Knee Pain

Definition

What is knee pain?

Knee pain refers to pain occurring in the area of the knee. It can have various causes, including injuries, overuse, inflammation, or degenerative conditions such as osteoarthritis. Knee pain can be described using different pain characteristics. Among others, the following characteristics are distinguished:

• Duration: acute knee pain, chronic knee pain
• Occurrence: knee pain at rest, knee pain during activity, knee pain after activity
• Location: knee pain in the front (e.g., pain under the kneecap), back (e.g., pain in the popliteal fossa), medial side knee pain, lateral side knee pain
• Intensity: from mild pain to severe knee pain up to the most extreme, nearly unbearable pain
• Quality: dull, stabbing, burning

Different types of knee pain

This section briefly describes different types of knee pain. It is a selection of the most common forms and is not exhaustive.

• Anterior/posterior cruciate ligament tear (ACL/PCL injury)

  The knee contains an anterior and a posterior cruciate ligament. A cruciate ligament tear or injury usually occurs due to sudden twisting motions (knee turned) or direct force impact. Typical symptoms include knee joint pain, a swollen knee, and knee instability. The anterior cruciate ligament is typically affected much more frequently.
  

• Meniscus tear / meniscal injury

  A meniscus tear affects the crescent-shaped cartilage discs in the knee that act as shock absorbers. These injuries often result from sudden twisting motions or heavy loads. Symptoms include knee joint pain, a swollen knee, and locking of the knee joint. Affected individuals often report pain when straightening the knee.
  

• Medial collateral ligament tear / injury

  A medial collateral ligament tear affects the inner side ligament of the knee, which provides joint stability. This injury often results from external force, such as in sports accidents. Symptoms include medial-sided knee pain and limited mobility. The inner side of the knee may be swollen in some cases.
  

• Lateral collateral ligament tear / injury

  A lateral collateral ligament tear affects the outer side ligament of the knee that helps stabilize the joint. This injury usually occurs from sudden twisting motions or strong external force, commonly in sports with rapid direction changes. Symptoms include lateral knee pain during activity, swelling, and joint instability.
  

• Cartilage injury

  A cartilage injury in the knee affects the protective cartilage covering the joint surfaces and can result from overuse, accidents, or wear and tear. Symptoms include pain, swelling, and limited joint mobility. People often report knee pain during activity.
  

• Patellar dislocation (patellar luxation)

  A dislocation of the kneecap, also called patellar luxation, occurs when the kneecap moves out of its normal position in the joint. This usually happens due to sudden twisting motions or direct force. Symptoms include severe anterior knee pain, swelling, and a visible misalignment of the kneecap.
  

• Patella fracture (patellar fracture)

  A patellar fracture is an injury to the kneecap often caused by a direct blow or fall onto the knee. The kneecap may break into several pieces or have a single crack. This fracture causes severe pain, swelling, and reduced knee mobility.
  

• Patellar tendon rupture

  A patellar tendon rupture is an injury to the tendon that connects the kneecap to the tibia. It often occurs during sports activities, especially with sudden jumps or landings. A patellar tendon rupture causes severe knee pain, limited mobility, and inability to extend the leg.
  

• Quadriceps tendon rupture

  A quadriceps tendon rupture is an injury to the tendon that connects the thigh muscle (quadriceps) to the kneecap. This injury often occurs during explosive movements like sudden jumps or rapid direction changes. A rupture leads to severe pain, swelling, and significant limitation in extending the knee.
  

• Knee osteoarthritis

  Knee osteoarthritis is a degenerative condition in which the cartilage in the knee joint wears down over time, causing knee joint pain, swelling, and limited mobility. It commonly occurs with increasing age but can also be promoted by injuries or overuse. Symptoms often worsen over time, making walking and other activities difficult. Knee pain can occur with activity as well as at rest.
  

