Knee Pain: What you can do about it

Knee Pain: Why it happens and what you can do about it

Knee pain is one of the most common problems people come to physiotherapy with. It affects runners, gym-goers, people who sit at desks all day, and even those who simply increased their walking recently.

The frustrating part about knee pain is that it rarely has one simple cause. Many people assume they have “damaged something” or that their knee is “worn out,” but in reality, most knee pain is related to how the knee is being loaded over time.

Understanding why your knee hurts is the first step to getting it better.

Understanding the Knee Joint

The knee is the largest joint in the body and acts as a hinge between the thigh bone (femur) and the shin bone (tibia). It also includes the kneecap (patella), which helps the quadriceps muscle produce force efficiently.

Several structures help the knee function smoothly:

• Cartilage that cushions the joint

• Ligaments that stabilise the knee

• Tendons that connect muscles to bone

• Muscles in the hips, thighs, and calves that control movement

Because the knee sits between the hip and ankle, it is heavily influenced by how those joints move. This is why knee pain often has more to do with overall movement and strength than the knee itself.

Common Causes of Knee Pain

Most knee pain seen in physiotherapy falls into a few broad categories.

1. Load Exceeding Capacity

The most common reason knees become painful is when the load placed on them exceeds what the tissues can handle.

This often happens when someone:

• Suddenly increases running or walking distance

• Starts a new exercise programme

• Returns to activity after time off

• Changes training intensity or terrain

Your tissues adapt to stress gradually. When the increase happens too quickly, the knee can become irritated.

2. Patellofemoral Pain (Pain Around the Kneecap)

Pain at the front of the knee is extremely common, especially in runners and people who sit for long periods.

Typical symptoms include:

• Pain when going up or down stairs

• Discomfort after sitting for long periods

• Pain during squats or lunges

• A general ache around or behind the kneecap

This is often related to strength deficits in the quadriceps and hips, rather than a structural injury.

3. Tendon Irritation

The patellar tendon connects the quadriceps muscles to the shin bone and plays an important role in jumping, running, and squatting.

Overloading this tendon can lead to pain just below the kneecap.

This is often seen in:

• Runners

• Athletes who jump frequently

• People who increase gym training too quickly

Tendons respond well to progressive strengthening and gradual loading.

4. Meniscus Irritation

The meniscus is a piece of cartilage that helps absorb shock in the knee.

While acute tears can occur with twisting injuries, many meniscus-related symptoms develop gradually and respond well to rehabilitation rather than surgery.

Symptoms may include:

• Pain when twisting

• Mild swelling

• A feeling of stiffness in the knee

Research increasingly shows that many meniscus injuries can be managed successfully with physiotherapy.

5. Knee Osteoarthritis

Osteoarthritis is often misunderstood. It does not necessarily mean the knee is “bone on bone,” and it certainly does not mean you must stop exercising.

In fact, exercise is one of the most effective treatments for knee osteoarthritis.

People with osteoarthritis may notice:

• Stiffness in the morning

• Pain after longer periods of activity

• Reduced knee movement

Strength training and gradual loading are key components of managing this condition.

Why Rest Alone Rarely Fixes Knee Pain

A common reaction to knee pain is to stop activity completely. While short periods of reduced load can help calm symptoms, long-term rest often makes the problem worse.

When the muscles around the knee become weaker, the joint has less support. This can actually increase symptoms when activity is resumed.

Instead, rehabilitation focuses on gradually rebuilding strength and load tolerance.

The Role of Strength in Knee Health

Strong muscles help absorb load before it reaches the knee joint.

The most important muscle groups for knee health include:

• Quadriceps (front of the thigh)

• Hamstrings (back of the thigh)

• Gluteal muscles (hips)

• Calf muscles

Strengthening these areas improves how forces are distributed through the knee.

Exercises often used in rehabilitation include:

• Squats

• Step-ups

• Lunges

• Single-leg strength work

These movements gradually increase the knee’s ability to tolerate load again.

Other Factors That Influence Knee Pain

Pain is rarely just about the joint itself. Several lifestyle factors can influence recovery.

Sleep

Poor sleep can increase pain sensitivity and slow tissue recovery.

Stress

High stress levels can amplify pain signals and reduce recovery capacity.

Training Load

Sudden spikes in activity are one of the biggest contributors to injury.

Gradual progression is key.

When Should You See a Physiotherapist?

Most knee pain improves with the right approach, but professional guidance can speed up recovery.

You should consider seeing a physiotherapist if:

• Pain has lasted longer than 2–3 weeks

• The knee repeatedly becomes swollen

• Pain is limiting exercise or daily activities

• You are unsure how to return to training safely

A physiotherapist can assess movement, strength, and training load to create a rehabilitation plan tailored to you.

The Good News About Knee Pain

The majority of knee pain improves with the right combination of education, strength training, and gradual loading.

Knees are incredibly adaptable. When given the correct stimulus, they can become stronger and more resilient than before.

Recovery rarely follows a perfectly straight line. There will often be good days and bad days, but with a structured plan and consistent effort, most people return to the activities they enjoy.

If knee pain is stopping you from running, training, or staying active, physiotherapy can help you build strength, improve movement, and return to activity with confidence.