Knee pain can cause discomfort. This can be caused by numerous factors, including injury, overuse, muscle weakness, arthritis, and structural changes within the joint. Symptoms can vary from mild stiffness to severe pain, which can affect everyday activities such as walking, climbing stairs, standing, and daily tasks.
The knee is one of the largest joints in the body. It supports our body weight and enables us to perform basic movements such as walking, running, squatting and sitting. Keeping our knee strong, flexible and mobile is important to enable us to move comfortably.
This article will look at the common causes of knee pain and the symptoms that can be experienced. We will also look at treatments available and exercises that can help with physiotherapy.
What is knee pain?
Knee pain can cause discomfort in the knee joint. This could be felt at the front, back, inside, outside or underneath the knee cap. Some people may only experience knee pain when they are physically active whereas others can have stiffness.
Knee pain can be a sudden onset following an injury or it can slowly develop. Depending on the cause of your pain and the severity of your symptoms, different treatments can be used.
Common causes of knee pain
There are several reasons why you could be experiencing knee pain. Understanding what is causing the pain can help you understand the best treatments to use.
Osteoarthritis
Osteoarthritis is a joint condition that can cause wear and tear. It is common in elderly individuals. Pain, stiffness, swelling and limited movement can occur. Symptoms often get worse after long periods of activity or rest.
Muscle weakness
If the muscles supporting your knee are weak e.g. quadriceps, hamstrings, gluteals this can cause poor control of the joint. This can make everyday activities such as stairs, standing from a chair and walking harder.
Ligament injury
There are many ligaments within the knee joint. An injury to any of these such as the ACL (anterior cruciate ligament), PCL (posterior cruciate ligament), MCL (medial collateral ligament) or LCL (lateral collateral ligament) can occur during sport, sudden movements or a fall.
Pain, swelling, instability and difficulty putting weight through the knee can occur.
Meniscus injury
There are 2 pieces of cartilage within the knee joint known as menisci. This helps distribute forces and absorbs impact. A tear can occur following twisting of the knee or wear and tear. Common symptoms can include pain, swelling and catching. Difficulty fully bending or straightening the knee can be experienced.
Patellofemoral pain
Pain can occur around or behind the knee cap. Pain can increase when going up stairs, squatting, running, jumping or sitting with bent knees for long periods.
This can be caused by changes to training, muscle strength and movement patterns.
Tendinitis/Tendinopathy
Tendons help move your body by connecting muscles to bone. Pain can occur from irritation to the patella tendon or quadriceps tendon.
Overuse
Increasing your exercise intensity too much, long distance running without proper preparation or doing lots of deep squats can cause overload to the knee joint. Ensuring you increase your training appropriately can help reduce symptoms.
Bursitis
Small fluid filled sacs called bursae help reduce friction around the knee joint. Inflammation can occur causing localised pain, tenderness and swelling. This can occur after long periods of kneeling.
Common symptoms
Depending on the cause of your knee pain you may experience:
- Pain when walking, running and stairs
- Stiffness after sitting or upon waking in the morning.
- Swelling around the knee.
- Tenderness when touched.
- Difficulty bending or straightening the knee.
- A feeling of instability.
- Clicking, catching and locking.
- Difficult squatting, kneeling or standing for long periods.
- warmth or redness.
If you have symptoms that are persistent, recurring or swollen see a healthcare professional.
Types of knee pain depending on where it is
Where the pain is felt can give you some clues.
Front of the knee:
Pain can be caused by patellofemoral pain, patellar tendinopathy or irritation around the knee cap.
Inside of the knee:
Pain can be caused by meniscus injury, medial collateral ligament injury, osteoarthritis or irritation of surrounding soft tissues.
Outside of the knee:
Pain can be caused by issues to the iliotibial band, lateral meniscus injury or lateral collateral ligament injury.
Back of the knee:
Pain can be caused by Baker’s cyst, tendon issues, meniscus injury or joint issues. If you have sudden swelling and pain at the back of your knee, especially with swelling in the calf seek prompt medical attention.
Best exercises for knee pain.
Physiotherapy can help to increase muscle strength, flexibility, balance and functional movements. The correct exercises will depend on the cause of your knee pain and your current abilities.