• Runner’s knee

  Runner’s knee, also known as patellofemoral pain syndrome, is a painful condition caused by faulty or excessive stress in the knee. It typically manifests as pain at the front of the knee, especially during activities such as running, climbing stairs, or squatting. The cause is often poor alignment of the kneecap or overuse of the muscles around the knee.
  

• Patellar tendinopathy (jumper’s knee)

  Patellar tendinopathy, also known as jumper’s knee, is a painful inflammation at the attachment of the patellar tendon to the lower edge of the kneecap. This injury frequently occurs in sports that require repeated jumps or quick direction changes, such as basketball or volleyball. It is another form of faulty or excessive loading in the knee. Affected individuals complain of severe knee pain during activity, particularly when jumping or climbing stairs.
  

• Rheumatoid arthritis

  Rheumatoid arthritis, also called chronic polyarthritis, is a chronic inflammatory disease in which the immune system attacks the joints, particularly those in the hands and feet. The knee joint can also be affected. This autoimmune disease leads to knee joint pain, swelling, and stiffness in the affected joints, which can severely limit mobility. Over the course of the disease, joint damage and deformities can occur, causing pain both during activity and at rest.
  

• Baker’s cyst

  A Baker’s cyst is a fluid-filled swelling in the back of the knee that arises from increased production of joint fluid. People often complain of pain in the popliteal area. A Baker’s cyst frequently occurs as a consequence of knee conditions such as osteoarthritis or joint inflammation and can cause a feeling of tightness, swelling, and movement restriction.

Causes of knee pain

The causes of knee pain are diverse — from acute injuries to chronic illnesses to faulty or excessive stress in the knee, many factors can lead to knee complaints. The most common causes can broadly be divided into three categories: injury-related causes, degenerative diseases, and inflammatory processes. With the exception of injury-related causes, which often result from increased force impact (e.g., opponent contact, rapid changes in direction, stop-and-go movements, etc.), lifestyle and environmental conditions have a decisive influence on degenerative diseases and inflammatory processes.
In earlier times, our ancestors had to move much more holistically and extensively to obtain food. Hunting, gathering berries, or farming are a few examples. For long distances this movement was often done barefoot on natural ground. The ground surface and the extent of movement helped develop well-conditioned foot and leg muscles that were naturally loaded. Lifestyle has changed drastically over millennia. Modern civilization is often characterized by lack of movement and a sedentary lifestyle. When we do move today, it is often on hard, flat surfaces like concrete or asphalt and in rigid, supportive shoes. Consequently, changes in movement quantity and quality lead to physical adaptations. The following describes how these changes can affect the development of knee pain.

Lack of exercise and a sedentary lifestyle

Modern lifestyles characterized by inactivity and prolonged sitting lead to improper loading of the musculoskeletal system. Lack of movement and a sedentary lifestyle cause physical changes that can promote knee pain. The following changes significantly contribute to the development of knee pain:

• Weakened muscles

  Lack of movement and a sedentary lifestyle lead to atrophy of essential muscles. Foot and leg muscles play a crucial role in knee health. Muscles around the knee, especially the quadriceps (front thigh muscle), hamstrings (back of the thigh), and calf muscles, provide stability. When these muscles are weak, the knee lacks necessary support, which can result in uncontrolled movements and improper loading. This increases the risk of injuries such as ligament strains or meniscal damage. Strong muscles also offload the knee joint by absorbing shock during walking, running, or jumping. Weak muscles cannot perform this function adequately, causing joint surfaces to press together more strongly. This promotes cartilage wear and can lead to knee osteoarthritis. Muscular imbalance, for example between quadriceps and hamstrings, can alter the position of the kneecap and cause malalignment. This can lead to runner’s knee (patellofemoral pain syndrome) or jumper’s knee (patellar tendinopathy), because the kneecap no longer tracks properly.
  
