Most knee pain comes from a handful of problems with recognisable patterns. We work out which one you have, then build the strength that lets the knee take its load again.
Where a knee hurts says a lot about why. Pain around or behind the kneecap that is worse on stairs and after sitting is usually patellofemoral pain. An ache on the inner side with stiffness first thing, in someone over 45, points towards osteoarthritis. Pain on the joint line after a twist, with catching, suggests the meniscus, and a sharp, focal pain just above or below the kneecap is usually a tendon. A pinpoint sore spot a couple of fingers below the joint on the inner shin is often the pes anserine tendons and the bursa beneath them.
One assessment separates these in most cases. A scan is rarely needed to start, partly because meniscal fraying and cartilage change are common on the scans of knees that do not hurt at all.
Common symptoms:
Almost every knee problem on that list improves with strength work, and the diagnosis decides where the work starts. For knee osteoarthritis, NICE recommends therapeutic exercise as first-line care, and a 2024 Cochrane review of 139 trials found that exercise probably improves pain and function. For kneecap pain, a 2018 international consensus statement recommends combining hip and knee strengthening in preference to knee exercises alone.
Degenerative meniscal tears in middle age usually respond to the same kind of programme. The five-year follow-up of the ESCAPE trial found physical therapy performed as well as arthroscopic partial meniscectomy, so surgery becomes a conversation after a genuine trial of rehab rather than before it. Tendon pain around the kneecap settles with progressive loading, and runners often need their weekly volume and hills adjusted while the strength builds.
Knees recover best when the load they meet climbs in step with the strength that supports them. Here is the order we work in.
We map where the pain sits, test the kneecap joint, the joint line, the ligaments and the tendons separately, and check the hip and the foot, so the plan targets the structure actually involved.
Stairs, squat depth, running volume and long spells of sitting get adjusted to a level the knee tolerates, which usually calms things within a couple of weeks.
Progressive quadriceps, hip and calf loading is the part that changes how the knee copes, moving from controlled range work to single-leg strength.
We rebuild tolerance for the hills, stairs, sport or long walks you want back, and leave you with maintenance work that keeps the knee comfortable.
Not sure whether your knee pain is the kneecap, the joint, the meniscus or a tendon? Book a free discovery call and we will talk through your symptoms, with no obligation.
Book a Free Discovery CallIf this is your first visit, start with an initial assessment with our specialist MSK physiotherapist, who will examine the knee, work out what is driving the pain and set out your plan. Already assessed? Book a follow-up session. Any other appointment is on the full booking page.
Going down stairs loads the front of the knee at several times body weight while the quadriceps lengthens to control the drop. Kneecap pain and early joint wear both show up there first, and quadriceps and hip strengthening is what eases it.
It may be. NICE advises diagnosing osteoarthritis clinically in people aged 45 or over with activity-related joint pain and morning stiffness lasting no longer than 30 minutes. In younger knees, and where the pain sits around the kneecap, patellofemoral pain or a tendon is the more likely cause.
Rarely to start treatment. A scan earns its place after a significant injury, when the knee locks or gives way, or when surgery is being considered, and many findings on a knee MRI are also common in people with no pain.
Modifying the activity that flares it, while keeping the knee moving and strengthening, usually settles pain faster than complete rest, which also lets the thigh muscles weaken.
Most knee pain is managed without it. Surgery becomes a reasonable conversation for a knee that locks, a torn ligament in someone returning to pivoting sport, or osteoarthritis that still limits sleep and daily life after a genuine trial of strength work.
Often yes, at a reduced volume with fewer hills, while strength work goes in alongside. We set the limits by how the knee behaves the morning after a run.
Book a thorough assessment at our Uckfield clinic and we will work out what is driving it and build a plan to get the knee strong again.
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