Start with gentle movements and avoid any that cause sharp pain or significant swelling.
Quadriceps sets
This exercise will help strengthen the muscles at the front of your thigh.
Position:
- Lie on your back with your legs straight.
- Place a small rolled towel under your knee (if comfortable).
- Contract the muscles at the front of your thigh.
- Gently push the back of your knee towards the towel/ floor.
- Hold for around 5 seconds then release.
- Repeat 8-12 times.
Straight leg raises
This will help strengthen the quadriceps and hip muscles whilst keeping the knee straight.
Position:
- Lie on your back with one knee bent and the other leg straight.
- Contract the thigh muscles.
- Lift the leg approximately 20-30cm off the floor (or as high as is comfortable).
- Hold for a few seconds then slowly lower.
- Repeat 8-12 times (if comfortable).
Avoid if you are unable to keep your knee straight or it causes increased pain.
Heel slides
This will help gently increase bending of the knee.
Position:
- Lie on your back with your legs straight.
- Gently slide your heel backwards towards your bottom.
- Bend your knee as far as is comfortable.
- Hold for a few seconds then return to start position.
- Repeat 8-12 times.
Avoid bending your knee too far if it causes pain.
Seated knee extensions
This will help strengthen the quadriceps. It can help with control when walking and standing.
Position:
- Sit upright in a sturdy chair with feet on the floor.
- Slowly extend your knee.
- Hold for 2-5 seconds (if comfortable).
- Controlled lower your foot.
- Repeat 8-12 times.
Avoid over extending your knee. Move within your comfortable range.
Hamstring stretch
The hamstring is located at the back of the thigh. Gently stretching can help increase flexibility.
Position:
- Sit on the edge of a chair.
- Extend one leg in front. Ensure your heel is on the floor.
- Ensure your back is fairly straight and gently lean forwards from your hips.
- Stop when you feel a gentle stretch at the back of your thigh.
- Hold for 15-30 seconds. Repeat 2-3 times.
Avoid bouncing.
Calf stretch (standing)
The calf muscles help move the ankle. Increasing their flexibility can help some people move more comfortably.
Position:
- Stand facing a wall with both hands on the wall.
- Step one leg back. Ensure your heel remains on the floor.
- Bend your front knee and gently lean towards the wall.
- You should feel a comfortable stretch at the back of your calf.
- Hold for 15-30 seconds. Repeat 2-3 times on each side.
Use a wall or sturdy surface for balance.
Sit to stand
This will help strengthen the muscles used when standing from a chair. It can help with functional movement.
Position:
- Sit in a sturdy chair with your feet about hip width apart.
- Lean forwards from your hips.
- Press through your feet and slowly stand.
- Controlled lower back into the chair.
- Repeat 5-10 times. Use your hands if required.
Ensure you use a chair that is a comfortable height. Avoid if it causes significant pain.
Note: These exercises are a general example and are not a treatment plan for all knee issues. A physiotherapist can help you choose the most appropriate exercises for your issue. They will also be able to adapt the number of repetitions, resistance and range to suit your symptoms.
Physiotherapy treatment for knee pain
Physiotherapy can help with many types of knee pain.
Treatments can include;
Exercise
Your physio may prescribe exercises to help strengthen your quadriceps, hip muscles, improve balance, flexibility and functional movements. This will depend on your diagnosis and how well you tolerate the exercises.
Range of movement
Gentle exercises can help reduce stiffness. This can help keep your knee mobile. This can be helpful if your knee is stiff following an injury or lack of activity.
Hands on treatment
Your Physio may use certain hands on techniques to help with mobility. This is usually used alongside exercises and functional rehabilitation.
Gait and Movement Training
Walk and movement re-training can help identify any issues with balance, gait patterns and activities such as sitting from a chair and climbing stairs.
Activity Modification
Limit any activities that aggravate your symptoms. Once symptoms have improved, gradually introduce activities depending on your condition and how you are responding.
Strengthening Exercises
Once tolerable, resistance exercises can be introduced to strengthen and increase muscular endurance of the knee and hip muscles. Exercising gradually will help increase your strength for daily activities and recreational activities.
Home Treatments for Knee Pain
Simple treatments may help reduce any mild pain in your knee.
