Knee Pain – The #1 Cause (It’s NOT What You Think) + How to Foam Roll for Knee Pain

Knee pain.

I know first hand how excruciating knee pain can be, and it stopped me from being able to run or hike for 8 and 6 years respectively. Little did I know there was one major cause that never would have occurred to me, and there was a simple solution!

What prompted this post was several of you that I know and love who are far away, have terrible knee pain and can’t come and see me for 1-1 work. You guys have been telling me how horrible it is and asking me “what can I do?!”

I couldn’t sit back and not give you something to try on your own!

The IT Band is notoriously blamed for knee pain, but I have not found it to be a major cause. It certainly can contribute, as can other factors like tight hips or a history of sprained ankles. But 70-80% of the time it is something quite surprising (that quickly becomes obvious).

Find out what the main cause is in the first video, and then I’ll teach you how to foam roll to target this one specific spot.

Keep in mind that this is addressing the #1 cause, but not ALL causes. Foam rolling for pain relief takes longer than coming to see me in my private practice (for many reasons), but it can still be effective. Give it at least a week.

  • I had knee pain for ten years until I noticed one side of my body was stiff and so it kept twisting my knee as I walked. I loosened my pelvis freeing each buttock and, hey presto, no more knee pain!

  • Bridget May says:

    Can you fix the videos? They don’t seem to be working. It shows an internal server error 500. thanks! Looks like it could be really good!

  • Chantel kapp says:

    Hi. Thank youn for sharing…
    I always enjoyed cross country running…and hadnalot of knee pain.. At the time i aslo didnt weatr propper running shoes. I have miniscus tear in left knee andbwas very painful..they cut and cleaned the area twice and fine now…I have stopped running…i do mountain biking andbreally been enjoying the sport, i have done some nice adventourous edurance races and kneesactually have been great……my question is if i start running short distance…would that be ok for knee?

    • Hi Chantel – it is incredibly difficult for me to give you proper advice without knowing a lot more about your past and present experience and knee pain. You can always TRY running and see what happens! I always advocate doing what you love, and if you can’t because of pain…find out what your body needs so you can do the thing you love without pain. I am very familiar with knee pain, and didn’t run for 8 years. I do now. I hope you can begin running again! If you want personalized help I do offer Skype sessions and would be able to help you much better that way: https://mobilitymastery.com/skype-sessions/

  • Ellen says:

    Hi Elisha – how long should I do this for? A few minutes, take a break, and then again?

    • Hi Ellen – I would do a few minutes a day, making sure you hunt out the best spots (the lump especially, if you’re doing this for knee pain), and spend 30 seconds to a minute or more on each good spot. I would do this once a day for a week and see what happens. Everyone will be a bit different so just gauge your progress by how you feel, and you may want to add some of my other techniques too. Hope this helps!

  • Rose says:

    So my coach tagged myself and some team members in your video about “The ONE stretch…” I then started to explore more of your website and found THIS video! I literally just rolled out but I did find that I have a huge knot on that part of my calf. I have been running so much because I am training for a Ironman 70.3. We have done research and all kinds of stretches to try and fix my knee pain because I am down to about only being able to run 1.5 miles before the dreaded stabbing pain works. I am hoping THIS works and I appreciate your work. It’s really cool and I look forward to learning more from you! I’ve got 5 months to build up and I feel like I’ve been going backwards with my running. (Let me add that swimming and cycling is just dandy and I have zero knee pain.) So crossing my fingers here! Thanks so much!

    • Hi Rose! I’m happy you found me! If you read my “Meet Elisha” page then you know I know ALL about knee pain and how much it SUCKS. I’ve been in private practice 4 years full time (8 tota) and after hundreds of cases of knee pain this is without question the #1 cause. There are definitely other causes though too. I offer Skype sessions if you’re looking for personalized solutions (like 4 techniques tailored to the pain you describe to me), rather than one. There’s a page in the meny for more info. This one and the other calf one are a GREAT start though!

      Also, stay tuned Monday (or subscribe and get an email notification) for a blog post and another video that will help a lot. Let me know how this goes for you and if you have questions ask away!

  • David C says:

    Why do you say most knee pain is caused by tightness in the superolateral gastrocnemius? Anecdotally and personally, it seems much knee pain is caused by tight quads since it’s hard to get a full ROM quad stretch because the calves get in the way. After being diagnosed with patellar tendonitis, I found foam rolling the vastus medialis as well as the vastus lateralis to be excruciatingly painful yet extremely therapeutic. What are your thoughts and any tips on mobilizing the quads? Thanks!

    • Hi David – Thanks for your comments and questions. Personally speaking, I had my own knee pain that stopped me from running for 8 years and hiking for 6. When I discovered a powerful version of fascia release work in 2008 (that would lead to a full time career getting people out of pain) all the lightbulbs started going off, and it was by releasing the fascia specifically in that superolateral gastroc that allowed me to trail run and hike again. So I have personal experience with this pain pattern.

