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Understanding Patella Pain in the Modern Age

Patella Pain

My dear reader,

If there is one condition that perfectly captures the mismatch between human evolution and modern living, it is patella pain — sometimes called runner’s knee, patellofemoral pain, or patellar tendon irritation. Different names, same message:

The knee is complaining about something the rest of the body has forgotten to do.


People often arrive in my clinic pointing directly at their kneecap:

“Paulius, it hurts right here.

What’s wrong with my knee?”


And I smile gently — not because the pain isn’t real,

but because the knee is rarely the villain.


In the human kinetic chain, the knee is the polite diplomat:

always negotiating between the wild power of the hip

and the grounded logic of the foot.

When those two lose communication,

the knee bears the consequences.


Let’s explore why modern people suffer from this so often —

and what our ancient ancestors can teach us about it.


THE PATELLA: A BEAUTIFUL LITTLE ENGINE THAT NEEDS COORDINATION


The kneecap is not just a piece of bone stuck at the front of the knee.


It is a biomechanical amplifier — redirecting the force of the quadriceps,

guiding smooth knee motion, absorbing impact, and stabilising movement.


But the patella has two weaknesses:


1. It relies on perfect alignment.

If the hip rotates inward or the foot collapses,

the patella loses its track.


2. It hates monotony.

Repetitive, single-plane movements irritate it quickly.

And what does modern life offer?

  • flat floors

  • soft shoes

  • endless sitting

  • weak hips

  • collapsed arches

  • repetitive gym exercises

  • running on straight pavements

A perfect cocktail for patellofemoral irritation.


THE REAL CAUSES: NOT IN THE KNEE, BUT ABOVE AND BELOW


Let’s trace the dysfunction through the kinetic chain.


1. FOOT OVERPRONATION — THE COLLAPSED FOUNDATION

When the arch collapses:

  • the tibia rotates inward

  • the knee collapses inward

  • the patella is dragged off track

The foot is not a foot.

It is the first domino.


Our ancestors walked on soft soil, stones, uneven ground —

terrain that strengthened the intrinsic foot muscles.


We walk on flat concrete in padded shoes.

The foot gets weaker.

The knee pays the price.


2. WEAK GLUTE MEDIUS & EXTERNAL ROTATORS — THE SLEEPING STABILISERS

The hip’s job is to:

  • prevent the knee from collapsing inward

  • support the pelvis

  • balance forces through the leg


But modern sitting shuts the glutes down.

For hours.

Every day.

When the hip becomes passive,

the knee becomes the shock absorber.

The patella is not made for that.


3. TIGHT QUADS & TFL — THE CONSTANT PULLERS

In many clients I see:

  • quads are overworking

  • TFL is tight and irritated

  • lateral fascia is shortened

  • patella is being pulled sideways

This is extremely common in:

  • runners

  • cyclists

  • gym-goers focused mostly on squats

  • people who sit a lot but also train a lot

The body is doing its best with poor movement variety.


4. WEAK FOOT–HIP CONNECTION — THE LOST COORDINATION

Our ancestors moved on varied terrain,

so the foot and hip worked as a team.

Modern life breaks the conversation.

You step on flat floors → foot muscles fade

You sit for hours → glutes fall asleep

You train in straight lines → knee loses dynamic tracking

The result?

Patella pain becomes a coordination problem, not a joint problem.


EVOLUTIONARY MISMATCH: WHY MODERN PEOPLE SUFFER MORE THAN ANCIENT HUMANS


Let’s visit the evolutionary past.

Hunter-gatherers:

  • walked 15–20 km a day

  • climbed

  • ran on uneven ground

  • crouched often

  • carried loads

  • used full hip extension

  • moved unpredictably

Their patellas enjoyed:

  • constant lubrication

  • strong guidance from hips

  • dynamic load variation

  • natural foot strengthening

  • multi-directional movement

Our patellas endure:

  • repetitive motion

  • weak hip control

  • collapsed arches

  • stiff ankles

  • tight quads

  • sitting

  • predictable surfaces

  • overuse without variety


The knee didn’t change.

The environment did.

The knee is simply overwhelmed by modern predictability.


WHY JANMI INTEGRATED THERAPY HELPS


Patella pain is never just about the knee.

In a JANMI session, I explore:

1. Foot mechanics

How does the arch behave?


Is the ankle stiff?


Does the foot collapse?


2. Hip stability

Is the glute medius asleep?


Is the pelvis rotating?


Is the hip drifting inward?


3. Fascial tension

Is the quads/TFL pulling the patella sideways?


Is the lateral chain overworking?


4. Myofascial restrictions

Are the calves too tight?


Is the IT band glued to the quad?


Is the patellar tendon overloaded?


5. Nervous system tone

Is stress tightening quads and hip flexors?


This is not massage.


This is movement logic + fascial release + nervous system reset.


A FINAL MESSAGE FROM ME


If your kneecap hurts,


it is almost never because something is wrong with the patella itself.

It is because the patella has been left alone

to negotiate between a weak foundation (the foot)

and a sleeping stabiliser (the hip).

Your body is not failing.

It is compensating — heroically, constantly, quietly.


The solution is not to attack the knee.

The solution is to reorganise the whole chain.


And that is what JANMI exists to do.


Warmly,

Paulius






 
 
 

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