Knee Instability and Knee Alignment: Research Update | Chiropractor Singapore

Knee pain is the number one complaint we see at our chiropractic clinic. As an evidence-based chiropractor, we follow the latest research to make sure you are receiving the best chiropractic treatment possible.

Just a couple of weeks ago, two new studies were published about knee instability and knee alignment. Today, we are going to share both studies with you.

Study #1: knee instability vs. knee pain

Perceived Instability Is Associated With Strength and Pain, Not Frontal Knee Laxity, in Patients With Advanced Knee Osteoarthritis

Unfortunately, the full text for the paper on knee instability is not available online yet. We’ve looked into a couple of databases to no avail. Keep a look out for this space because we will update it once we have access.

Even without full text access, we think this paper is 100% mention-worthy. The study looked at perceived instability (from the patient’s perspective) and compared it to knee strength, pain, and knee joint laxity.

The study found that patients who perceived their knees to be unstable were found to have poorer knee extensor strength and more pain. The knees themselves, however, demonstrated no laxity.

This is mind blowing right?

We hear clients talking about their knee instability a lot. Perhaps you also think you have an unstable knee. Research tells us that it is possible to have a perceived instability WITHOUT laxity in the knee joint.

Three takeaway lessons:

  1. If you think you have knee instability, make an appointment with a good health professional to have it assessed
  2. Don’t be surprised that there is no instability
  3. Acknowledge that the perceived stability is present despite having no laxity issues – starting working on your knee strength or knee pain

Knee strengthening exercises for knee pain

So based on this study, there are two things that we can work on – knee pain and knee strengthening.

It is true that these patients do perceive that there is an instability in the knee. We are not going to discount that. Perhaps the knee instability is coming from muscular weakness? We don’t know.

What we do know is that laxity is not an issue. We don’t need to work no that.

We also know, from research, that active care is the #1 treatment approach to musculoskeletal pain.

In essence, exercise is your one-stop solution for both the weakness and also the pain.

At Square One, we work a lot on functional knee stability with our clients. For us, this means the capacity to support themselves on one leg either at a given position (one leg stand) or during a specific movement (one leg squat).

Most clients will find movements like one leg squat difficult because they cannot “balance”. While there is an element of balance in performing a one leg squat, we find that the issue, more often than not, lies in the strength.

This makes sense, right? If you cannot support yourself either in a static position or in a specific movement, it totally explains why you might feel unstable.

N.B. This doesn’t mean that knee strengthening alone can make your knee pain go away. Pain, especially musculoskeletal pain, is often multifactorial. There are other issues to address on top of strength. This is also why people who attempt to “fix” their own injuries with an online strength-based rehabilitation program often fail.

It is not because rehabilitation or exercise doesn’t work. It’s because there is more to recovery than strength.

Study #2: Healthy knees vs. normal knee alignment

When it comes to visiting a chiropractor, most people think of getting their spine aligned. When it comes to visiting a chiropractor for knee pain, you may also be thinking of your knee alignment.

Alignment is the rage these days. We hear about text neck problems on social media, we see Singapore chiropractors pushing Facebook ads on the importance of having your spine aligned, your massage therapist or yoga instructor may have pointed out issues to do with your alignment … is there any validity to alignment?

No, we don’t think so.

But let us let the research do the talking.


knee pain, chiropractor singapore, chiropractic clinicHealthy knees have a highly variable patellofemoral alignment: a systematic review

We love studies like this because the title does all the talking.

Alignment of the knee in this study refers to static alignment – how the knee cap seats in relation to your leg bone.

Guess what? The study looked at 402 knees found alignment of the knee cap in HEALTHY knees to be “extremely variable”.

Patellar tracking exercises

We don’t usually work with patellar tracking at Square One because, as the research suggests, normal knees have very varied patellar alignment. With varied alignment, it is plausible to expect patella tracking on its own, to be different from individuals.

When it comes to knee pain, we don’t also subscribe to trying to attain a “normal knee alignment”. Because, what is normal? As such, we don’t work around ‘how to realign your knee’ or ‘put your knee back into alignment’.

Take away lessons:

  1. Knee alignment is varied in healthy knees
  2. Patellar tracking exercises may not always be relevant since alignment differs greatly between individuals to begin with
  3. Manual therapy or advice that claims to put your knee back into place (dislocation cases aside) are probably just bullsh*t.

Seek chiropractic first

It may not be intuitive for people to seek chiropractic first when it comes to knee pain. However, chiropractors can help with knee pain.

As mentioned earlier, knee pain is the #1 reason people come to our chiropractic clinic.

Are you currently suffering from knee pain? Drop us a message via the form below and we will try our best to help!

Additional readings:



    author avatar
    Dr. Jesse Cai Chiropractor
    Jesse, a chiropractor with a unique approach, believes in empowering his clients to lead functional and fulfilling lives. Jesse worked with high-level Australian athletes, including roles such as Head Sport Trainer for Forrestfield Football Club, board member of Sports Chiropractic Australia, and member of Sports Medicine Australia.