The kinetic chain: why lower limb pain is rarely simple

The hip, knee and ankle do not work in isolation. They are part of a continuous chain of movement that runs from the lumbar spine through the pelvis, hip, knee, ankle and foot. A problem at any point in that chain creates compensatory load everywhere else.

This is why assessment at Nudge looks well beyond the area that hurts. We examine the joints above and below the site of pain, how the whole limb moves under load, and what the gait pattern reveals about where the system is breaking down.

Hip conditions we treat

Hip osteoarthritis

Gradual onset pain in the groin, buttock or outer thigh, with morning stiffness and reduced range of motion. Common in adults over 50 but occurring earlier with a history of injury, hip dysplasia or high athletic demand. Treatment focuses on joint mobilisation, soft tissue release of the surrounding hip musculature, progressive strengthening of the hip stabilisers, and gait retraining to reduce mechanical stress on the joint. Consistent conservative management helps many patients significantly delay or avoid surgical intervention.

Greater trochanteric pain syndrome

Pain on the outer hip, often worse with lying on that side, prolonged walking or standing. Driven by irritation of the gluteal tendons and associated bursa. Weak gluteals and tight ITB are almost always contributing. Responds well to targeted gluteal strengthening, soft tissue release and load management.

Hip impingement (FAI)

A deep pinching sensation in the groin with hip flexion, common in younger active patients. Joint mobilisation, movement retraining and strengthening for hip stability are the primary tools. Managing training load during rehabilitation is equally important.

Piriformis syndrome and deep gluteal pain

Deep buttock pain that can refer down the back of the leg, closely mimicking sciatica. Distinguishing between piriformis syndrome and true nerve root involvement requires careful assessment. Treatment involves deep soft tissue release, targeted stretching and correction of the sitting postures and movement patterns driving the compression.

Knee conditions we treat

Patellofemoral pain (runner's knee)

Pain around or behind the kneecap, aggravated by stairs, squatting, running and prolonged sitting. One of the most common presentations in active people and one of the most responsive to treatment when the biomechanical drivers are properly addressed. VMO activation, gluteal strengthening and patellar mobilisation form the core of rehabilitation.

Knee osteoarthritis

Gradual onset pain, stiffness after rest, crepitus and reduced walking tolerance. Conservative management including joint mobilisation, quadriceps and gluteal strengthening, and gait retraining reduces pain and improves function significantly. Many patients avoid or postpone knee replacement through consistent care.

Meniscal injuries

Sharp localised pain with possible swelling, locking or giving way. Can be acute from a twisting injury or degenerative in older adults. Treatment focuses on restoring range, managing load and progressive rehabilitation. We are also clear about when a presentation warrants surgical referral.

ITB friction syndrome

Outer knee pain in runners and cyclists, driven by ITB tightness and weak hip abductors. Releasing the ITB and its proximal drivers alongside specific gluteus medius activation produces consistent results.

Patellar and quadriceps tendinopathy

Pain at the base or top of the kneecap, worse with jumping and loading. Eccentric loading programs are the gold standard and form the foundation of rehabilitation alongside soft tissue work and load management.

Ankle and foot conditions we treat

Plantar fasciitis

Sharp heel pain with the first steps in the morning, easing with movement but returning after prolonged standing. Deep soft tissue release of the plantar fascia and calf, combined with intrinsic foot strengthening, stretching prescription and footwear guidance, produces significant improvement in most cases.

Achilles tendinopathy

Pain and stiffness in the Achilles, typically worst in the morning and with loading. Eccentric calf loading is the cornerstone of rehabilitation. Load management is equally critical as the tendon needs progressive stress to heal but will not tolerate too much too soon.

Ankle sprains and chronic instability

One of the most undertreated injuries in sport. An ankle that was not fully rehabilitated after a sprain develops proprioceptive deficits that increase re-injury risk significantly. Acute management involves early gentle mobilisation and swelling control. Chronic instability requires progressive balance training, strengthening and sport-specific preparation before return.

Shin splints (medial tibial stress syndrome)

Pain along the inner border of the shin in runners, particularly those who have increased mileage too quickly. Soft tissue release, biomechanical assessment and a structured return-to-running program address both the injury and the cause.

Morton's neuroma

Burning pain in the ball of the foot with numbness into the toes. Soft tissue release, metatarsal mobilisation, footwear advice and offloading strategies form the conservative management. We refer to podiatry when orthotics or further intervention is indicated.

How we approach lower limb pain

Your initial appointment runs 60 minutes. We take a thorough history covering the onset and behaviour of your pain, previous injuries, relevant imaging and your activity goals. Physical assessment includes gait analysis, postural and alignment assessment, active and passive range of motion testing, orthopaedic testing specific to the suspected condition, strength assessment, neurological screening where indicated, and kinetic chain assessment of the joints above and below your pain.

Treatment combines manual therapy specific to the affected joint and surrounding structures with a progressive exercise program targeting the muscular deficits contributing to the problem. Advice on footwear, training load, activity modification and sleep positioning is integrated throughout.

The goal is not just symptom relief. It is a body that moves and loads properly enough that the problem does not keep returning.

When to book

Book an appointment if your pain has persisted beyond a few days, is affecting walking, work or sport, or keeps returning despite rest. If you have morning stiffness in your hips or knees, recurrent ankle instability, or want a clear assessment before considering surgery, an initial consultation will give you a full picture of what is going on and what the best path forward looks like.

Seek immediate medical attention rather than booking with us if you cannot bear weight at all, the joint looks deformed or dislocated, you have signs of DVT including calf swelling, warmth and redness, or you suspect an acute complete Achilles rupture.