Solving the Mystery of Knee Pain

A physical therapist works to understand why knee pain affects some people and not others — and how to treat it.
Lisa Hoglund, PT, PhD, Professor, Department of Physical Therapy. Photo credit ©Thomas Jefferson University Photography Services.

Knee pain affects approximately 1 in 4 adults, and the condition can have profound effects on a person’s life. People with knee pain often struggle with everyday activities like walking, climbing stairs, and even sitting for extended periods. Despite knee pain’s prevalence, doctors and physical therapists remain unsure of its exact risk factors and have yet to find treatment methods that work for everyone.

Physical therapist Lisa Hoglund, PT, Ph.D., hopes to change that. She’s been studying and helping patients with knee pain since she started as a practicing physical therapist, and hopes to discover the causes behind specific knee pain conditions in order to better treat them. Dr. Hoglund discusses what drove her to study knee pain and what her research has revealed so far.

Q: How would you describe your research to the person riding the elevator with you?

A: My research is trying to solve the puzzle of why some people develop knee pain, and how we can provide the best nonsurgical treatments to reduce their pain and help them be more physically active. To do this, I investigate the muscular and structural factors that may cause knee pain — specifically, knee osteoarthritis and patellofemoral pain.

Q: Can you tell me more about those conditions?

A: Knee osteoarthritis occurs when the cartilage in the knee joint thins, leading the knee to feel stiff and painful. Patellofemoral pain is a painful condition of the kneecaps that often occurs in physically active people who use their legs a lot. We don’t know why some active people develop patellofemoral pain and some don’t.

Q: What are the risk factors for knee osteoarthritis and patellofemoral pain?

We know that people who are overweight are at risk of developing knee osteoarthritis, but not everyone who is overweight develops it. Some people develop knee OA but are not overweight — so the solution may not be to lose weight! Similarly, some people with patellofemoral pain have faulty biomechanics — improper movement of their knees and hips during running and landing from jumps — but not everyone. And those faulty biomechanics are sometimes associated with muscle weakness, but not always. So, we can’t treat everyone with patellofemoral pain and knee osteoarthritis with the same exercises, because every case is different.

Some people also think that patellofemoral pain only affects women, so there’s very little research about it in men. This may be because more women do experience patellofemoral pain, making it more difficult for researchers to enroll men in studies. But still, as many as 40% of patients with patellofemoral pain are male! However, the muscles and structures of males and females are different — for example, women have wider pelvises — so we need information about both sexes to guide us in development of treatments. I’m trying to fill the gap in our knowledge about patellofemoral pain in males.

Photo credit ©Thomas Jefferson University Photography Services.

Q: What questions are you exploring right now?

A: One question I’m currently exploring is how the hip and thigh muscles “turn on” and change their activity in men with patellofemoral pain as they perform different tasks such as squatting, walking, and hopping.

Q: What first sparked your interest in your area of research?

A: I’m a physical therapist in addition to a researcher, and my clinical practice exposed me to many patients with painful knees. I found there was no “cookbook” treatment for my patients — some improved with certain exercises and treatments, while others didn’t. I wanted to find out if there were certain tests that could help me design effective and efficient physical therapy treatment plans to help people return to a healthy, active lifestyle.

Q: Have your physical therapy treatment plans found success?

A: Yes! The best memory I have from my research is from a study I conducted for patients with patellofemoral osteoarthritis, the type of knee osteoarthritis that affects the patellofemoral part of the knee (the “kneecap”). My earlier research had shown their knee pain may actually stem from hip weakness, so I developed a hip-strengthening program that became progressively more challenging over 6 weeks. They began with easy exercises that didn’t stress their knees at all, like clamshells, then slowly progressed to more challenging exercises that also stressed their knees, like forward lunges. Some people were able to significantly reduce their knee pain and participate in activities they hadn’t been able to do in a long time: walking for fitness, going up and down stairs, taking care of their homes, and more. Helping people to improve their quality of life, be more physically active, and have less pain — that’s really what I strive for through my research and my clinical work as a physical therapist. Those improved lives are what really makes all my work worth it!

Q: What’s something you’re passionate about outside of your research?

A: I love traveling in our country and it’s my goal to visit all 50 states. I’ve been to 48 at this time. The last two on my list: Oklahoma and Alaska!

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