Knee Pain: Complete Guide to Causes, Diagnosis & Treatment

Expert physiotherapy solutions for lasting knee pain relief, improved stability, and optimal function

Knee pain is one of the most common musculoskeletal complaints, affecting people of all ages and activity levels. The knee is the body's largest joint and bears significant stress during daily activities, making it vulnerable to both acute injuries and chronic degenerative conditions.

Knee pain accounts for a substantial portion of orthopedic consultations, particularly among active individuals, athletes, and older adults. Whether caused by sports injuries, arthritis, mechanical problems, or overuse, knee pain can significantly impact mobility, independence, and quality of life.

The encouraging news is that most knee pain responds well to conservative treatment. Research shows that 70-80% of knee conditions improve significantly with physiotherapy, often eliminating the need for surgery or long-term medication. Understanding the cause of your knee pain and pursuing appropriate treatment is key to recovery.

Understanding Your Knee

The knee is a complex hinge joint where the thighbone (femur), shinbone (tibia), and kneecap (patella) meet. It's supported by four main ligaments, cushioned by two menisci (cartilage pads), and controlled by surrounding muscles. This intricate structure allows for both stability and mobility but also creates multiple potential sources of pain.

Key Structures:

  • Bones: Femur, tibia, patella (kneecap), fibula
  • Ligaments: ACL, PCL (inside joint); MCL, LCL (sides)
  • Menisci: Medial and lateral cartilage shock absorbers
  • Muscles: Quadriceps (front), hamstrings (back), calf muscles
  • Cartilage: Smooth surface covering bone ends
  • Bursae: Fluid-filled sacs reducing friction

Common Causes of Knee Pain

Patellofemoral Pain Syndrome (Runner's Knee)

Pain around or behind the kneecap, one of the most common knee complaints. Caused by tracking issues of the patella, muscle imbalances (weak quadriceps/glutes, tight IT band), or biomechanical problems. Worsens with stairs, squatting, prolonged sitting, or running.

Prevalence: Accounts for 25-40% of knee problems seen in sports medicine clinics. More common in women and young, active individuals.

Meniscus Tears

Tears in the C-shaped cartilage pads that cushion the knee joint. Can occur from acute trauma (twisting injury) or degenerative changes with age. Symptoms include pain along joint line, swelling, catching/locking sensations, and difficulty fully extending the knee.

Types: Traumatic tears (sports injuries in younger people) vs. degenerative tears (gradual wear in adults 40+). Many degenerative tears are found in people without symptoms.

Knee Osteoarthritis

Gradual wear and tear of knee cartilage, common in people over 50, those with previous injuries, or obesity. Causes pain, stiffness (especially morning and after rest), swelling, decreased range of motion, and crepitus (grinding sensation).

Impact: A leading cause of disability in older adults. Physiotherapy is first-line treatment before considering surgery.

Ligament Injuries (ACL, MCL, PCL, LCL)

Tears or sprains of the ligaments stabilizing the knee. ACL tears most common in pivoting sports (football, basketball), often with a "pop" and immediate swelling. MCL injuries from direct blow to outer knee. Causes instability, swelling, and difficulty bearing weight.

Recovery: Partial tears often heal with physiotherapy. Complete ACL tears may require surgery for high-demand athletes, though many patients do well with rehabilitation alone.

Patellar Tendinitis (Jumper's Knee)

Inflammation or degeneration of the tendon connecting kneecap to shinbone. Common in jumping sports (volleyball, basketball) and running. Causes pain just below the kneecap, especially during and after activity, stairs, or jumping.

Risk factors: Repetitive jumping, tight quadriceps, training errors, hard playing surfaces. Tends to be chronic if not addressed properly.

Iliotibial (IT) Band Syndrome

Irritation of the IT band where it crosses the outer knee. Common in runners and cyclists. Causes sharp pain on outside of knee, typically appearing after a certain distance or time and improving with rest.

Cause: Often related to weak hip abductors, training errors, or biomechanical issues. Very responsive to physiotherapy addressing underlying weakness.

