---
title: It’s Not Where It Hurts
description: How compensation patterns work, and why treating the painful spot often fails.
canonical: https://www.sneharamchandani.com/blog/its-not-where-it-hurts
last-updated: 2026-09-15
---

# It’s Not Where It Hurts

August 12, 2026 - 6 min read

A patient comes in with pain in the front of the knee. The knee has been scanned, iced, taped, and rested. It keeps coming back. Almost every time, the knee is not the problem.

## The body solves problems by borrowing

When a muscle is injured, inhibited, or simply not doing its job, the brain does not wait for it to recover. It recruits another muscle to take over. That substitution keeps you moving, which is the whole point in the short term. The trouble starts when the substitute never stands down.

The classic example is a runner with knee pain. The quadriceps are overworking because the gluteus medius on that side is not firing enough to stabilise the hip. Treat the quadriceps and the pain settles for a few days. It returns, because nothing changed about the reason the quads were overloaded in the first place.

## Why the painful muscle is usually the victim

The muscle that hurts is often the one carrying extra load, not the one causing the problem. A tight hip flexor can be compensating for an inhibited glute. Tight lower back muscles can be covering for glutes that switched off after years at a desk. An old ankle sprain can still be changing how you walk years after the ligaments healed, with the lower back paying the bill.

This is what NeuroKinetic Therapy (NKT) is built to find. It uses manual muscle testing to work out which muscles are overactive and which are inhibited, then releases the overactive one and immediately reactivates the inhibited one. The test is also the proof: if the muscle that tested weak now holds, the pattern has shifted, and you know before you leave the room.

## What this changes in practice

It moves treatment from "where does it hurt" to "why is this tissue under load." That distinction is the difference between temporary relief and a fix. I go deeper into the assessment side in [what they don’t teach you in physio school](/blog/what-they-dont-teach-you-in-physio-school).

I treat these cases at [MuscleLab Clinic](https://musclelab.in) in Mumbai, the ones that have already seen three other clinics. I also train physiotherapists in the full NKT protocol across India, and you can follow that work at [NKT India](https://www.instagram.com/nkt_india) or read [my background](/about). If you are organising a workshop or podcast on pain science, [get in touch](/contact).

The knee is rarely the problem. It is usually just the messenger.

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