Knee Pain: Causes, Symptoms and Treatment

Knee pain is something most people deal with at some point. It’s actually one of the top reasons patients walk through my door.

Whether you’re an athlete, on your feet all day, or just trying to live an normal life,knee pain can sneak up on you and make even simple tasks a challenge.

If your knees are bothering you, or you just want to keep them healthy,this guide will show you how to stay strong and comfortable.

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What Causes Knee Pain?

Knee pain means any kind of pain or discomfort you feel in or around your knee joint. It’s very common and can happen to anyone.

This pain can come from different parts of your knee, like the:

• Muscles
• Bones
• Cartilage
• Ligaments
• Tendons

Knee pain isn’t always the same. It might feel like:

• A mild ache that comes and goes
• A sharp pain that makes it hard to move or bend your knee

It could be caused by an injury (like a sprain), from overusing your knee, or from a long-term condition like arthritis.

No matter the cause, understanding your knee pain is the first step to feeling better.

How Common Is Knee Pain?

Knee pain is really common. It’s one of the main reasons people go to the doctor, especially as they get older. Around 25% of adults experience frequent knee pain, and it becomes more common with age.²

The chance of having knee pain goes up as you age, mostly because of things like osteoarthritis.

Who Gets Knee Pain the Most?

Knee pain can affect anyone, but some groups are more prone. We help Sandton patients manage it daily.

• Older Adults (50+): Cartilage and joint changes become more common with age, which can contribute to osteoarthritis and pain.¹
• Women: More likely to get knee osteoarthritis due to knee shape or hormones.¹
• Athletes or Active Individuals: Running or jumping can cause ITB Syndrome or “runner’s knee” (Patellofemoral Pain Syndrome).³
• Injury Recoverers: Past knee injuries, like MCL tears, cause ongoing pain.⁴
• Body weight: Weight changes the load going through the knee during walking, stairs and daily activity, and can be relevant in conditions such as knee osteoarthritis.²

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What Are Common Symptoms of Knee Pain?

1. Pain When Bending the Knee: Whether you’re walking, climbing stairs, or simply getting up from a chair, bending your knee might cause a sharp or dull pain.
2. Swelling Around the Knee: Your knee might look puffy or feel tight, especially after being active or sitting for a long time.
3. Stiffness in the Knee: It might be hard to fully straighten or bend your knee, especially first thing in the morning or after sitting for a while.
4. Popping or Clicking Sounds: You might hear or feel a popping or clicking sound when you move your knee.
5. Weakness or Buckling: Your knee might feel weak, like it could give out when you put weight on it. This can make walking or standing feel unstable.
6. Pain When Touching the Knee: The skin around your knee might be sensitive, and even a light touch can cause discomfort.
7. Difficulty Bearing Weight: It might hurt to put your full weight on the affected knee, making it hard to walk or stand.
8. Increased Pain with Activity: Activities like running, jumping, or even just walking for a long time might make the pain worse.
9. Difficulty with Daily Activities: You find it hard to do everyday things like kneeling, squatting, or getting in and out of a car.
10. Pain at Rest: Even when you’re sitting or lying down, you might feel a throbbing or aching pain in your knee.

What Happens in Knee Pain?

The knee is a hinge joint that connects the thigh bone (femur) to the shin bone (tibia). It’s one of the biggest joints in your body and is supported by ligaments, tendons, cartilage, and muscles.

Here’s a breakdown of the key parts:

Cartilage

This smooth tissue covers the ends of the bones in the knee. It helps the bones move smoothly against each other and absorbs shock when you walk or run.

When the cartilage wears down or gets damaged, it can cause pain and stiffness.

Menisci

These are two pieces of cartilage between the femur and tibia. They act like cushions, spreading out the weight and reducing friction in the knee.

Ligaments

Ligaments are strong bands of tissue that connect the bones and keep the knee stable.

There are four main ligaments in the knee, which control the movement and stability of the joint.

Tendons

Tendons connect muscles to bones. The quadriceps tendon connects the muscles at the front of the thigh to the kneecap, and the patellar tendon connects the kneecap to the shin bone. These tendons help you straighten your knee.

Synovial Membrane

This is a thin lining inside the knee joint that makes fluid to keep the joint lubricated and reduce friction.

Inflammation: The Body’s Reaction to Injury

Inflammation is one of the main reasons for knee pain. When part of the knee gets injured, the body reacts by sending extra blood and immune cells to the area.

This response helps with healing but can also cause swelling, heat, and pain.

• Synovitis: Sometimes, the lining of the knee (synovial membrane) becomes inflamed. This condition is called synovitis. It leads to an increase in fluid in the knee, which causes swelling and pain.
• Tendonitis: Tendons can become inflamed from overuse or injury, leading to tendonitis. This is common in people who do repetitive activities that put stress on the knee, like running or jumping.