Bursitis

Inflammation of fluid-filled sacs around the knee joint. Prepatellar bursitis (front of kneecap) common from kneeling. Pes anserine bursitis (inner knee) in runners and overweight individuals. Causes localized swelling, warmth, and pain with pressure or movement.

Treatment: Usually responds well to activity modification, ice, and physiotherapy. Rarely requires invasive treatment.

Common Symptoms:

  • • Pain with specific movements (stairs, squatting, running)
  • • Swelling or puffiness around the knee
  • • Stiffness, especially after rest or in the morning
  • • Weakness or instability, feeling knee might give way
  • • Reduced range of motion or difficulty fully straightening/bending
  • • Popping, clicking, or grinding sensations (crepitus)
  • • Locking or catching sensation during movement
  • • Pain that worsens with activity and improves with rest

How Physiotherapy Helps Knee Pain

Physiotherapy is the gold standard conservative treatment for knee pain, recommended as first-line intervention by leading orthopedic organizations worldwide. It addresses both symptoms and underlying mechanical causes.

Pain Relief

Manual therapy, therapeutic modalities, and specific exercises reduce pain through multiple mechanisms: decreasing inflammation, relaxing muscle spasm, improving joint mechanics, and modulating pain signals. Many patients experience significant relief within 2-4 weeks.

Improved Stability

Strengthening exercises target muscles that support and stabilize the knee (quadriceps, hamstrings, glutes, calves). Strong muscles compensate for ligament laxity, protect cartilage, and improve proprioception, reducing instability and fall risk.

Better Function

Functional training helps you return to daily activities, work, and sports safely. Progressive loading and task-specific exercises rebuild confidence and capability for squatting, climbing stairs, running, and other demanding movements.

Correcting Biomechanics

Analysis and correction of movement patterns, muscle imbalances, and alignment issues address the root cause of many knee problems. Improving hip and ankle function often resolves knee pain by optimizing force distribution.

Avoiding Surgery

Studies show physiotherapy can help avoid surgery for many conditions. For meniscus tears, arthritis, and some ligament injuries, outcomes with physiotherapy alone are often comparable to surgical intervention, without the risks and recovery time.

Long-Term Management

Education, exercise programs, and self-management strategies help you maintain improvements and prevent recurrence. Learning what aggravates your knee and how to modify activities empowers long-term success.

Evidence of Effectiveness:

  • 70-80% of knee pain patients improve significantly with physiotherapy alone
  • Exercise therapy as effective as surgery for meniscus tears in many cases
  • Reduces pain and improves function in knee osteoarthritis by 30-50%
  • 90% success rate for patellofemoral pain with proper rehabilitation
  • Reduces need for knee replacement surgery in arthritis patients

Physiotherapy Treatment Approaches

Comprehensive Assessment

Detailed evaluation including pain history, mechanism of injury, functional limitations, range of motion testing, strength assessment, patellar tracking analysis, and biomechanical screening of hip, knee, and ankle. May include special tests to identify specific structures involved.

Quadriceps Strengthening

Progressive exercises targeting the quadriceps muscles, particularly the VMO (vastus medialis oblique) which stabilizes the kneecap. Includes straight leg raises, wall sits, step-ups, and eventually squats and lunges. Strong quads are crucial for knee protection and pain reduction.

Hip and Core Strengthening

Many knee problems stem from weak hip muscles (glutes, hip abductors). Exercises like clamshells, side-lying leg lifts, bridges, and single-leg balance improve knee alignment and reduce stress. Core stability exercises enhance overall lower limb function.

Manual Therapy

Hands-on techniques including patellar mobilization, soft tissue massage, joint mobilization of knee/hip/ankle, and myofascial release. Addresses muscle tightness, improves joint mobility, reduces pain, and optimizes tissue healing.

Stretching and Flexibility

Targeted stretching of commonly tight structures: quadriceps, hamstrings, IT band, calf muscles, and hip flexors. Improved flexibility reduces abnormal stress on the knee joint and allows for better movement patterns.