      Usually people who have knee pain have a ball or knot of fascia back there that is pulling the patella laterally and distally, or down and to the side. I’ve been doing this work for 8 years and I’ve worked on hundreds of people with knee pain. There ARE other causes, absolutely, but the typical main cause IS that area of the gastroc.

      One thing to consider based on your comments is this: most pain in the body (things like knee or hip pain and all the “itis”‘s) are caused by tight FASCIA, not tight muscles. It’s true you can’t separate muscle from fascia or vice versa, but it does not matter how strong you are, what matters is what’s happening in that giant web of fascia (we have more fascia than anything else). Most of us are aware of the “knots” we have in our shoulders, but don’t realize we have those knots in our calves, quads, adductors, hamstrings…biceps! Everywhere. And that tissue is supposed to be smooth, fluid, and when it’s at optimal health there is no differentiation between muscle groups or within a muscle group when compression is applied and movement generated. (The lumps disappear, there’s no pain and everything is smooth).

      Having said the above, I will say that while the “quads” are generally not a predominant cause of knee pain as a WHOLE, I have found that the VMO fascial junction where it meets gracilis to be the third most common cause of knee pain (after the gastroc and lower lateral hamstring – or semitendinosus – where it meets the ITB fascia).

      Generally, medial knee pain is due to that VMO/gracilis fascia, maybe even high adductor, while lateral knee pain is almost always calf related, and pain directly under the knee cap tends to come from crunchy fascia in the popliteal fascia.

      I love “nerding” out with people so I appreciate your question!

      I will be releasing a lot more videos including some for the specific areas you mention. I’ve asked people on Facebook (via Mobility Mastery on FB) what they want the most right now and hip flexors was voted in, so that will be the next video.

      Thanks and keep me posted on that knee pain!

  • Darla Martin says:

    hello. I have damaged the meniscus in my right knee. Currently I’m in a sleve brace. What else can I do. It just seems to get worse. I love hiking

    • Hi Darla! I know ALL about knee pain as I had my own and it stopped me from hiking and running for 6 and 8 years respectively. It sucks! The good news is you absolutely CAN do those things again. If you were a client of mine in-office I could almost guarantee you’d be hiking again within weeks. Without being able to work on you myself, it’s difficult to say exactly what is causing your knee pain, but first of all…if I were you I would immediately stop using the brace. Please know I am not a doctor and am not attempting to give medical advice or diagnose you. But from experience I can tell you that just makes your knee weak and reliant on the brace for stability.

      The #1 cause of knee pain is what I describe in the videos in this blog post. The #2 cause is typically in your hamstring, low and near the IT Band. There are other causes of knee pain too, and sometimes it can depend on your gait, if you’ve sprained ankles before or your daily habits.

      I am taking clients via skype who can’t come see my in-office. Try the above foam rolling technique and if you want more of my help specific to YOU and your body, consider a Skype session. Let me know how it goes and if I can help you in any other ways!

  • Carol McKee says:

    On June 8 I fell and fractured my femur,left leg. Surgery and PT. I have seen progress but seem to be dealing with scar tissue in the knee area. A lot! Did not injure the knee but the doc made a big incision across the knee cap area to get to the fracture. So, the knee continues to be stiff and I just wonder if you have ant ideas how to get it to release more. I am frustrated with PT progress and do most of my exercise at home. Any thoughts would be great!! Thanks!!

    • Hi Carol – My guess is you need to release the fascia (including some of that scar tissue) in your quad, specifically the top of the quad. I am planning to release a video that will teach you how to do this my way, and I believe I will get it posted by Friday. In the meantime you could take a look at my post for the IT Band, and how to roll that. It’s very similar to what I will show for the quad. https://mobilitymastery.com/foam-rolling-and-the-it-band-hint-its-not-the-enemy/

      Alternatively, if you want more immediate and personalized solutions (more than one video) for your situation, I am offering Skype sessions. It would be similar to my private in-office clients, where I get a health history and the story of your injury, where it hurts etc, and then I’ll tailor a fascial release protocol specifically for you. I’ll show you what to do while we Skype, and have you try the techniques so I can make sure you’re getting the most out of them. There’s a link under the header for more information on that, and to sign up if you’re interested. I can help individuals like you with specific issues a LOT better this way than with one video at a time in a blog post.

      Good luck and keep me posted!

  • Hi
    I saw your videos on Facebook ( social media is such a great tool)
    In your video you talked of a lump by your knee, At times I get a lump on top of my knee on the outside would that be something that an IT stretch could help?

  • April says:

    Thank you! This is really helpful! I wish I could see you in person for this! I’ll be trying this today and keep at it to see if I get relief!

    • Hi April! I’m happy you found this helpful and I would love to hear how this works for you! Keep me posted and don’t hesitate to get in touch if you have questions 🙂

      • Jackie says:

        Thanks for the information I will get a form roller

  • Elissa Dryer says:

    Great info! Thank you for sharing!

  • >