Knee Pain and Orthotic Support


Download PDF Now

The knee forms a crucial link in the lower extremity chain, transferring ground-reaction forces to the hips and trunk. Research has shown that normal walking with hard leather shoe heels produces a .5 G impact at the skull.1 Forces that can be measured as far up as the skull obviously transmit significant forces through all points in between. If the knees are not properly aligned, these forces can cause repetitive microtrauma in the knees as well as farther up the Kinetic Chain.

Barring trauma, most cases of knee pain stem from structural imbalances in the body, beginning with the feet. If excessive pronation is present, an increased rotational force is transmitted to the knee joint, causing a medial torquestrain. The ligaments, tendons and cartilage must resist this strain. Over time, this moderate stress develops into a microtrauma condition which causes gradual degenerative changes in the joint. We are all aware that structure dictates function.

When a patient has biomechanical problems in their feet from excessive pronation or supination, the forces from heel strike shock are not absorbed properly, but are transmitted directly into the knee joint. Over time, this stress can cause the knee to develop degenerative arthritic symptoms.

You need to address pedal imbalances to reduce rotation and shock stresses on the knees. This will control patients’ present symptoms and lessen future joint degeneration.

Clinical Management with the A-S-R Program

The A-S-R (Adjustments, Support and Rehabilitation) Program is a 3-step approach that allows you to provide comprehensive patient care by adjusting misalignments, supporting permanent structural faults and using rehabilitation to address soft tissue concerns.

Step 1: Adjust

Adjusting the knee removes restricted motion, especially internal rotation fixation and also helps put the knee in proper alignment.

Step 2: Support

Custom-made functional orthotics support the bones and soft tissues of the feet in their proper position of function. By correcting pedal imbalances, orthotics help prevent overuse injuries and knee-joint degeneration. A 1999 journal of Manipulative and Physiological Therapeutics research study proved that orthotics improve the structural alignment of the foot, creating a more symmetrical foundation throughout the Kinetic Chain.2 The shock­absorbing properties of orthotics provide almost immediate symptom relief for patients with chronic, degenerative knee problems.3

Step 3: Rehabilitate

Strengthening muscles that cross the knee joint with rehabilitative exercises helps stabilize the area and lower the incidence of serious knee injury.4 Foot Levelers’ Thera­Ciser® exercise system enables your patients that perform a range of move­ments to build strength in muscles interacting with the knee. The exercises include strengthening and coordinating contraction of muscles involved in flexion, extension and rotation.


Misalignments in the knees can cause pain and even put your patients at risk for degenerative joint changes. When the lower extremities are properly aligned, pedal imbalances are supported by orthotics and the supporting muscles are strengthened through rehab, your patients’ knee joints should remain functional for many years.


  1. Light LH, McLellan GE, Klenerman L. Skeletal transients on heel strike in normal walking with different footwear. J Biomech 1980; 13: 477–480.
  2. Kuhn DR et al: Radiographic evaluation of weightbearing orthotics and their effect on flexible pes planus. J Manip Physiol Ther 1999; 22(4): 221­–226.
  3. Hyland JK Musculoskeletal shock: causes and prevention. Practical Res Studies, 2001; 10(4): 1–4.
  4. Roy S, Irvin R. Sports Medicine Prevention, Evaluation, Management and Rehabilitation. Englewood Cliffs, NJ: Prentice-Hall, 1983