Gait and Movement Retraining

Analysis and correction of walking/running patterns, squatting technique, and stair negotiation. Video analysis may be used to identify and correct faulty biomechanics contributing to knee stress.

Therapeutic Modalities

Ice/heat therapy, ultrasound, electrical stimulation, or therapeutic taping to manage pain and swelling. Used strategically to complement active treatment and facilitate exercise participation.

Education and Activity Modification

Understanding your condition, learning proper body mechanics, identifying aggravating activities, and implementing temporary modifications. Guidance on appropriate footwear, training load management, and gradual return to activities.

Recovery Timeline & What to Expect

Week 1-2Initial Phase - Pain Control

Focus on reducing pain and swelling. Activity modification to avoid aggravating movements. Gentle range of motion exercises, ice/heat therapy, and manual therapy. Begin basic quadriceps activation exercises. Expect gradual pain reduction and improved ability to perform daily activities.

Week 3-6Strengthening Phase

Progressive strengthening of quadriceps, hamstrings, glutes, and core. Increased emphasis on functional exercises. Gradual return to normal walking pattern and stairs. Pain should be significantly reduced. Focus on building endurance and control.

Week 6-12Advanced Strengthening & Return to Activity

Higher-level strengthening exercises, functional training, sport-specific activities if applicable. Emphasis on movement quality and biomechanical optimization. Most patients achieve substantial functional improvement. Transition to independent exercise program.

OngoingMaintenance & Prevention

Continue home exercise program 2-3 times weekly. Periodic check-ins with physiotherapist. Maintain strength, flexibility, and proper movement patterns. Most people remain pain-free with minimal intervention.

Condition-Specific Timelines:

  • Patellofemoral Pain: 6-12 weeks for significant improvement
  • Meniscus Tear (conservative): 8-12 weeks
  • Mild-Moderate Arthritis: 8-12 weeks, ongoing management
  • MCL Sprain (Grade II): 4-8 weeks
  • Patellar Tendinitis: 8-16 weeks (can be chronic)
  • IT Band Syndrome: 4-8 weeks
  • Post-ACL Reconstruction: 6-9 months to return to sport

Preventing Knee Pain

Maintain Strong Muscles

Regular strengthening of quadriceps, hamstrings, glutes, and core muscles. Strong muscles support and protect the knee joint. Incorporate resistance training 2-3 times weekly focusing on lower body and core.

Maintain Healthy Weight

Each kilogram of excess weight adds 4-6 kg of pressure on knees during walking. Even 5-10% weight loss significantly reduces knee stress and arthritis risk. Combines with exercise for optimal knee health.

Wear Proper Footwear

Good arch support and cushioning reduce knee stress. Replace athletic shoes every 500-800 km. Avoid high heels for prolonged periods. Consider orthotics if you have significant biomechanical issues.

Warm Up Properly

10-15 minutes of dynamic warm-up before sports or exercise. Gradually increase intensity. Include movements that prepare muscles and joints for demands of your activity. Never skip warm-up.

Practice Good Technique

Learn proper form for squatting, lunging, landing from jumps, and sport-specific movements. Poor technique places excessive stress on knees. Consider working with a coach or physiotherapist to refine movement patterns.

Progressive Training

Increase activity intensity and volume gradually (10% rule). Sudden increases in training load significantly raise injury risk. Allow adequate recovery between intense training sessions.

Stay Flexible

Regular stretching of quadriceps, hamstrings, IT band, and calf muscles. Tight muscles alter knee mechanics and increase injury risk. Incorporate flexibility work into your routine 3-5 times weekly.

Address Problems Early

Don't ignore persistent knee pain or minor injuries. Early intervention prevents progression to chronic problems. See a physiotherapist at first signs of persistent discomfort.

