The knee has one primary job: transfer load between the hip and the foot. It's a hinge — extraordinarily good at what it does, but entirely dependent on what the hip above it and the foot below it are doing. When either fails to distribute load correctly, the knee absorbs the difference. Over time, that absorbed load becomes injury. Patellofemoral syndrome, runner's knee, IT band syndrome, patellar tendinopathy: these aren't knee diseases. They're load transfer failures wearing a knee-pain mask.
The hip and the knee
Hip abductor weakness — particularly the gluteus medius — is the single most common upstream driver of knee pain. When the hip can't stabilize the pelvis through the gait cycle, the femur collapses inward, the patella tracks laterally, and the medial knee structures are overloaded. This pattern produces patellofemoral syndrome, medial knee pain, and IT band syndrome at a rate that should make the hip the first place any knee examination starts.
Applied Kinesiology identifies which hip muscles have been inhibited — not just weak in the conventional sense, but neurologically offline. The gluteus medius that tests inhibited despite normal strength testing is the one that isn't firing when it should. Activating it, not just strengthening it, changes the load pattern at the knee immediately.
Excessive pronation, supination, and altered toe-off mechanics all change the rotational forces transmitted through the knee with every step. A patient with three years of patellofemoral pain whose foot mechanics have never been assessed is not an unusual presentation. The knee is downstream of two joints. Both need to be evaluated.
Patellar tendinopathy and Shockwave Therapy
Patellar tendinopathy — jumper's knee — and chronic IT band insertional pain are the knee presentations where Shockwave Therapy (ESWT) produces the strongest results. Both involve tendon tissue that has become chronic and stuck: the body has stopped actively repairing it, and manual therapy and rest can only do so much. ESWT restarts the healing process in that tissue directly. Dr. Cohen uses it when the clinical picture specifically calls for it, not as a default — but for chronic patellar tendinopathy that hasn't responded to a proper load management program, it's often the intervention that finally moves the needle.
Presentations we treat
Patellofemoral syndrome
Anterior knee pain from poor patellar tracking. Hip abductor inhibition and foot mechanics assessed first. Patellar taping to correct tracking while the pattern is being corrected.
Runner's knee
Lateral knee pain from IT band friction syndrome. Hip and foot mechanics, ART for the IT band and lateral quad, ESWT for the insertional component.
Patellar tendinopathy
Jumper's knee. Load management, proximal and distal mechanics, ESWT for chronic presentations that haven't responded to other treatment.
Meniscus irritation
Non-surgical meniscus presentations. Joint mechanics restored, load pattern corrected. Surgical consultation if structural assessment warrants it — Dr. Cohen will tell you directly.
Post-surgical knee
ACL reconstruction, meniscus repair, TKA. The compensations formed around the surgery need to be found and corrected. Normal imaging doesn't mean normal mechanics.
MCL / LCL strain
Medial and lateral collateral ligament injuries. Acute and chronic. Full kinetic chain assessment to identify what created the abnormal load that stressed the ligament.