Wear and Tear: Aging and Overuse

As people get older, the knee joint and surrounding tissues can change. In some people, these changes contribute to pain, stiffness or reduced tolerance for activity.

This process often leads to knee pain because the joint doesn’t work as smoothly as it should.

• Cartilage Breakdown: Over time, the cartilage in the knee can wear away, especially in areas that bear a lot of weight. When this happens, the joint may become more sensitive and less tolerant of load, which can contribute to pain and stiffness.
• Meniscal Wear: The menisci can also wear down over time. When they get thinner or tear, they don’t cushion the knee as well, which can lead to more pain and damage.

Mechanical Problems: When the Knee Doesn’t Move Right

Sometimes, the way the knee moves can cause pain. These mechanical issues can come from loose ligaments, poor alignment, or other factors that make the knee move incorrectly.

Loose Ligaments

Ligaments can stretch out or become loose after an injury or over time, leading to instability.

When the knee is unstable, it can move in ways it’s not supposed to, causing pain and more injuries.

Patellar Tracking Problem

This happens when the kneecap (patella) doesn’t move correctly within its groove on the thigh bone.

If the kneecap doesn’t move properly, it can rub against the bone, leading to pain and damage to the cartilage.

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Common Conditions that Cause Knee Pain

Beyond the conditions above, knee pain can also stem from a number of other problems:

• Bursitis: inflammation of the small fluid-filled sacs (bursae) that cushion the knee, often causing swelling and tenderness after repeated kneeling or pressure.
• Gout: a form of arthritis where crystals build up in the joint, causing sudden, intense pain, redness and swelling that can affect the knee.
• Rheumatoid arthritis: an inflammatory condition in which the immune system affects the joint lining, causing pain, swelling and stiffness in the knee.
• ACL injury: a sprain or tear of the anterior cruciate ligament, one of the knee’s main stabilising ligaments, often from a sudden twist, pivot or awkward landing.
• Plica syndrome: irritation of a fold in the knee’s lining, which can cause pain, clicking or a catching sensation, usually with repetitive activity.
• Patellar dislocation: when the kneecap slips out of its groove, usually after a twist or direct blow, causing pain, swelling and a feeling of the knee giving way.
• Patellar tendon rupture: a tear of the tendon below the kneecap that can affect your ability to straighten the knee, usually after a forceful load or fall.
• Fractures: a break in one of the bones around the knee, such as the kneecap, thigh bone or shin bone, usually after significant trauma, causing pain, swelling and difficulty bearing weight.

These are not all treated the same way, which is why the pattern of your symptoms and a proper assessment matter.

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When to get your knee checked

Seek immediate emergency medical assessment if you develop:

• new one-sided calf pain, swelling or warmth accompanied by chest pain, shortness of breath, coughing up blood or sudden collapse (possible pulmonary embolism).

Seek urgent, same-day medical assessment if you have:

• new one-sided calf pain, swelling, warmth or a change in skin colour (possible DVT);
• a hot, red or markedly swollen knee, particularly with a fever or feeling unwell;
• a knee that has suddenly locked and cannot fully straighten;
• an inability to put weight through the leg after a significant injury;
• an obvious deformity after trauma, or a rapid, large swelling after a knee injury;
• the knee repeatedly giving way and causing you to fall.

Arrange an assessment promptly if you have:

• swelling that keeps returning or is not settling;
• persistent catching or intermittent locking;
• significant night pain, or symptoms that are worsening rather than improving;
• knee pain that is substantially limiting your normal activity.

This is general information, not a diagnosis. If you are worried, get assessed.

Common Mistakes People Make With Knee Pain

Ignoring persistent or changing symptoms

Most knee pain settles and is not a sign that damage is steadily getting worse. But pain, swelling or stiffness that is persistent, recurring, or changing in character is worth having assessed, so you understand what is contributing to it and how best to manage it.

Self-diagnosing and self-treating

Rest and simple pain relief can help for a while, but they do not replace an assessment when symptoms are persistent or you are unsure what is going on.

Pushing through versus avoiding everything

The answer is usually neither complete rest nor forcing through severe pain. Movement is often helpful, but repeatedly doing activities that cause a large, sustained flare-up can make it harder to rebuild capacity. The aim is to find a tolerable level and progress from there.

Delaying assessment when it is warranted

You do not need physiotherapy for every minor niggle. But if symptoms are persistent, recurrent, limiting your activity, or your knee locks, gives way or keeps swelling, an assessment can help clarify the picture and build a more specific plan.