  But muscle function around the knee is not the only important factor. The feet, which are the first point of contact under load, play a key role in knee health. Functional foot muscles support the longitudinal arch of the foot, which reduces force transmission to the knee when standing and walking. Intact foot muscles enable a natural roll-off of the foot and protect against uncontrolled foot collapse after heel strike. Uncontrolled foot collapse transmits an impact to the knee with each step instead of allowing physiological guidance. This faulty and excessive loading leads to overuse of structures in and around the knee joint.
  

• Foot deformities

  Weakened muscles can also lead to foot deformities. Foot deformities can significantly influence the development of knee pain because they change the entire leg axis and load distribution in the knee joint. The feet form the base of the musculoskeletal system and any malalignment can affect the knee, hip, and even the back. For example, foot malalignment often changes the position of the lower leg and knee joint. This can shift the leg axis inward (knock-knees) or outward (bowlegs), resulting in uneven loading of the knee joint. Over time this can cause pain and joint wear (osteoarthritis).
  
  Collapsed longitudinal arches due to weak foot muscles can lead to flatfeet. This removes the foot’s natural shock absorption during walking and standing. The acting force is transmitted directly to the knees with each step. The increased load can therefore lead to knee pain.
  

• Reduced circulation

  Poor circulation can significantly influence the development of knee complaints because the knee joint and surrounding structures rely on an adequate supply of oxygen and nutrients. Poor circulation can slow healing processes, weaken tissue, and promote inflammation in the knee. The knee joint is surrounded by cartilage, tendons, ligaments, and muscles, all requiring sufficient blood flow to remain healthy. When circulation is impaired, these structures receive insufficient oxygen and nutrients, which can deteriorate tissue quality. This increases the risk of cartilage damage, tendon irritation, and degenerative conditions like knee osteoarthritis.
  After injuries or overload, good circulation and oxygen transport are essential for healing. Poor blood flow can delay regeneration and cause small damages in the knee to not properly recover. This can lead to chronic pain and persistent complaints in the long term. Impaired circulation can also slow the removal of metabolic waste from tissue, which can foster inflammatory reactions in the knee joint and amplify pain and swelling. Circulation plays an especially important role in conditions such as rheumatoid arthritis or gout, as inflammatory processes can be exacerbated by poor blood flow.
  

• Fascial dysfunction

  Fasciae are connective tissue structures that envelop and connect muscles, tendons, ligaments, and organs. Fascia can change its original structure and become brittle, adherent, or hardened when loaded irregularly or physiologically improperly. The fascial network loses its elastic function, impairing its role. Fascia play a central role in movement, stability, and force transmission. Loss of elastic properties increases tensions around the knee joint. Increased tension pushes the thigh and lower leg bones closer together and brings the kneecap closer to the joint. This additional pressure accelerates cartilage wear and creates unnatural tensions that can favor injuries and inflammation.
  Hardened or adherent fascia can negatively affect blood vessels and thus lead to poor circulation, slowing regeneration of muscles, tendons, and cartilage. Hardened or adherent fascia can also limit knee mobility and cause improper loading. More on this in the next section.
  

• Joint stiffness

  Lack of movement and a sedentary lifestyle lead to joints not being moved through their maximal possible range. Natural stiffening of the joints follows. Immobile joints, especially in and around the foot, prevent a natural roll-off and increase the force impact on the knee joint. Knee joint pain can result. The knee joint can also naturally stiffen from inactivity, reducing range of motion and resulting in non-physiological loading. Surrounding structures such as muscles, tendons, and ligaments must work harder, promoting improper and excessive loading and causing pain. Reduced mobility also diminishes nutrient supply to the cartilage, increasing the long-term risk for osteoarthritis and joint damage. With natural stiffening, the muscles around the knee are used less and atrophy. Since muscles stabilize the knee joint, weakness leads to more instability and a higher injury risk. As a result of joint stiffening, affected individuals often adopt unhealthy movement patterns to compensate for limitations. This can overload other joints like the hip or ankle and lead to additional complaints.