Limit Activities
Reduce any activities that are causing your symptoms to get worse. This could be running, jumping and repeated deep squats. You generally won’t need to stop completely. Try to do gentle movements.
Ice
Applying an ice pack (wrapped in a light towel) can help reduce pain and swelling if it is a recent minor injury. Apply for around 15-20 minutes. Don’t apply directly onto your skin.
Heat
Gentle heat can help relieve stiffness if you have a chronic condition and there isn’t much swelling. Don’t apply to a hot, red and swollen knee.
Wearing Comfortable Footwear
Wearing comfortable footwear can help with walking. The most suitable footwear for you will depend on your foot biomechanics, activity and underlying condition.
Maintain a Healthy Weight
If you are overweight, losing weight gradually and sustainably can decrease pressure on your weight bearing joints.
Avoid Sitting for Long Periods
If your knee feels stiff when sitting for long periods then try to change your position and take short breaks to move around when you can.
When to See a Doctor?
Not all knee pain is urgent. However you should see a doctor if:
- You’re unable to put weight through your knee or move it after an injury.
- Your knee is very swollen or deformed.
- Your knee is locked and you can’t straighten your knee.
- Your knee is hot and red.
- You have sudden severe pain or quick swelling after an injury.
If you have swelling or pain in your calf. Especially if you have sudden breathlessness or chest pain as this can be a sign of a blood clot. If you have sudden breathlessness or chest pain seek emergency care.
If you are still experiencing pain that is persistent, recurrent, affecting your sleep or normal activities then arrange to see a doctor or physiotherapist.
How to Prevent Knee Pain
Whilst you cannot prevent all knee issues there are some things you can do to help look after your knees.
- Strengthen your quadriceps, hamstrings, gluteal and calf muscles.
- Warm up before playing sport or doing any strenuous exercise.
- Gradually increase the duration and intensity of your exercise.
- Use correct techniques when lifting, jumping, running and squatting.
- Allow recovery time between intense exercise.
- Maintain balance and flexibility with appropriate exercise.
- Wear comfortable footwear.
- Don’t push through recurrent pain.
FAQs
1. What is the most common cause of knee pain?
Common causes of knee pain include osteoarthritis, overuse, muscle weakness, patellofemoral pain, tendon issues and meniscal or ligament injuries. Depending on your age, activity levels, history of injury and symptoms, the most likely cause will vary.
2. What exercise is best for knee pain?
The best type of exercise will depend on what is causing your pain. Quadriceps sets, straight leg raises, heel slides and sit to stand exercises (with appropriate modification) may help some individuals. The best exercises will depend on the cause of your pain and what functional ability you have.
3. Is walking good for knee pain?
Gentle walking can be helpful for some. If your pain worsens try reducing the distance or intensity. Avoid walking through severe pain, instability or significant swelling.
4. Should I use ice or heat?
Using ice can help to manage pain and swelling following a recent minor injury. Using gentle heat can help reduce stiffness if you have a chronic condition. It will depend on the cause of your pain and symptoms. Don’t delay seeing a doctor if you are experiencing any warning signs.
5. Can Physiotherapy help with knee pain?
Physiotherapy can help improve strength, mobility, balance and function in many knee conditions. Your treatment should be specific to your underlying issue. This may involve exercises, advice, activity modification and selected manual techniques.
6. Why does my knee ache when I climb stairs?
Pain when climbing stairs can be linked to patellofemoral pain, osteoarthritis, quadriceps weakness, tendon issues and other knee conditions. If your symptoms are persistent then they should be assessed to find out the cause.
7. Can knee pain resolve itself?
Mild pain caused by a temporary overuse injury can improve with appropriate activity modification and gradually returning to movement. Pain caused by a significant injury, infection, inflammatory condition or severe joint disease may need specific treatment.
Conclusion
Knee pain can affect your ability to walk, exercise, work and carry out daily activities. However often with the correct approach you can improve your comfort and function. Understanding why you might be experiencing pain, limiting aggravating activities and doing appropriate strengthening and mobility exercises can help.
Physiotherapy can be an important part of improving strength, flexibility, balance and movement of your knee. However you should ensure the exercises you do are specific to your underlying condition. If you are experiencing persistent or severe symptoms you should see a qualified healthcare professional.