When Surgery May Be Needed

Most knee pain can be managed conservatively with physiotherapy. However, surgery may be considered in specific situations:

  • Complete ACL tear in high-demand athletes or those with significant instability affecting function
  • Locked knee from meniscus tear that cannot be reduced
  • Severe arthritis with significant pain and disability after failed conservative treatment
  • Recurrent patellar dislocations causing instability
  • Failed conservative treatment after 3-6 months of proper physiotherapy

Important Notes:

  • • Always try physiotherapy first - outcomes are often comparable to surgery without the risks
  • • Many meniscus surgeries can be avoided with proper rehabilitation
  • • Knee arthroscopy benefits are limited for arthritis and degenerative meniscus tears
  • • Even if you choose surgery, pre-operative physiotherapy improves post-surgical outcomes
  • • Post-surgical rehabilitation is essential for optimal recovery

When to Seek Medical Attention

Seek immediate medical evaluation for:

  • Inability to bear weight on the leg
  • Severe swelling within first few hours of injury
  • Obvious deformity or misalignment of the knee
  • Severe pain that doesn't improve with rest and ice
  • Heard or felt a "pop" at the time of injury
  • Knee locks and won't fully straighten or bend
  • Knee gives way or feels very unstable
  • Signs of infection: fever, warmth, redness, severe swelling

Also see a healthcare provider if: Pain persists beyond 2 weeks, significantly limits daily activities, occurs without obvious injury, or you're unsure whether physiotherapy is appropriate.

Find Expert Physiotherapists for Knee Pain Near You

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Frequently Asked Questions

What are the most common causes of knee pain?

The most common causes include: patellofemoral pain syndrome (runner's knee), meniscus tears, osteoarthritis, ligament injuries (ACL/MCL), patellar tendinitis, IT band syndrome, and bursitis. In younger, active individuals, overuse injuries are most common. In older adults, arthritis is a leading cause.

How do I know if my knee pain is serious?

Seek immediate medical attention if you experience: inability to bear weight, severe swelling within hours, visible deformity, knee that locks or gives way, severe pain, or injury accompanied by a "pop" sound. Also see a doctor if pain persists beyond 2 weeks, significantly limits activities, or occurs with fever or redness.

Can physiotherapy help knee pain without surgery?

Yes. Studies show 70-80% of knee pain cases improve significantly with physiotherapy alone, avoiding surgery. Even for conditions like meniscus tears and mild-moderate arthritis, conservative treatment is often as effective as surgery. Physiotherapy focuses on strengthening, improving biomechanics, and reducing pain through evidence-based techniques.

How long does it take to recover from knee pain?

Recovery time varies by condition. Simple strains may improve in 2-4 weeks, patellofemoral pain in 6-12 weeks, meniscus issues in 8-12 weeks, and post-surgical rehabilitation in 3-6 months. Consistent physiotherapy, home exercises, and addressing underlying causes significantly speed recovery.

What exercises are best for knee pain?

Effective exercises include quadriceps strengthening (straight leg raises, wall sits), hamstring and glute strengthening (bridges, clamshells), flexibility work (quad and hamstring stretches), and low-impact aerobic exercise (swimming, cycling). However, the best exercises depend on your specific condition. A physiotherapist will prescribe appropriate exercises for your diagnosis.

Should I rest or exercise with knee pain?

Avoid complete rest, as this can lead to muscle weakness and stiffness. Instead, modify activities to avoid aggravating movements while maintaining knee movement and strength. Low-impact exercises like swimming or cycling often work well. Your physiotherapist can guide you on appropriate activity levels during recovery.

When do I need surgery for knee pain?

Surgery is typically considered when: conservative treatment fails after 3-6 months, there's a complete ligament tear affecting stability, you have a locked knee from meniscus tear, severe arthritis significantly limits function, or there's structural damage requiring repair. However, always try physiotherapy first - many patients avoid surgery through proper rehabilitation.

Can knee pain be prevented?

Yes, many knee injuries are preventable. Maintain strong quadriceps and hip muscles, practice proper form during activities, gradually increase training intensity, wear appropriate footwear, maintain healthy weight, and address muscle imbalances early. Regular strengthening and flexibility exercises can reduce knee injury risk by 50% or more.

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