MSK Physiotherapy – Knee Pain

Some of the most common causes of knee pain include:

• Osteoarthritis (OA): The most frequent cause, especially in older adults. NICE recommends clinically diagnosing OA without imaging in many patients.
• Injury: Ligament sprains (e.g., ACL, MCL), meniscal tears, tendon injuries, or fractures.
• Inflammation: Conditions like rheumatoid arthritis, gout, or bursitis.
• Mechanical / Biomechanical Factors: Poor alignment, overuse, repetitive strain.
• Other Causes: Referred pain (from hip or back), infection (rare), or tumours (very rare).

To better understand your symptoms, it helps to recognise different “types” of knee pain:

• Degenerative / Mechanical Pain: Typically from OA. Pain is often activity-related, may worsen throughout the day, and is accompanied by stiffness.
• Inflammatory Pain: May involve swelling, warmth, redness, and more constant discomfort.
• Post-Traumatic Pain: Follows an injury — sudden onset, sometimes with swelling, bruising, or instability.
• Overuse Pain: Gradual onset due to repetitive stress or overloading (e.g., runners, manual workers).
• Instability / “Giving Way” Pain: Suggests ligament or meniscus issues.

You should consider seeking medical advice if:

• Pain is severe or persistent, and affecting daily activities.
• There is significant swelling, redness, or heat around the knee.
• You cannot put weight on the knee, or walking is very difficult.
• You experienced a traumatic injury (e.g., a “pop,” fall).
• Your knee is locking, clicking, or giving way (instability).
• Self-care (exercise, lifestyle changes) hasn’t helped after a 4-6 weeks.

1. Therapeutic Exercise
   • The NHS offers exercises specifically for knee osteoarthritis — including strengthening, balance, and mobility exercises. NHS Inform
   • For a guided video, the NHS Fitness Studio has a Pilates for Knee Problems class to help strengthen and mobilise the knee safely. nhs.uk
2. Symptom Management & Lifestyle Adjustments
   • Use ice or heat to reduce pain or swelling, but always protect the skin (wrap a pack in a towel)
   • Maintain a healthy weight, since excess weight increases stress on the knee joint.
   • Wear supportive footwear, like well-fitting trainers with good cushioning, to reduce joint load.
   • Pace your activity: On “good” days, don’t overdo it; on “bad” days, adjust your tasks so you stay moving without flaring up.
   • Avoid prolonged immobility – try to move your knee gently every hour if you’re sitting or lying for a long time.
3. When to Use Pain Relief
   • Over-the-counter painkillers (e.g., paracetamol or ibuprofen gel/tablets) can help you manage discomfort so you can keep exercising. Consider using a walking aid to reduce joint load, especially during flare-ups or if mobility is limited.

• The use painkillers non-medication management (e.g., exercise) can complement the treatment process however this should be discussed further with your pharmacist/GP.

1. Red Flags: When to Be Cautious
   • If your knee pain follows trauma (e.g., a fall), or you have severe swelling, bruising, instability, or can’t straighten or bear weight, seek medical (A&E/GP).

Why These Self-Help Strategies Matter

• Regular exercise builds strength around the knee, supports joint structures, and improves function.
• Weight management can significantly reduce joint load and improve symptoms.
• Learning to pace activities helps prevent flare-ups and preserves your ability to stay active.
• Using ice / heat and pain relief safely allows you to continue with movement, which is central to recovery.

• Not necessarily. Many people with knee pain can be managed with non-surgical treatments (exercise, weight loss, self-management).
• Surgery (like knee replacement) is considered if non-surgical options haven’t worked and your pain or function is severely impacted.

• Generally you should be diagnosed clinically (without imaging) if: you’re 45 or older, have activity-related joint pain, and your morning stiffness is short (≤ 30 minutes).
• Imaging (X-ray) is not routine unless there are “atypical features” such as sudden severe symptoms, joint deformity, or signs of other diagnoses.
• MRI, CT, or advanced imaging are not routinely needed for typical Osteoarthritis.

• You might benefit from manual therapy, but only as part of a broader treatment plan not as a standalone.
• A physiotherapist can design a tailored exercise plan, monitor progress, and guide you safely even when pain increases initially.

• Medications: Topical NSAIDs are first-line. Oral NSAIDs are effective but have risks; paracetamol / weak opioids are limited to short-term, infrequent use.
• Injections: Steroid injections can help in the short term, especially to support your ability to do exercise. However, long-term repeated steroid injections may risk cartilage damage and joint deterioration
• Surgery: Joint replacement for osteoarthritis (e.g., knee replacement) can significantly improve pain and function in selected cases. Risks and benefits should be weighed carefully

• Knee pain is common, and most people don’t necessarily need surgery.
• Self-management (education, exercise, weight control) is the foundation of evidence-based care.
• Imaging (like X-ray) is only used when clinically needed; MRI or CT are not routine for typical osteoarthritis.
• Medications and injections can help, but their use depends on individual factors.
• Hands-on therapy is valuable but should be part of a broader, personalized plan.
• If non-surgical treatments don’t work, a specialist can assess whether surgical options are appropriate.

• UK information on osteoarthritis nhs.uk
• British Orthopaedic Association / Commissioning Guide for painful knee osteoarthritis BOA
• Patient support organisations: e.g., Versus Arthritis (for peer support, self-management tools)