Hard, flat floors and rigid, supportive shoes

Hard, flat floors and rigid, supportive shoes have significant effects on the knee joints and can cause or exacerbate knee complaints. The following factors contribute substantially to the development of knee pain.

• Reduced shock absorption and increased force impact

  Reduced shock absorption and increased force impactWhen walking on hard, flat floors and in rigid, supportive shoes, higher forces act on the musculoskeletal system, especially at heel strike. Because industrial floors are stiff and conventional shoe soles are rigid, the forces cannot be absorbed and lead to increased stress on the body. This increased force first affects the feet and is then transmitted to the knees. The worse the feet can absorb forces, the more the knee — the next higher joint — is loaded, increasing the risk of osteoarthritis, overload pain, or inflammation in the knee.
  Furthermore, early and increased force impact shortens the possible reaction time of the responsible muscles. If the muscles cannot contract in time, the joint is insufficiently stabilized, leading to improper and excessive loading. Insufficient muscular activation of the feet results in an uncontrolled collapse of the midfoot after heel contact. The so-called collapsing foot adds an extra impact to the knee joint, overloading it. The knee-stabilizing lower and upper leg muscles also cannot react quickly enough due to early and increased force impact. Reduced muscular activation leads to an unstable knee joint, increasing the load on the knee and surrounding structures.

• Restricted foot function and muscle weakening

  The human knee joint is part of a complex system coordinating movement from the foot up through the leg to the hip. Flexible, natural movement patterns are crucial to distribute load evenly and minimize pressure on the knee. Rigid, supportive shoes can significantly impair these natural movements. Such shoes artificially stabilize the foot and restrict ankle mobility. Important muscles and tendons that contribute to leg stabilization are activated less. This can lead to increased loading on the knee joints and surrounding structures, raising the risk of injuries, inflammation, and wear in and around the knee. Studies show that rigid, supportive shoes are often associated with reduced muscle activity in the calf and thigh muscles. These muscles play a crucial role in offloading the knee joint. Weakness in these muscle groups increases the risk of improper and excessive loading of the knee.
  

• Unnatural movement sequence

  Natural movement patterns are designed to respond dynamically to changing surfaces. Hard, flat floors and rigid, supportive shoes make physiological movement sequences considerably harder. On one hand, lack of muscle activation at heel strike causes the foot to collapse downward uncontrollably. The collapsing foot and its consequences for the knee were described earlier. On the other hand, the stiffness of industrial floors and conventional shoe soles prevents natural foot roll-off. Without roll-off, the knee joint is not moved through its full range and is loaded repeatedly in the same region with each step. This causes some structures to be overloaded and others underloaded. Overloaded structures are prone to injury, inflammation, and wear. Underloaded structures can deteriorate. Additionally, rigid, supportive shoes reduce sensory feedback from the foot, decreasing information exchange and adaptive capability. If the foot does not land correctly, the pull directions of muscles and tendons that stabilize the kneecap change. This can lead to patellar maltracking and complaints such as runner’s knee (patellofemoral pain syndrome) or jumper’s knee (patellar tendinopathy).

Symptoms of knee pain

It is important to note that the following lists represent the most common symptoms of knee pain. The list is not exhaustive. Atypical symptoms are also possible. Symptoms often depend on factors such as pain sensitivity, cause of injury, severity, physical constitution, etc. A physician should be consulted for a definitive diagnosis.

