The Knee–Core Connection: An Osteopathic View on Injury, Integration, and Stability

In osteopathy, one of our core approaches to treatment is that the body is a unit; no structure works in isolation, and when one part suffers, the entire system compensates. This principle becomes especially clear in the case of knee and other lower limb injuries and their impact on overall stability and function.

While a knee injury is often seen as a localised event—perhaps involving a ligament strain, meniscal tear or damage to cartilage—the downstream and upstream effects ripple throughout the musculoskeletal system, and can lead to issues or follow-on injuries that are seemingly unrelated.

The Hidden Consequences: Core Dysfunction After Knee Injury

Following a knee injury, the nervous system often responds by limiting load or altering motor patterns in an effort to protect the affected joint. This generally includes reducing the use of the affected limb and shifting weight-bearing to the opposite side of the body. While this is a natural reaction to injury, problems may arise when these compensations persist after acute symptoms have resolved.

As these new movement strategies become habitual, the core—especially the deep stabilisers that are situated close to the spine and pelvic floor—can become poorly coordinated and unbalanced. The pelvis may tilt asymmetrically, the lumbar spine may adopt a less stable position, and breathing patterns can shift subtly, further disturbing stability.

This instability can force other structures, such as the joints at the back of the pelvis (known as the sacro-iliac joints), or lumbar spine joints, to absorb excess stress during movement. Over time, this added strain can result in overuse injuries or sprains of the pelvis or lumbar spine, or overuse type strains to the hip flexors or gluteal muscles as these areas attempt to compensate for the lack of core stability and altered lower limb mechanics caused by the initial knee injury.

Proprioception: The Body’s Built-In GPS

Proprioception is your body's ability to sense its position in space. It's what allows you to walk in the dark or balance on one leg without looking at your feet. Your joints contain receptors which provide the necessary information to your brain to build a real-time picture about overall body position.

After a knee injury, these receptors may become less effective, leading to reduced awareness of limb positioning. This is particularly notable after ligament injuries like ACL tears, where the body's ability to detect joint angle changes is disrupted. Poor balance not only affects athletic performance but also everyday tasks like climbing stairs or walking on uneven ground, and can have lasting changes on posture and our gait..

A loss of proprioception can be an issue for young and old alike. For athletes and active individuals, impaired proprioception can hinder performance, delay return to sport, and increase the risk of re-injury due to reduced joint awareness and stability during dynamic movements. In older adults, diminished proprioception can compromise balance and coordination, increasing the risk of falls and further injury. In both groups, restoring proprioceptive function is crucial—not only for safe and effective movement, but also for rebuilding confidence in mobility and preventing long-term complications.