Understanding Knee Pain in Athletes and Gym Enthusiasts: Causes, Mechanisms, & How Chiropractic Care Can Help

Whether you're just getting into fitness, returning to an active lifestyle, or you're a seasoned athlete training at high intensity, knee pain can be a frustrating and limiting obstacle. The knee joint plays a central role in nearly every dynamic movement—running, squatting, lunging, jumping—and when it’s compromised, it affects your ability to train, compete, and recover. Unfortunately, knee pain is one of the most common complaints in both recreational and professional athletic populations.

At Canoe Chiropractic, we frequently work with athletes and fitness enthusiasts experiencing knee discomfort due to a combination of high-impact sports, faulty movement mechanics, muscle imbalances, and postural stress. These factors often go unrecognized until they lead to significant dysfunction, pain, or even injury. Left unchecked, these issues can disrupt training progress and lead to long-term joint degeneration.

Understanding the root causes and the biomechanical mechanisms behind knee pain is essential for effective treatment—and more importantly, for injury prevention. Chiropractic care offers a non-invasive, functional approach that addresses more than just the symptoms. This article explores the most common knee injuries seen in active individuals and highlights how chiropractic evaluation and treatment can support healing, enhance movement quality, and reduce future injury risk.

1. Meniscus Injuries

The menisci are two C-shaped pads of fibrocartilage that cushion and stabilize the knee joint. Injuries to these structures often result from twisting the knee while bearing weight—a common occurrence in sports like basketball, soccer, or during heavy squats.

According to recent medical textbooks, the menisci play a vital role in joint congruence, load transmission, proprioception, and shock absorption. The medial meniscus is more commonly injured due to its firm attachment to the joint capsule, limiting its mobility. Meanwhile, the lateral meniscus is more mobile and therefore less susceptible to injury.

Mechanism:

Meniscal injuries often result from a combination of joint loading and rotational force. Imagine an athlete pivoting rapidly on one foot while the knee is flexed—this creates a twisting motion that compresses the femur against the tibia with the meniscus caught in between. The resulting shear force can tear the meniscal tissue, particularly in the medial meniscus, which lacks the mobility to adapt to such stress. Deep squats and kneeling under load further increase the axial compression on the joint, exacerbating the likelihood of damage. Over time, repetitive use or microtrauma can also cause fraying and degeneration of the meniscus, especially in individuals with altered biomechanics or those exposed to high training volumes. These injuries often co-occur with ligamentous damage, particularly involving the ACL, due to the interconnected biomechanics of knee stability.

Specific tear patterns—such as radial tears, bucket-handle tears, and horizontal cleavage tears—are commonly diagnosed via clinical orthopedic testing and confirmed through MRI. These patterns can influence both the treatment approach and recovery outcomes(Petri et al., 2022; StatPearls, 2021, 2023; ScienceDirect, 2023).

2. Ligamentous Tears (ACL, MCL, LCL)

Ligaments provide critical structural support to the knee joint, resisting abnormal movements and maintaining joint integrity during dynamic activity. The most commonly injured ligaments include the anterior cruciate ligament (ACL), medial collateral ligament (MCL), and lateral collateral ligament (LCL). These injuries frequently occur in sports such as football, basketball, soccer, and skiing, which demand sudden stops, pivots, jumping, and quick directional changes.

Mechanism:

Ligamentous tears in the knee often result from mechanical forces that exceed the tensile capacity of the ligament fibers. One of the most commonly injured structures, the ACL, is typically compromised when an athlete performs a rapid change of direction while the foot remains planted. This movement introduces a combination of valgus stress and internal tibial rotation, especially when the knee is flexed. These forces create a twisting motion that places immense strain on the ACL, often resulting in a tear.

The MCL, located on the inner portion of the knee, is frequently injured alongside the ACL in these same scenarios, especially if there is a lateral blow to the knee or an inward collapse during landing. Conversely, the LCL is more often injured through varus stress or direct trauma to the medial (inner) knee.

Interestingly, over 70% of ACL tears occur via non-contact mechanisms, often due to faulty neuromuscular control and poor landing mechanics. These can involve excessive quadriceps activation during deceleration, knee valgus, or limited hip control—all of which increase anterior tibial translation and stress on the ACL.

Technological advances in video analysis and MRI have enabled better visualization of injury pathways, enhancing prevention strategies and rehab protocols (Grassi et al., 2023; Oh, Kim, Lee, & Lee, 2021).

3. Bursitis

Bursitis is an inflammatory condition affecting the bursae—small, fluid-filled sacs that reduce friction between moving tissues such as bones, tendons, and muscles. In the knee, the most commonly affected bursae include the prepatellar bursa (in front of the kneecap), infrapatellar bursa, and pes anserine bursa (located medially below the knee joint). This condition is prevalent among athletes and active individuals whose training or sport involves repetitive kneeling, direct pressure to the anterior knee, or friction from overuse.