• Knee pain during activity: mild to severe knee pain when walking, running, or doing other activities. Knee pain when climbing stairs. Pain can also occur during flexing, extending, and bending the knee even under low load. Typically, knee pain during jogging occurs so often that the activity is no longer possible.
• Rest pain: mild to severe knee pain at rest or at night. Resting knee pain often indicates inflammation or osteoarthritis in the joint. Start-up pain: knee pain when standing up after a long period of rest.
• Weather-related complaints: pain and stiffness can worsen in damp or cold weather.
• Tenderness: the knee is sensitive to touch or pressure, e.g., at the kneecap or tendon insertions.
• Swelling: swollen knee with visible or palpable fluid accumulation in the joint, often due to irritation or injury.
• Warmth & redness: the knee feels warm and is red, which may indicate joint inflammation.
• Joint effusion: fluid accumulates in the knee joint, causing tension and restricted mobility. Knee joint pain can result.
• Restricted movement: the knee can no longer be fully bent or straightened, often due to swelling or cartilage damage. In such cases, pain when extending the knee beyond the possible range often occurs. Knee pain when flexing can also occur as a consequence of movement restrictions.
• Sensation of locking: sudden movement impediments in the knee, often caused by meniscal damage or loose joint bodies. Moving the knee joint often causes pain.
• Instability: a feeling that the knee gives way or buckles, usually due to ligament injuries or muscle weakness.
• Stiffness: a feeling of an immobile knee, especially after prolonged sitting or in the morning. Often associated with pain when standing up.
• Protective posture: unconsciously avoiding certain movements, which can additionally strain other joints.
• Muscle tension: hardening of overstrained muscles.
• Pain types: depending on the cause, stabbing, dull, or throbbing pain may occur.
• Numbness or tingling: nerve irritations can cause numbness or a ‘pins-and-needles’ sensation.
• Radiating pain: knee complaints can radiate into the thigh or lower leg.

Conventional therapy - What helps for knee pain

There are several approaches to treating knee pain. Below are some therapies for knee complaints. The list is not exhaustive. Various measures can also be combined to treat knee issues. Medical consultation is recommended to determine the appropriate therapy for knee problems.

• Rest and load reduction: temporary offloading to avoid overuse and irritation.
• Physiotherapy: special exercises and therapy techniques aim to improve mobility, strengthen muscles, and relieve the joint so that knee pain during activity and at rest is reduced.
• Targeted strength and mobility training: regular and focused strength and mobility training can alleviate knee pain.
• Exercise therapy: gentle exercise (e.g., swimming, cycling, or yoga) promotes mobility and muscle strength without overloading. It also improves blood circulation.
• Weight reduction: relieving the knee joints and surrounding muscles by reducing body weight.
• Fascial training: loosening adhered fascia to improve mobility and reduce pain.
• Massage: massages to release tension and blockages.
• Cold and heat therapy: cold (e.g., ice packs) to reduce inflammation, heat for muscle relaxation.
• Magnetic or electrotherapy: promoting circulation and reducing pain.
• Dietary changes and supplements: anti-inflammatory diet (e.g., omega-3 fatty acids) and supplements that support cartilage (e.g., glucosamine, chondroitin).
• Orthopedic aids: braces or orthoses to support and stabilize the knee joint. Shoe insoles to correct malalignment and relieve specific joint areas.
• Medication: pain and anti-inflammatory drugs.
• Alternative therapies: acupuncture, taping, or osteopathy to relieve pain and promote circulation.
• Joint injections: hyaluronic acid to improve joint lubrication and reduce pain. Cortisone to reduce inflammation during acute flare-ups and relieve pain.
• Autologous blood therapy (PRP): this method uses the healing properties of the patient’s own blood to support cartilage regeneration and relieve pain.
• Surgical measures: arthroscopy for minimally invasive joint cleaning, e.g., removal of cartilage debris. Osteotomy to correct malalignment by bone cuts. Knee replacement (partial or total) to replace the knee joint in advanced osteoarthritis.

Often, many of these measures unfortunately do not lead to long-term pain reduction because the root causes of knee problems are not addressed. The goal of any treatment for knee complaints should therefore be the elimination of causes. As described above, lack of movement, sedentary lifestyle, hard flat floors, and rigid supportive shoes should be addressed. The kybun mode of action appears to be a suitable therapy for knee pain that can eliminate these mentioned causes.

