality of the selected researches was measured by using PEDro scale. Of the total, 14 selected studies demonstrated that individuals with knee pain had decreased muscular strength for hip abduction, external rotation and extension on the affected side compared with healthy individuals. Flat foot, abnormal Q angle and over pronation or supination of foot can also results in knee pain. This review concluded that hip muscle weakness and abnormal subtalar mal-alignment place extra stress on knee and create muscular imbalance leading to knee pain. This should be prevented by either proper posture or strengthening programs.