The AIM files

The AIM files : Runners knee pain, a case study.

In this article I want to explore and demonstrate  how a small deviation in the foot can alter the whole structure above it and cause pain and discomfort in completely different areas of the body. We will look at a client that came to me with severe and long term knee pain. This client is a very active man with several years of endurance training under his belt. The Knee pain first showed up  couple of  years ago when he began training for the New York marathon. As most of us do, (in our infinite wisdom) he kept “running through it” and gritted it out to complete his goal. (props for that)


However , after completing the marathon, he found that every time he ran his right knee would blow up in pain. It continued to get worse until he literally couldn’t run a kilometer or two without having to stop because the pain was so bad.


When we looked at his structure, I could immediately see that his left foot was stuck in pronation(flat) in a static stance. A flat foot is an immediate red flag, and an obvious point for me to start investigating. When we had taken his injury history, this client had a history of ingrowing toenails on that left big toe, which may well have caused an adaptive pattern in gait to avoid bearing his weight fully on that side. 

The problem is that once our nervous system adapts to an altered centre of gravity, that "feels normal" so we aren't even aware of it. Often, we never readjust back to our natural centre when the injury has healed. 




A flat foot on the left side will shift the centre of mass towards the right. It will supinate(arch) the right foot and and shift the hips towards the right, this will hike the right hip and drop the left hip. 

In order to maintain balance and stay upright, the spine will flex right to keep the centre of mass over the balance point (shifted towards the right leg)  and the neck will flex left in an effort to maintain a level skull.  


So we see a shift of millimeters at the foot, and the whole skeleton must rearrange itself as a result !! And this is just in the frontal plane, there are 2 other planes (sagittal and transverse) that we haven’t even looked at !










When we look at the muscle and connective tissues, we can clearly see how an altered structure will put these tissues under stress. (forgive my childlike writing in the diagram)

In this image we can clearly see the cascade of alternating long and short fibers along each side of the body.

The body is an amazing adapter, even when we force it to operate in terrible conditions, sit all day long  and deprive it of the movement that it so badly desires and needs, the body will adapt and continue to allow us to operate in this sub optimal state!! Amazing.

Some may look at this picture and call this a dysfunctional body. But it is far from dysfunctional, this little trooper is doing everything in its power to remain operational and functional.

The human body is hardwired for perfection, it is always trying to return to a state of “zero tension”.

If we can give it the correct cues and input, it will respond !!


So, you will remember that this particular client's pain presented in the right knee, however the knee pain was a symptom rather than the cause, the flat (pronated) left foot was causing the weight to shift right of centre and the right knee was simply carrying the majority of his bodyweight.

Stack some long distance road mileage on top of this and we see how the right knee could get a little cranky ! The poor little guy is working overtime to keep this marathon running beast in the game!!









In AIM (ANATOMY IN MOTION) we look at everything in terms of the Flow Motion Model which is essentially a map of the human body in motion as it moves through the gait cycle (walking).

We begin with the assessment and use that to figure out where the person cannot move, this in turn leads us to a particular phase of the gait cycle that is difficult for the body to achieve.


Once we have figured out which phase or phases (it is often more than one) are relevant to the individual, we can then start to slowly  move them into that difficult phase that they find hard to achieve.

With this client I started with the feet, using wedges to encourage the feet to move in their natural range and to create space for the foot to move into. As the feet began to move somewhat correctly we brought it up the body, section by section until we had him moving into that phase with every joint in the body in the correct position. Moving slowly and safely into this forgotten position.

And This is where the magic happens, as the body achieves forgotten range, the nervous system can recognize that this is a safe position again and allow that movement to return to its physical vocabulary.



After just one session (3 are generally recommended) , this client was immediately feeling different and better. With his left foot operating correctly and his centre of mass shifted back towards its natural centre point, the pain in his knee went away!

He has ran close to 10 long distance races since with no knee pain !!



Pain is an indicator, a warning system. Our body telling us that something is not right. But focusing on the area of pain is not always the correct path.

This client's pain could have easily showed up in the hip,  lower back, upper back, shoulder, neck, or any combination of the above. The solution would have been pretty much the same regardless. Bring the structure back to its natural centre point (zero tension) and many of these ailments can dissipate.  


I love this work.


In closing : a flat foot has the ability to completely alter the whole structure above it. And here’s the real bad news : 85-90% of people have one foot that is flatter than the other!!! 

In essence, 85-90% of people are operating in a sub optimal state !

Stay tuned for my next article where we will be discussing some actions and exercises that you can use to mobilize and strengthen your feet to get them moving in a more natural way. building a healthy environment for your body to operate in. 

keep moving !