Knee pain is a common issue that affects people of all ages and fitness levels. Whether the source of pain is caused by injury, overuse, or age related issues such as arthritis, it can significantly impact an individual’s day to day life, making simple tasks such as walking, difficult. Knee pain can range from a mild discomfort to debilitating pain and is often described as dull, aching, or stabbing pain that can be felt in a variety of locations within the knee including anteriorly, posteriorly, laterally, or under the kneecap.  Knee pain affects approximately 25% of adults, and its occurrence has risen nearly 65% over the past 2 decades.¹ Knee pain is the second most common cause of chronic pain, accounting for nearly 4 million primary care visits each year. 

Although knee pain is extremely common, there are a few factors that make an individual more prone to developing such pain. Some of which include:

• Age: As we age we are more likely to experience knee pain due to the natural wear and tear on the knee joint that is accumulated over a lifetime (osteoarthritis). 
• Obesity: An obese individual is more likely to experience knee pain due to the increased stress placed on the knee joint. 
• Gender: Women are more prone to develop osteoarthritis but not necessarily experience more pain than their male counterparts. 
• Athletes: Athletes are more prone to overuse injuries such as patellar tendinopathy. 
• Occupation: Individuals whose job requires them to spend prolonged periods of time on their feet, engage in repetitive bending or heavy lifting, are more prone to develop knee pain. 

Knee pain can have a significant impact on an individual’s daily life, making tasks such as walking, climbing stairs, or exercising challenging. Because of this, knee pain can also play a role in the loss of one’s independence, which can be frustrating and even lead to anxiety or depression. Beyond the physical and mental challenges, the cost of managing knee pain can become a burden whether through medical appointments, medications, or surgical intervention.

While knee pain can sometimes be a short-term issue, it can also become a chronic condition that requires proper diagnosis and treatment by a healthcare provider such as a Physical Therapist (PT). PTs play a crucial role in the treatment of knee pain by providing an in-depth assessment and diagnosis of the root cause of pain. PTs provide a non-invasive, long term solution to knee pain through hands-on techniques, stretching, and strengthening interventions that help to restore proper mobility, reduce pain, and improve stability of the joint while reducing the risk of reinjury.  

Causes of Knee Pain 

The knee is the largest joint in your body and is extremely complex. It is made up of multiple ligaments and provides the attachment and origin site for 8 different muscles in your legs. The knee joint plays a crucial role in supporting your weight and absorbing impact as you move, thus is one of the most frequently injured joints in the human body. 

Understanding the cause of knee pain is crucial to the development of an effective treatment plan. Some of the most common causes include ²: 

• Osteoarthritis: Degenerative joint disease caused by wear and tear on the joint.
• Injury: The knee joint is made up of multiple ligaments, muscles, bones, and cartilage, making it prone to injury. Some of the most common injuries include arthritis, tendinopathies and sprains.
• Overuse: Repetitive movements such as running, jumping or high impact sports.

As previously mentioned, there are a number of underlying conditions that contribute to knee pain and although some might be avoidable, others are not. As we age, the knee joint deteriorates due to everyday wear and tear that is placed upon the joint and the more active we are the greater load we apply to the joint. However, this can be avoided by proper maintenance of the knee joint, which we will discuss later. Another predisposing factor is weight. Obesity is correlated with an increase in osteoarthritis which may lead to knee pain. Although an individual may have arthritis, not all will experience knee pain.

Symptoms of Knee Pain 

Knee pain can be described in a variety of ways and the specific symptoms depend on the source of the pain whether it is injury, arthritis or overuse. Knee pain is most often described as dull, sharp, burning, aching or stabbing.² Knee pain is often associated with swelling and stiffness that may be brought on acutely, such as with an injury, or over a prolonged period of time. This swelling and stiffness is often accompanied by a feeling of warmth as well as visual redness. Knee pain can also present with a feeling of instability or weakness, and it might feel as though your knee might give out when walking or traversing stairs. On the contrary, some root causes of knee pain might cause you to experience limited range of motion, i.e. difficulty bending or straightening your knee. This reinforces the importance of a thorough  examination by a healthcare professional, such as a PT, to determine the source of knee pain. Knee pain might also make it difficult to bear weight on the affected leg. 

There are common pain symptoms that require a dichotomy of follow-up questions. This is where PTs come into play. PTs are extensively trained to provide an in-depth assessment that allows for differential diagnosis of the knee to identify anything that requires immediate medical attention and to provide the most effective treatment plan, often allowing the patient to recover without surgical or medication intervention. Some examples include:  

• Pain that worsens with squatting: Patellofemoral pain syndrome, Meniscus tear, arthritis, or quad tendonitis 
• Pain with twisting/ pivoting: Meniscus, ACL, MCL or LCL tear
• Pain that is experienced with a crunching/ grinding sensation: Arthritis 
• Pain felt with a pop: ACL tear
• Posterior knee pain: Meniscus
• Outer knee pain: LCL tear, PFPS or general knee pain, or lateral meniscus

Diagnosis of Knee Pain 

If you are experiencing knee pain, first seeking the assistance of a physical therapist is a smart and effective approach. PTs are well trained in orthopedic testing and differential diagnosis allowing them to often determine the cause of pain without imagining. Imagining such as MRIs and X Rays can be beneficial however, they are often unnecessary. ³ Imaging results can lead to undue fear and anxiety, causing patients to avoid movement, which can slow the recovery process. In many states, you can go directly to a PT without seeing a doctor first, which is known as direct access, however, it is important to check your individual insurance and state policies. 