How kybun works - What helps for knee pain

kybun products aim to eliminate the harmful effects of hard, flat surfaces and rigid, supportive shoes while actively addressing lack of movement and the sedentary lifestyle. Through the elastic-springy properties of kybun products, the musculoskeletal system is both unloaded and activated. The unloading helps reduce knee pain in the first step. Activation addresses the underlying causes of knee problems so that complaints can be resolved long-term. Thus, kybun shoes are well suited for knee pain because they help in treatment through the following mechanisms:

• Muscle activation and stabilization of the knee joint

  When walking in kybun shoes, the heel can sink deeply into the elastic-springy sole thanks to its compressible design. This allows the load to build up slowly and in a controlled manner, giving the body more time to activate the relevant muscles. The tensed leg muscles stabilize the knee joint and relieve both the joint itself and the surrounding structures. In contrast, walking on hard, flat surfaces in rigid, supportive shoes subjects the feet to undamped forces. Because the load occurs abruptly, muscles have too little time to react, and necessary knee joint stabilization does not occur. This can lead to improper and excessive loading of the knee and adjacent structures.

• Reduction of force impact from hard, flat surfaces through damping effect

  At heel strike in kybun shoes, the elastic-springy sole material compresses, allowing the rearfoot to sink deeply. This controlled cushioning reduces force impact and decreases load on the knee joint and surrounding structures. Similar to an airbag in a car, the kybun sole absorbs impact forces and enables a gentle, joint-relieving movement. This can already significantly reduce knee pain during activity from the first steps.

Furthermore, because the heel sinks slowly into the elastic-springy material, the body has more time to tense the relevant muscle groups. With improved baseline muscle tension, individual joints can be stabilized and force impact on the spine and surrounding structures reduced.

• Activation and strengthening of muscles through elastic-springy properties

  When walking and standing on the elastic-springy kybun surface, the body continuously makes small compensatory movements to maintain balance. The deliberate instability of kybun products activates the stabilizing deep muscles that are crucial for posture and joint stability.
  As a result, the knee joint and surrounding structures are better supported and relieved. At the same time, coordinative skills improve because the interaction between the nervous system and muscles is optimized. This leads to enhanced body awareness and greater precision in each movement.

Balance and EMG

Balance ability was measured using a force plate by tracking center-of-pressure movement front-to-back (ant-post) and side-to-side (med-lat) when standing. Simultaneously, electromyography (EMG) recorded muscular activity.

By activating and strengthening the foot muscles, foot deformities such as splayfoot, valgus/varus collapse, or flatfoot — often caused by muscular deficits — can be countered. An intact longitudinal arch at heel strike reduces the forces generated, thereby relieving individual spinal segments and soft tissues. Preventing inward or outward collapse of the foot keeps the leg axis in its physiological position and protects the back and related structures from additional improper and excessive loading. When the heel sinks slowly and in a controlled manner into the elastic-springy material, a myofascial pre-tension develops in the involved muscles. This pre-tension and improved muscle activity can stabilize and guide the spine early, reducing force impact on the back and surrounding soft tissues.

• Natural foot roll and increased range of motion thanks to rebound effect

  The elastic-springy kybun shoes with a rebound effect allow for controlled heel strike thanks to muscular pre-tension and reduced acceleration. This prevents uncontrolled foot collapse that would otherwise impact the knee joint and surrounding structures with every step. Active roll-off on the elastic kybun material uses the full range of motion of the foot — from heel to toes. Through this natural motion, the knee joint is also loaded dynamically instead of being repeatedly stressed in the same movement range. This prevents inflammation, injuries, and cartilage wear by reducing point loads. At the same time, the knee joint remains mobile and is protected from tension and blockages. The physiological movement activates and strengthens muscles, promotes circulation, and can thereby relieve knee pain.

