When Knee Pain Isn’t Really About The Knee

Jane, a client, came to me with a knee that was “killing her.” She had been to her doctor and was sent for X-rays.

She’d seen a physiotherapist who put a TENS machine on the muscles above her knee. She went for a massage because she thought she needed to release tight muscles.

She was defeated.

She could no longer go for those long beach walks, which was the reason she moved to Kingsburg in the first place.

Her doctor finally told her, “You’ll just have to learn to live with it.”

And it’s not as if she wasn’t “doing all the right things.”

She took a weekly yoga class for flexibility.

She went to Pilates and could “do a teaser,” convinced she had a strong core.

She lifted weights at home twice a week to prevent her bones from becoming brittle.

Yet she was still stymied, and so were the professionals she’d seen. Why was this healthy, active woman suddenly in so much discomfort?

What I Noticed Right Away... and it wasn’t what was wrong with her...

Jane walked into my studio. She was 63, and at first glance, she looked terrific, remarkable, for her age or any age. What I notice is that most people have a lot more that’s right with them than wrong. And they become fixated on what’s wrong, losing sight of what’s right. That’s my starting point...let’s point out the stuff that’s working and let that help the stuff that isn’t. It’s a powerful mindset shift. In my opinion, get the mind in the right place, and the body will follow.

During my posture evaluation, I noticed:

1️⃣Her left pelvis sat higher than her right.

2️⃣She was standing on the outside of her right foot and the inside of her left.

3️⃣Her head wasn’t aligned over her spine.

To someone casually observing, she might appear to have “good posture.” But alignment is about details. The shifts our body makes to find a balanced relationship with gravity.

Then I asked her to place her hands together and roll slowly down through her spine.

That’s when my hunch was confirmed. (Pardon the pun)!

As she rolled down through her spine, the right side of her back rounded, while the left stayed flat. In other words, the right side of her rib cage had a larger backwards curve than the left. A classic sign of scoliosis.

Yes💯…Jane had scoliosis. She said she’d been told this as a teenager, and doctors over the years had mentioned it. But nothing was ever done. She didn’t need a brace, and she didn’t need surgery, so the advice was simply:

“Just keep moving.”

Except… that advice wasn’t working anymore.

Her curve had progressed. As scoliosis does with age if left unmanaged.

I asked whether anyone had X-rayed her spine since she went through menopause.

“No,” she said.

I encouraged her to get spinal imaging so a medical professional could assess if there were degenerative changes. Most of us over 50 have some, and usually our bodies adapt. But with scoliosis, degeneration can accelerate or become symptomatic.

Studies show that over 68 percent of women over 60 have scoliosis.

And most recreational exercise programs, whether they are group fitness, yoga and Pilates, are not aware of this statistic or equipped to provide safe, appropriate exercise for women with curvy spines.

Some of Her Exercises Were Making Things Worse

I asked Jane to tell me the exercises she had been doing; they consisted of lots of forward flexion in Pilates and lots of twists in yoga.

I thought to myself:

These are the exact movements her spine needs to avoid if she’s going to get out of pain. I knew I needed to educate her about ways to exercise that would help her lengthen, straighten, and strengthen her spine. She needed better information about what was good for her spine and what was not.

She looked at me, puzzled.

“But what does that have to do with my knee?”

Well, what happens in the spine affects what happens in the knee.

I guided her through a series of spinal lengthening exercises.

Instead of crunching through her abdomen to “stabilize” her core, I asked her to reach her sit bones long and reach her ears in the opposite direction

I told her to think about moving her body parts away from one another instead of towards one another. Like stretching an old sweater back into shape.

“Do you feel your belly tighten?” I asked.

“Yes,” she said, surprised. “ I always thought I needed to crunch my waist to have stronger abs”.

“Yes most people do. And for some exercises it might be what’s needed but for activating and stabilizing your core it isn’t always the right thing to do”, I said.

Then we moved to stand in front of the mirror.

I asked her to place her hands on her hips and asked her to glide her pelvis to the right, because she habitually shifted her pelvis towards her left , which I suspected was the true reason her right knee was complaining.

“What do you notice when you shift your pelvis that way?” I asked.

“It feels weird.” She said. “I feel crooked.”

To a crooked body, straight feels weird.

After just a few “straightening” exercises, she could suddenly stand easily on one leg… on both sides.

She was dumbfounded.

“I’ve always had terrible balance. How did you do that?”

Before I explained, I handed her a Pilates Magic Circle and had her do three exercises to anchor the new alignment between her pelvis and ribcage. Because I know that without activating the muscles involved in retraining her posture, none of this education would hold. She’d leave my studio, have a few pain free days and then the grip would come back and she’d chalk this up to another thing that didn’t work.

The most important thing I needed to get across to her was this was about educating her body to move in a different way. It would take time and she would need to be an active participant.

The bad news was…Nobody was going to fix her. The good news was that she could learn to manage her spine herself.

She would have to learn to lengthen, straighten, and strengthen her spine.

The Moment Her Knee Freed Up

Then I had her lie down on the Pilates Trapeze Table that is a piece of the Pilates Apparatus. But she could do this equally well lying on the floor in her living room.

“Bring one knee toward your chest,” I said.

Of course, she chose the “good knee,” which folded and lifted easily.

“Now try the other one.”

She hesitated, then lifted it, and grasped it without strain.

The look on her face was priceless.

“I can bend my knee! But… we didn’t work on my knee.”

“Correct.” I said like it wasn’t a surprise to me.

Her knee wasn’t injured.

Her knee was compensating for her scoliosis.

Once we lengthened, straightened, and strengthened her spine, her knee could finally do its actual job again.

Moving Forward…because it’s always about movement.

Jane left my studio and immediately booked another three Private sessions.

I told her that in three sessions, I could teach her a routine to help her:

✅ Gain confidence in her body again

✅ Get back to doing the activities she loved

✅Prevent further compression or degeneration.

Her pain wasn’t a mystery.

It was simply the body doing what it does best: compensating—until it no longer could.

And once we addressed the real issue, everything changed. Including her attitude about aging well in her body.