Knee Pain

Understanding Knee Pain

Your knees are remarkable joints that play a critical role in nearly every movement you make—walking, climbing stairs, standing from a chair, squatting, running, and countless other daily activities. As the largest joints in your body, your knees bear significant forces and stress, making them vulnerable to various injuries and conditions. Understanding what’s causing your knee pain and seeking early evaluation when problems arise can make the difference between quick recovery and chronic disability.

The Complexity of the Knee Joint

Your knee is far more than a simple hinge joint. It’s an intricate structure consisting of multiple components working together:

Key Structures of the Knee

Bones:

Femur (thighbone)
Tibia (shinbone)
Fibula (smaller bone alongside the tibia)
Patella (kneecap)

Cartilage:

Articular cartilage: Smooth covering on bone ends allowing frictionless movement
Meniscus (medial and lateral): C-shaped cartilage “shock absorbers” between the femur and tibia that cushion forces and stabilize the joint

Ligaments (connecting bone to bone):

ACL (Anterior Cruciate Ligament): Prevents forward sliding of the tibia and controls rotation
PCL (Posterior Cruciate Ligament): Prevents backward sliding of the tibia
MCL (Medial Collateral Ligament): Provides stability on the inner knee
LCL (Lateral Collateral Ligament): Provides stability on the outer knee

Tendons (connecting muscle to bone):

Quadriceps tendon: Connects thigh muscles to the kneecap
Patellar tendon: Connects kneecap to shinbone (technically a ligament)
Hamstring tendons: At the back of the knee

Other Structures:

Plica: Thin folds of synovial tissue (remnants from development)
Bursa: Fluid-filled sacs reducing friction
Synovial membrane: Produces lubricating fluid

This complex system must work in perfect coordination. When any component becomes injured or dysfunctional, pain and limitation result—and because the knee is critical for movement, even minor problems can significantly impact your daily life.

Why the Knee Is Critical for Movement

Your knees are essential for:

Walking and running
Standing and sitting
Climbing stairs
Squatting and kneeling
Balance and stability
Participating in sports and recreation
Maintaining independence

Because the knee is so central to movement, knee problems don’t just affect the knee itself—they impact your entire life. This is why early diagnosis and intervention are crucial. Don’t wait and hope knee pain resolves on its own.

Common Causes of Knee Pain

Sprains (Ligament Injuries)

Sprains occur when ligaments (tissues connecting bones) are stretched or torn. In the knee, this commonly affects:

MCL Sprains (most common):

Usually from force to the outside of the knee
Pain and tenderness on the inner knee
Swelling
Instability or feeling the knee may “give way”
Difficulty pivoting or changing direction

LCL Sprains (less common):

From force to the inside of the knee
Pain on the outer knee
Similar symptoms to MCL injuries

ACL Tears:

Often from sudden stops, direction changes, or awkward landings
Common in sports (basketball, soccer, football, skiing)
Often accompanied by a “pop” sound at injury
Immediate swelling (within hours)
Feeling of instability
Difficulty bearing weight
Knee “giving way” with pivoting movements

PCL Tears:

Less common than ACL tears
Usually from direct impact to the front of the shin (dashboard injury, falling on bent knee)
Less dramatic symptoms than ACL tears
May have mild swelling and discomfort
Feeling of instability when walking downhill or stairs

Strains (Muscle or Tendon Injuries)

Strains involve injury to muscles or tendons around the knee:

Quadriceps strains:

Pain in the front of the thigh above the knee
Difficulty straightening the leg
Weakness with knee extension

Hamstring strains:

Pain in the back of the thigh
Difficulty bending the knee
Tenderness behind the knee

Symptoms of strains typically include:

Sharp or aching pain
Muscle spasm or cramping
Swelling
Weakness
Limited range of motion
Tenderness when touching the affected area

Meniscus Tears

The meniscus (medial and lateral) are cartilage pads that absorb shock and stabilize the knee. Tears can occur from:

Acute injury:

Twisting movements while weight-bearing
Sudden pivoting or rotation
Deep squatting
Direct trauma

Degenerative changes:

Age-related wear and tear
Minor movements can tear degenerative meniscus
More common after age 40

Symptoms of meniscus tears:

Pain along the joint line (inner or outer knee)
Swelling (may develop gradually over 24-48 hours)
Catching or locking sensations
Feeling that the knee may “give way”
Difficulty fully straightening the knee
Pain with twisting or rotating movements
Pain with deep squatting
Clicking or popping sounds

Important note: Like many conditions, meniscus tears visible on MRI don’t always cause symptoms. Many people over 40 have meniscus tears that cause no pain. Treatment focuses on symptomatic tears.

Plica Syndrome

Plicae are thin folds of synovial tissue in the knee—remnants from fetal development. Most people have them without problems, but sometimes a plica becomes irritated, inflamed, or thickened:

Causes:

Repetitive knee bending (cycling, running, climbing stairs)
Direct trauma to the knee
Overuse activities
Sometimes no clear cause

Symptoms:

Pain on the inner front of the knee
Snapping, popping, or clicking sensation (especially when straightening knee from bent position)
Feeling of “something catching” in the knee
Tenderness when pressing on the affected area
Swelling (sometimes)
Pain worsens with activity, especially stairs and prolonged sitting

What makes plica syndrome tricky: Symptoms can mimic meniscus tears or other conditions, making accurate diagnosis important.

Patellar Tendonitis (“Jumper’s Knee”)

Patellar tendonitis is inflammation and degeneration of the patellar tendon, which connects the kneecap to the shinbone:

Causes:

Repetitive jumping or landing (basketball, volleyball)
Running, especially with sudden increases in intensity
Repetitive knee extension activities
Poor biomechanics or muscle imbalances
Inadequate warm-up or recovery

Symptoms:

Pain at the front of the knee, just below the kneecap
Tenderness when pressing on the patellar tendon
Pain with jumping, running, squatting, or climbing stairs
Stiffness, especially after sitting or first thing in morning
Weakness with knee extension
Sometimes mild swelling

Progression: Often starts as mild discomfort after activity, progressing to pain during activity if not addressed early.

When Self-Care Is Appropriate

For mild knee pain or minor injuries, initial self-care can be effective:

R.I.C.E. Protocol:

Rest: Avoid activities that worsen pain (but don’t become completely inactive)
Ice: Apply for 15-20 minutes every 2-3 hours in first 48-72 hours
Compression: Use elastic bandage to reduce swelling
Elevation: Keep knee elevated above heart level

Additional self-care:

Over-the-counter anti-inflammatory medication
Gentle range of motion exercises
Avoiding aggravating movements
Using assistive device if needed for walking

When to Seek Professional Evaluation: Early Intervention Is Key

Because your knee is critical for movement, you should not wait and hope knee problems resolve on their own if:

Seek evaluation within 1-2 days if:

Pain doesn’t improve with basic self-care
Swelling is significant or increasing
You heard a “pop” at the time of injury
Knee feels unstable or “gives way”
You cannot bear weight comfortably
Range of motion is significantly limited
Knee locks or catches during movement
Pain interferes with daily activities or sleep

Seek immediate evaluation if:

Severe pain that prevents any weight-bearing
Obvious deformity of the knee
Inability to move the knee at all
Signs of infection (fever, redness, warmth, severe swelling)
Severe trauma (car accident, significant fall)

Why Early Intervention Matters

Addressing knee problems early:

Prevents minor injuries from becoming chronic problems
Reduces the risk of secondary damage (compensation injuries)
Identifies serious injuries (ACL, meniscus tears) requiring specific treatment
Prevents muscle atrophy and weakness from developing
Maintains range of motion
Allows faster return to activities
Decreases likelihood of long-term disability
Often avoids the need for surgery

Delaying evaluation can lead to:

Worsening of initial injury
Development of compensatory movement patterns
Secondary problems in hip, ankle, or opposite knee
Chronic instability
Progressive muscle weakness
More extensive treatment needed
Prolonged disability
Increased likelihood of surgical intervention

Our Comprehensive Diagnostic Approach

When you visit our office with knee pain, we conduct an extensive evaluation to identify the exact cause and severity:

Detailed History

Mechanism of injury: How did it happen? Sudden or gradual onset?
Symptom characteristics: Location, quality, timing of pain
Mechanical symptoms: Clicking, popping, catching, locking, instability
Functional limitations: What activities are affected?
Previous knee problems: Past injuries or surgeries
Activity level: Sports, work demands, daily activities
Swelling pattern: Immediate or delayed, constant or intermittent

Physical Examination

Visual inspection: Alignment, swelling, bruising, deformity
Palpation: Tenderness over specific structures (joint lines, tendons, ligaments)
Range of motion: Active and passive movement, comparing to opposite knee
Strength testing: Quadriceps, hamstrings, hip muscles
Gait analysis: How you walk and any compensations
Special orthopedic tests:
- Ligament stability tests: Lachman, drawer tests, valgus/varus stress tests for ACL, PCL, MCL, LCL
- Meniscus tests: McMurray’s, Apley’s, Thessaly test
- Patellar tests: Patellar apprehension, compression, tracking
- Plica tests: Specific palpation and movement tests
- Tendon tests: Resisted movements, palpation of tendon insertions
Functional testing: Squatting, single-leg balance, stairs if appropriate
Assessment of contributing factors: Hip strength, ankle mobility, biomechanics

When We Refer for Imaging

Based on examination findings, we may recommend:

X-rays (for):

Suspected fractures
Severe trauma
Significant arthritis
Bone abnormalities
Foreign bodies

MRI (for):

Suspected ACL or PCL tears
Meniscus tears requiring visualization
Complex knee problems
Persistent symptoms without clear diagnosis
Pre-surgical planning

Ultrasound (for):

Tendon problems
Some ligament injuries
Fluid collections or cysts
Real-time assessment of structures

When We Refer to Specialists

We coordinate with orthopedic specialists when:

Immediate referral:

Complete ACL or PCL tears in active individuals
Complex multi-ligament injuries
Locked knee that won’t straighten
Suspected fractures or dislocations

Referral after trial of conservative care:

Meniscus tears not responding to conservative treatment
Persistent instability despite rehabilitation
Mechanical symptoms (locking, catching) interfering with function
Severe arthritis limiting quality of life

Co-management:

Some patients benefit from our rehabilitation while being monitored by a specialist
Post-surgical rehabilitation after knee procedures

Our Evidence-Based Treatment Approach

For most knee conditions, conservative care is highly effective—especially when started early.

Manual Therapies

Joint mobilization: Restoring proper knee, hip, and ankle mechanics
Instrument-assisted soft tissue mobilization: Addressing muscle tension, scar tissue, and fascial restrictions
Myofascial therapy: Releasing tightness in muscles around the knee
Trigger point release: Addressing painful muscle knots
Patellar mobilization: Ensuring proper kneecap movement

Advanced Technologies

Shockwave therapy:
- Highly effective for patellar tendonitis
- Stimulating healing in chronic tendon problems
- Breaking down scar tissue
- Accelerating recovery
Laser therapy:
- Reducing inflammation in tendons, ligaments, and joint
- Accelerating tissue healing
- Decreasing pain and swelling
Cupping therapy: Improving blood flow and reducing muscle tension

Movement-Based Rehabilitation (The Foundation)

This is crucial for knee recovery:

Early Phase:

Range of motion exercises
Gentle strengthening
Reducing swelling and pain
Protected weight-bearing if needed

Progressive Phase:

Quadriceps strengthening: Critical for knee stability and function
Hamstring strengthening: Balancing muscle forces
Hip strengthening: Gluteal muscles control knee alignment
Calf strengthening: Supporting overall leg function
Core stability: Affecting lower extremity mechanics
Balance and proprioception training: Preventing re-injury