• Improved circulation through increased movement activity

  Improved circulation plays a decisive role in knee complaints because it positively affects the joint and surrounding structures. It efficiently delivers nutrients and oxygen to cartilage, ligaments, tendons, and muscles that are essential for knee stability. Because cartilage is only limitedly vascularized, increased blood flow can promote regeneration and support healing. Better circulation also helps remove metabolic waste and pro-inflammatory substances more quickly, reducing swelling and relieving pain, especially in chronic conditions such as osteoarthritis. Inflammatory processes that damage the joint over the long term can be slowed. Joint lubrication production is also stimulated, improving mobility and protecting cartilage from wear. Additionally, the muscles around the knee benefit: well-perfused muscles perform better, are more relaxed, and are less prone to tension that could burden the knee. The elastic-springy kybun materials promote movement and activate muscles around the knee joint. In this way circulation is increased, which supports the benefits mentioned earlier.
  

• Promoting movement and reducing sedentary time

  The elastic-springy kybun products increase the joy of movement because their unique material relieves knee joints and surrounding structures. At the same time, movement activates and strengthens muscles while promoting circulation — both yielding the positive effects already described. Using kybun products can also reduce sitting times, preventing harmful shortening and blockages of myofascial structures. Increased walking and standing particularly stretch often shortened hip flexors and the posterior muscle chain of calves and thighs. This improves mobility and supports a natural, healthy movement pattern of the knee joint and its surrounding structures.
  

• Care and protection of the fascia

  Fascia stabilize the knee joint and ensure even distribution of load with each step. They protect against inflammation, injury, and wear. Healthy fascia are elastic and free of adhesions and tension. This elasticity promotes knee mobility and supports circulation, which is crucial for nutrient supply and regeneration of the knee and surrounding structures. kybun shoes enable a natural movement sequence that preserves fascial elasticity.
  

• Optimized pressure distribution

  When walking and standing in kybun shoes, the entire sole of the foot is enveloped by the elastic-springy material, resulting in even pressure distribution. This reduces focal pressure on the knee joints. Additionally, the constant slight movement in kybun products increases the contact area, further reducing pressure points.

Usage tips for knee pain

Before wearing kybun shoes for the first time, consider some usage tips. Correct application can help relieve knee pain. In addition, knee problems should be treated with targeted therapy described in the next section.

• Wear kybun shoes initially only as long as your body tolerates. Introduce wearing breaks if pain increases or musculoskeletal fatigue occurs. Treatment of knee pain takes time. Because kybun products activate muscles, early reactions may occur especially at the beginning.
  
• Press your heel slowly and controlled into the elastic-springy material so that the knee joint is relieved. Try to find a loading point where knee joint pain and adjacent structure pain is reduced or absent. At the beginning, be careful not to roll too far over the heels.
  
• Take small, controlled steps initially, reducing roll-off over the forefoot to generate less movement in the knee joint. Gradually increase the foot’s range of motion over time if possible.
  
• Try the following exercises to enhance the effectiveness of kybun shoes and increase the chance of recovery.

What to do for knee pain? Helpful exercises

To enhance the effectiveness of kybun shoes and increase the likelihood of recovery from knee complaints, we recommend the following exercises for knee pain. The selection is not exhaustive and can be supplemented. In general, none of the exercises should increase pain in or around the knee. If an exercise worsens pain, it must be stopped. Pleasant and releasing sensations outside the pain point are desirable.

Exercises are divided into the following areas: “Proper walking in kybun shoes”, “Muscle length training”, “Fascia rolling”, and “Strengthening”. Ideally, the different areas are used complementarily as therapy for knee problems.

Proper walking in kybun shoes

The quality of each step is crucial in treating knee pain to reduce complaints and eliminate improper and excessive loading. kybun shoes therefore offer an ideal therapy for knee pain.

Controlled heel strike

• Gently and controlled press the heel into the elastic-springy material to determine load intensity and point without causing knee joint pain.
• Maintain controlled foot posture so the foot does not tilt inward or outward. This keeps the knee joint aligned.
• Place mid- and forefoot slowly and controlled so the knee is not subjected to impact.
• Slow exercises help rebuild the stabilizing muscles around the knee joint.

