3 main adjacent joint that has a significant influence to knee pain: 1 Hip, 2 Ankle, 3 Pelvic/Spin
So lets talk about all the joints down the chain, that can get a compensation due to the changing curvature in the spine.
So coming back to the analogy of the tilted building, once the building is tilted, the only way it can stay without toppling down is by forces that keep the weight of the building within its base surface area. Lets for example say that the our building is tilting to the R, see below picture on the Right.
Capital Gate Building in Abu Dhabi with a human body!
As you see, the upper body starts to lean to R, the pelvis has to shift to left to balance things out. That also means that the lower legs and feet have to go to the opposite direction.
However, past the pelvis, we have 3 important joints where changes occur. Hip, knee and ankle. As you see in the image above and below, R side leg has a slight knee bent. As now the pelvis isshifted to the left, L pelvis is positioned higher than the R, that results in changes in leg length. R leg ends up becoming longer and Left, shorter. Also the body weight is centered on the inside half of the right leg which makes the R hip to rotate Internally , R knee to go inward and the ankle of the R foot to pronate, all to compensate for the extra length.
When put together, there are torsional forces on the knee that rotates as well as leans the knee inwards. But the knee is only 1 axis joint. It can either bend or straighten. Not like the hip or ankle where it can rotate, abduct and adduct, on top of being able to bend and straighten. Hip and ankle have a lot of degrees of motion and multiple planes to move into.
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