Your first visit with a PT will include the initial evaluation. The PT will obtain a past medical history in which they will ask you questions regarding any symptoms you are experiencing, the history of injury if that is the cause of the pain as well as any activities that aggravate or relieve the pain. The PT will also do a hands-on assessment in which they will examine the knee for any bruising, swelling, warmth, and palpable or visual abnormalities. In addition, they will also assess the range of motion (ROM) of the joint looking for any limitations, laxity, or positions that exacerbate pain. Another component of the hands-on assessment includes a strength assessment. The PT will manually assess the strength of the muscles that surround the knee joint including the hamstrings, quadriceps, and glute muscles, looking for any weakness or imbalances. 

After completing the hands-on assessment, a PT will  conduct a number of functional assessments in order to identify any possible movement abnormalities that will better provide an insight into the root cause of pain. This often includes squatting, lunging, and an analysis of your walking pattern. There are also a number of orthopedic tests that are specific to a particular injury that can assist the PT in making an accurate diagnosis by ruling in or out a particular condition. By conducting such a comprehensive assessment, the PT is able to generate an effective treatment plan. However, if symptoms plateau or worsen, PTs might recommend imaging to provide a better insight into the source of pain. 

Treatment Options 

• Non-Surgical Treatments: Knee pain can often be treated without surgical intervention. Most knee conditions can be treated via an individualized and patient centered treatment plan. Emphasis is placed upon correcting muscle imbalances, movement abnormalities, and improving the strength of the muscles surrounding the knee joint. If a plateau is noted then a PT might recommend injections, generally cortisone injections, which will allow the patient to continue to progress with the treatment protocol. Injections, however,  are only a short term solution to pain management. A PT might also recommend incorporating low impact activities such as cycling or swimming to reduce the load on the joint however, this is patient specific. Weight loss can also contribute to a reduction in knee pain yet, is not the primary focus of an effective treatment plan and pain can be alleviated without weight loss. 

• Surgical Treatments: Surgical intervention is indicated when conservative treatments, such as PT, fail to provide pain relief. Surgical interventions range from minimally invasive procedures, such as arthroscopy, which repair injuries such as meniscal tears as well as minor arthritic deterioration. To open surgery, such as a total knee replacement, in which there is more disruption to surrounding structures and usually call for a longer recovery time. 

Preventing Knee Pain 

Pain in any form is multifaceted and the primary factor that influences pain is sleep. It is recommended that an individual should get 7-9 hours of sleep per night. Prioritizing sleep can help to expedite the recovery process as it allows us to perform at our best as well as for muscle recovery. Also, incorporating stretching and strengthening into your daily routine will allow you to create a robust knee that is more resilient to pain and injury. Additionally, maintaining a healthy weight is a crucial long-term goal as it reduces the wear and tear of the knee joint and in turn reduces the risk of injury and chronic pain. 

Living with Knee Pain

When living with joint pain it is important to stay consistent with the home exercise plan (HEP) provided to you by your physical therapist. In doing so, you will ensure a healthy, strong, and mobile joint. However, flare-ups are inevitable as life is busy. Over-the counter pain relievers can be beneficial in managing a flare-up. 

Coping with chronic knee pain can be challenging. It is important to protect your emotions well-being as well and methods such as meditation, mindfulness, or deep breathing can help manage the physical and emotional stress that is associated with chronic knee pain. Support groups can also be a helpful way to manage these emotions as they provide a sense of community and can provide useful tips to better manage pain. 

Physical Therapy for Knee Pain

At Confluent Health we strive to provide an individualized approach to the treatment of knee pain. We utilize interventions such as manual therapy, neuromuscular re-education, and targeted strength training to address the root cause of pain. Physical therapy effectively addresses knee pain by developing individualized treatment plans such as return-to -sport protocols, gait analysis and correction, and joint strengthening/stability protocols. By combining patient centered care, cutting-edge technology and a hands-on approach, our PTs help patients move without pain, feel stronger, and return to their daily lives.  For real success stories from our patients-click here!

Physical Therapy Near You

If you are experiencing knee pain, don’t wait, book your consultation at a physical therapy clinic near you! Whether you’re dealing with a recent injury or have been suffering from chronic knee pain, our expert PTs provide a comprehensive assessment that will have you back to pain free movement in no time! Together with partners in our nationwide network of over 1,600 sites of care, we’re constantly innovating to evolve skill sets, develop new tools, and set new benchmarks that are contributing to a stronger and healthier individual!