Controlled roll-off

• Light forefoot roll-off without initially pushing strongly off the big toes. The stronger the roll-off, the greater the knee joint’s range of motion. In a tense, blocked knee joint, increasing range can increase pain. In such cases, tensions and blockages must first be released.
• Explore the possible range of motion of the feet without causing pain. Increase the range of motion if possible.

Muscle length training

Muscle length training is crucial in treating knee problems because complaints often arise from shortening, tension, and blockages of myofascial structures. Targeted stretching can actively address these issues and are an ideal therapy for knee pain.

Front thigh (quadriceps)

• Light forefoot roll-off without initially pushing strongly off the big toes. The stronger the roll-off, the greater the knee joint’s range of motion. In a tense, blocked knee joint, increasing range can increase pain. In such cases, tensions and blockages must first be released.
• Explore the possible range of motion of the feet without causing pain. Increase the range of motion if possible.

Calf and posterior thigh muscles (hamstrings)

• Start in a hands-and-knees position.
• Raise the pelvis upward toward the ceiling.
• If possible, press the heels toward the floor to intensify the stretch.
• Hold the position 3 × 30 seconds.
• Perform 1–2 × daily.

Fascia rolling

Fascial training using a foam roller is important in treating knee pain because complaints often arise from shortening, tension, and blockages of myofascial structures. Regularly rolling out shortened and tense myofascial chains makes the foam roller an active therapy for knee problems.

Front thigh (quadriceps)

• Start lying on your stomach.
• Place the large roller under the thigh of the extended leg. Place the other leg bent for control.
• Roll the front thigh actively from the hip to just above the knee joint.
• Perform movements slowly and controlled. Adjust pressure to personal tolerance but work up to a tolerable pain boundary.
• Roll out any tight adhesions more intensively or hold position at that spot.
• 3 minutes per side.
• Perform 1–2 × daily.

Lateral thigh muscles

• Start in side-lying position.
• Place the large roller between the outer thigh area and the floor.
• Use the top leg for stabilization and to guide the movement at a right angle.
• Roll the lateral thigh actively from the hip to just above the knee joint.
• Perform movements slowly and controlled.
• Adjust pressure to personal tolerance but work up to a tolerable pain boundary.
• Roll out any tight adhesions more intensively or hold position at that spot.
• Straightening the top leg increases the exercise intensity.
• 3 minutes per side.
• Perform 1–2 × daily.

Strengthening

Targeted strength training helps strengthen leg muscles and thereby relieve the knee joints and surrounding structures. Stronger muscles better absorb forces acting on the knee during movement. Muscles also stabilize the knee joints and protect them from improper and excessive loading. Strengthening exercises are an effective therapy for knee problems and help reduce pain in the long term.

Squats

• Start position: standing, feet slightly wider than hip-width and slightly externally rotated.
• Slowly and controlled descend into a deep squat. Push the hips back and shift weight onto the heels.
• Ensure the force comes from the glutes. Stabilize knees so they do not collapse inward or outward.
• Slowly and controlled return to standing.
• If balance is an issue, hold onto a stable object with your hands.
• 3 sets of 8–12 repetitions.
• Perform 2–3 × weekly.

Side-lying leg raises

• Start position: side-lying.
• Feet, knees, hips, and head should be aligned in a straight line. A support can be placed under the head.
• Actively lift the top leg and then slowly lower it with controlled braking.
• At the lowest point, do not completely rest the leg on the ground; instead move it up again so the muscle remains active. If this is not possible, briefly rest the leg.
• Maintain a stable core and perform slow, controlled movements. The torso should not move.
• To increase difficulty, place a resistance band around the knees. The band should sit just above the knee joint.
• 3 sets of 8–12 repetitions.
• Perform 2–3 × weekly.