Mechanism:

Knee bursitis typically develops due to either acute trauma or chronic mechanical irritation. In high-impact or ground-based sports like wrestling, volleyball, and weightlifting, repeated kneeling or falling onto the knee can compress the prepatellar bursa, leading to inflammation. This repetitive compression disrupts the synovial lining of the bursa, increasing fluid production and triggering localized swelling and discomfort.

In cases of overuse, such as in endurance runners or cyclists, friction between tendons and the underlying bone surfaces can irritate deeper bursae like the pes anserine. This often results from improper biomechanics, tight musculature, or poor training mechanics. For example, medial knee bursitis is often associated with tight hamstrings and improper running form, which increase stress on the bursal region.

Left unaddressed, chronic bursitis can thicken the bursal walls and promote fibrosis, reducing joint mobility and exacerbating compensatory movement patterns. This can ultimately lead to more significant biomechanical dysfunction and secondary injury if the root cause is not corrected.

Imaging studies such as ultrasound or MRI can help confirm the diagnosis and rule out other soft tissue pathologies. Early intervention—including postural correction, offloading strategies, and chiropractic soft tissue therapy—can significantly improve outcomes (Lee et al., 2021; Uçar et al., 2022).

4. Fractures and Patellar Tracking Disorders

Knee pain in athletic populations can also stem from traumatic fractures or abnormal patellar tracking, both of which can severely impair performance and mobility. These conditions often present with anterior knee pain, swelling, and functional limitations during weight-bearing activities, particularly those requiring running, jumping, or squatting.

Mechanism:

Fractures around the knee joint most commonly involve the patella (kneecap), tibial plateau, or distal femur. In high-impact sports such as football, skiing, and skateboarding, a direct blow to the front of the knee—either from a fall or collision—can lead to a patellar fracture. The mechanism typically involves a combination of compressive force and direct trauma. In some cases, a strong eccentric contraction of the quadriceps muscle during an awkward landing or deceleration can also cause an avulsion fracture of the patella or tibial tuberosity (Varacallo et al., 2023).

On the other hand, patellar tracking disorders occur when the patella does not glide smoothly within the femoral trochlear groove during knee flexion and extension. This condition is often due to muscle imbalances, tight lateral structures, or anatomic variations such as a shallow trochlear groove or patella alta (high-riding patella). During dynamic activities like running or squatting, these abnormalities cause the patella to shift laterally, increasing friction between the patella and the femur. Over time, this misalignment can lead to patellofemoral pain syndrome (PFPS), a common overuse injury characterized by diffuse anterior knee pain.

Biomechanically, factors such as weakness in the vastus medialis obliquus (VMO), hip abductor dysfunction, and excessive foot pronation contribute to maltracking. These deficits alter the line of pull on the patella, further exacerbating abnormal movement and discomfort during activity (Boling et al., 2021).

Timely diagnosis and conservative care are essential to prevent complications like chondromalacia patellae or post-traumatic arthritis. Chiropractic care that includes neuromuscular re-education, manual therapy, and strengthening of stabilizing musculature can significantly aid in restoring proper patellar mechanics and reducing pain.

5. Postural and Biomechanical Dysfunction

Even in the absence of direct trauma, improper posture, faulty movement mechanics, and muscular imbalances can significantly contribute to chronic knee pain—especially among gym-goers and athletes engaged in repetitive training cycles.

Mechanism:

Knee pain stemming from postural and biomechanical dysfunction typically evolves over time due to cumulative stress on the musculoskeletal system. Prolonged sitting, for instance, often leads to tight hip flexors and weakened glutes, altering pelvic tilt and ultimately disrupting lower limb alignment. This misalignment can place abnormal loads on the knee joint during movement, especially in exercises like squats or lunges.

Additionally, poor movement mechanics—such as allowing the knees to cave inward (valgus collapse) during squatting or jumping—can increase stress on the medial structures of the knee. Over time, this can lead to strain in the joint capsule, ligaments, and surrounding musculature. A lack of ankle dorsiflexion, weak core stability, and dysfunctional hip control further exacerbate poor knee tracking.

Studies show that sedentary behavior, when combined with repetitive athletic loading, may increase the risk of developing patellofemoral pain and tendon-related injuries (Chen et al., 2022). Correcting these biomechanical deficits through neuromuscular retraining and postural intervention is crucial to preventing chronic knee dysfunction in athletes.

Tear Types and Their Biomechanical Origins

Meniscal tears are categorized based on the orientation and location of the tear within the fibrocartilage. These structural variations not only influence symptoms but also guide treatment decisions and predict long-term joint health. Below are three common tear types frequently seen in athletic populations, each with distinct biomechanical origins.

Radial Tears

Radial tears originate at the free inner margin of the meniscus and extend outward toward the peripheral attachment. These tears disrupt the circumferential collagen fibers that are essential for distributing load across the knee joint. Athletes performing repetitive weight-bearing movements—particularly those involving squats or deep knee bends—may develop radial tears due to high compressive and torsional stress in the joint. Since these tears compromise the meniscus’s ability to convert axial loads into hoop stresses, they significantly reduce shock absorption and stability (Beamer et al., 2019).