Functional Phase:

Sport or activity-specific training
Plyometric exercises (if appropriate)
Agility and cutting drills (for athletes)
Return-to-activity progression
Movement pattern correction

Condition-Specific Approaches

For ligament sprains:

Early protection and support
Progressive strengthening to compensate
Proprioceptive training
Gradual return to pivoting activities

For meniscus tears:

Load management
Exercises to improve mechanics
Strengthening to reduce stress on meniscus
Activity modification
Surgery referral if conservative care fails

For patellar tendonitis:

Eccentric strengthening exercises (highly effective)
Load management
Shockwave therapy
Addressing biomechanical factors
Progressive return to jumping/running

For plica syndrome:

Anti-inflammatory modalities
Stretching and strengthening
Activity modification
Addressing muscle imbalances
Usually responds well to conservative care

For all conditions:

Addressing biomechanical factors (foot mechanics, hip weakness, movement patterns)
Ensuring proper footwear
Activity modification during healing
Progressive loading as tolerated

The Kinetic Chain: Why Hip and Ankle Matter

Your knee doesn’t work in isolation. Problems in the hip or ankle often contribute to knee pain:

Hip weakness or tightness:

Allows knee to collapse inward
Increases stress on knee structures
Common contributor to many knee problems

Ankle stiffness or instability:

Alters forces transmitted through knee
Changes movement patterns
Can perpetuate knee problems

This is why our evaluation and treatment address your entire lower extremity, not just the painful knee.

What to Expect During Recovery

Timeline varies by condition:

Minor sprains/strains: 2-4 weeks
Moderate injuries: 4-8 weeks
Meniscus tears (conservative): 6-12 weeks
Patellar tendonitis: 6-12 weeks or longer
Post-surgical: Several months

Keys to successful recovery:

Consistent adherence to rehabilitation exercises
Appropriate activity modification (not complete rest)
Progressive loading and return to activities
Addressing contributing factors
Patience with the healing process

Prevention of Future Knee Problems

Once recovered, focus on:

Maintaining strength in quadriceps, hamstrings, and hips
Regular flexibility work
Proper warm-up before activities
Gradual progression when increasing activity
Attention to movement patterns
Appropriate footwear
Maintaining healthy body weight
Listening to your body’s warning signs

Don’t Wait and Hope

Knee pain is not something to ignore or push through. Because your knee is critical for movement and daily function, early evaluation and intervention are essential.

If you’re experiencing knee pain, especially with:

Clicking, catching, or locking
Swelling
Instability or “giving way”
Pain that doesn’t improve with basic self-care within a few days
Difficulty with stairs, squatting, or normal activities

Don’t wait. Schedule a comprehensive evaluation so we can:

Accurately diagnose your specific knee problem
Rule out serious injuries requiring immediate intervention
Identify contributing factors throughout the kinetic chain
Create a targeted treatment plan based on your diagnosis
Refer for imaging or specialist consultation if needed
Begin early intervention to prevent chronic problems
Guide your rehabilitation back to full function
Teach prevention strategies to avoid future injuries

The Bottom Line

Your knees are critical for movement, independence, and quality of life. Most knee problems—including sprains, strains, meniscus tears, plica syndrome, and patellar tendonitis—respond well to conservative care, especially when addressed early.

Early intervention:

Identifies serious injuries that need special attention
Prevents minor problems from becoming chronic
Accelerates recovery
Reduces likelihood of long-term disability
Often avoids the need for surgery
Gets you back to activities faster

Don’t accept knee pain as something you just have to live with. Don’t wait until you can’t walk without limping or climbing stairs becomes impossible.

Take action now. With accurate diagnosis, appropriate treatment, and commitment to rehabilitation, most people with knee problems can return to full, pain-free function.

Your knees carry you through life—take care of them, and they’ll take care of you.