Bucket-Handle Tears

This type of tear is a large longitudinal tear that causes a portion of the meniscus to displace into the center of the joint, often leading to mechanical symptoms like joint locking or catching. Bucket-handle tears are common in younger athletes, especially those involved in sports requiring rapid pivoting or deceleration. The tear typically results from a high rotational force applied to a flexed knee, often in conjunction with ACL injuries. These injuries are particularly concerning due to the risk of irreversible cartilage damage if not treated promptly (Chahla et al., 2020).

Horizontal Cleavage Tears

Horizontal tears split the meniscus into top and bottom layers, often forming a fluid-filled cavity. These are more common in older athletes or individuals with degenerative changes in the joint. Chronic loading patterns, joint malalignment, and diminished vascular supply contribute to the development of these tears. Though they may initially present with minimal symptoms, they can progress and destabilize the joint over time if not addressed. Horizontal tears often coexist with signs of early osteoarthritis (Logerstedt et al., 2021).

Knee pain in Athletes and how Chiropractic Can Help

At Canoe Chiropractic, we take a functional, biomechanical approach to diagnosing and managing knee pain. Our goal isn’t just symptom relief—it’s identifying and correcting the underlying cause.

1. Functional Movement Assessments

We evaluate your gait, squat form, hip/knee/ankle mobility, and postural alignment to understand how you're moving—and where things might be going wrong.

2. Chiropractic Adjustments

Misalignments in the spine, pelvis, or extremities can affect how forces travel through the body. Correcting these helps restore symmetry and reduce unnecessary joint stress.

3. Soft Tissue Therapy

Through techniques like myofascial release, instrument-assisted therapy, and trigger point work, we reduce tightness and scar tissue that may limit knee mobility.

4. Rehabilitation & Movement Correction

We’ll guide you through personalized rehab exercises, focusing on:

• Glute & hamstring strengthening

• Hip mobility

• Squat mechanics

• Core activation

  
  

Don’t Let Knee Pain Set You Back!

If you’re starting a new fitness routine or chasing a personal record, knee pain doesn’t have to hold you back. At Canoe Chiropractic, we’re committed to helping you move well and stay active—without relying on medication or surgery.

Book your appointment today for a personalized assessment and performance-focused recovery plan.

References

• Beamer, B. S., Walley, K. C., Okajima, S., Manoukian, O. S., Voss, A., & Rodeo, S. A. (2019). Analysis of radial meniscus tear repair: Biomechanical comparison of repair techniques. The American Journal of Sports Medicine, 47(2), 472–479.

• Boling, M. C., DiStefano, L. J., Padua, D. A., & Marshall, S. W. (2021). Biomechanical and neuromuscular risk factors for patellofemoral pain: A systematic review. Journal of Athletic Training, 56(1), 43–52.

• Chahla, J., LaPrade, C. M., Moulton, S. G., Dean, C. S., & LaPrade, R. F. (2020). Meniscal root tears: A biomechanical analysis of repair techniques. The Journal of Bone and Joint Surgery, 102(7), 600–607.

• Chen, Y., et al. (2022). The role of sedentary behavior in lower-limb biomechanics and injury risk: A systematic review. Physical Therapy in Sport, 55, 1–9.

• Grassi, A., et al. (2023). ACL injury trends and surgical outcomes in athletes. Sports Medicine, 53(2), 123–139.

• Hecimovich, M. D., et al. (2021). Chiropractic care in sports injury management: Evidence and efficacy. Journal of Sports Health, 13(6), 509–518.

• Lee, J., et al. (2021). Bursitis and overuse injuries: Clinical insights and management. Clinical Sports Medicine Journal, 40(3), 355–367.

• Logerstedt, D., Snyder-Mackler, L., Ritter, R., & Axe, M. J. (2021). Meniscal injury: Epidemiology and management in athletes. Current Reviews in Musculoskeletal Medicine, 14(3), 245–255.

• Oh, K., Kim, H., Lee, S., & Lee, J. (2021). Biomechanical risk factors for anterior cruciate ligament injury: A clinical review. Orthopaedic Journal of Sports Medicine, 9(4), 2325967121992658.

• Petri, M., Voigt, C., & Durselen, L. (2022). Meniscal injury and osteoarthritis risk: A comprehensive review. Journal of Orthopaedic Research, 40(1), 45–53.

• StatPearls. (2021). Knee injuries and tears. National Library of Medicine.

• StatPearls. (2023). Meniscus injuries. National Library of Medicine.

• Uçar, D., Aydın, T., & Bilekli, A. B. (2022). Clinical evaluation and management of knee bursitis in athletes: A diagnostic overview. Journal of Clinical Orthopaedics and Trauma, 26, 101763.

• Varacallo, M., Johanson, N. A., & Lemos, D. W. (2023). Patellar fractures. In StatPearls. National Library of Medicine.

• Wikipedia. (2023). Unhappy triad. https://en.wikipedia.org/wiki/Unhappy_triad