Why It Helps to Address Ongoing Knee Pain

Most knee pain improves over time and is usually not a sign of serious or worsening damage. But when knee pain is persistent and goes unaddressed, it can start to affect other things: how much you move, how confident you feel being active, and your day-to-day life. Over time, doing less can lead to reduced strength and movement confidence, which can make it harder to get back to the activities you want to do.

This is not about fear. Addressing ongoing symptoms early, with a clear plan, tends to make them easier to manage and helps you stay active and capable. If your knee pain is persistent, recurring, or limiting you, an assessment can help you understand what is going on and what to do about it.

What Can You Expect With Knee Pain?

How your knee pain settles depends a lot on what is causing it, how long it has been there, and how it responds to the right management. Many common causes of knee pain improve well, particularly when you stay active within comfortable limits and follow a clear, progressive plan.

Recovery is rarely a straight line. Some days will feel better than others, and a short-term flare-up does not mean you are back to square one. What matters more is the overall trend over the following weeks: gradually being able to do more, with less discomfort, as your strength and confidence build.

The timeline varies from person to person. Muscle- and tendon-related pain, and milder flare-ups of osteoarthritis, often settle over a few weeks with sensible loading and exercise. More involved problems, such as significant ligament or meniscus injuries, can take longer and sometimes need further investigation or a specialist opinion.

If your knee pain is persistent, keeps returning, or is limiting the things you want to do, an assessment can help clarify what is going on and give you a plan that fits your situation. You do not have to push through pain that is clearly not settling.

Treatment Options For Knee Pain

Exercise for Knee Pain

Exercise is a central part of managing most knee pain. Depending on what is driving your symptoms, it may include strengthening the muscles around the hip, thigh and knee, improving mobility, and gradually building your tolerance for activity. For conditions like patellofemoral pain, strengthening the hip and thigh muscles is often a useful focus.

• Strengthen the hips, quadriceps and hamstrings: building strength in the muscles that support the knee is a common part of rehabilitation and can help with pain and function.
• Work on mobility: mobility exercises can reduce stiffness and make movement feel more comfortable.
• Build up gradually and stay consistent: progress your activity at a manageable pace rather than pushing through sharp pain.

Myofascial Release

Myofascial release is used to address areas of muscle tenderness and tension around the knee and the surrounding muscles, such as the quadriceps, hamstrings and IT band. By working on areas of muscular and soft-tissue sensitivity, it can help reduce muscle-related discomfort and make movement feel more comfortable.

Orthopedic Manual Therapy

Manual therapy uses hands-on joint and soft-tissue techniques to address pain, stiffness and restricted movement around the knee. Helping the joint move more comfortably can support your return to activity and the rest of your rehabilitation.

Laser Therapy for Knee Pain

Laser therapy (low-level laser therapy) uses focused light and can be used to help reduce pain. For knee osteoarthritis, laser therapy can be used to help reduce pain and disability, and reducing symptoms can make walking, exercise and rehabilitation more comfortable.⁵ For tendon-related knee pain, such as patellar tendinopathy, laser therapy can be used alongside a progressive loading and exercise programme to help manage symptoms and support your rehabilitation.^{6, 7}

Dry Needling

Dry needling is used when painful or sensitive myofascial trigger points and muscle-related tightness are contributing to your knee symptoms. It is not the same as acupuncture; it is based on modern anatomy and an understanding of muscle function. The aim is to ease muscle-related pain and tightness, which can make movement more comfortable.

Strapping and Taping

Taping and bracing can provide a temporary sense of support during activities that might otherwise be uncomfortable. In my practice, I find some patients benefit from taping because it gives them a physical cue during movement. Around the knee, this can help some people feel more aware of how the knee is moving during walking, stairs, squatting or sport. For others, it simply helps them feel more comfortable and supported while they rebuild strength and confidence.

Combining Treatments

In practice, these approaches are often used together and tailored to you. Exercise usually forms the foundation, with manual therapy, myofascial release, taping or laser used alongside it depending on what is driving your symptoms.

Conclusion

As a physiotherapist, I want you to know that knee pain doesn’t have to be a permanent part of your life. With the right plan and consistency, many people make meaningful progress. The goal is to help you move more comfortably, rebuild confidence in your knee and get back to the activities that matter to you.

I’ve seen many people walk into my practice feeling frustrated by knee pain, but I’ve also seen them walk out stronger and more confident after sticking with their treatment plan.

If you ever need anything, don’t hesitate to reach out, I’m here to help you on this journey so you can start feeling like yourself again.



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Common questions about knee pain

How long does knee pain usually take to improve?

It depends on the cause. Many muscle- and tendon-related problems, and milder flare-ups of osteoarthritis, settle over a few weeks with sensible loading and exercise. More involved injuries, such as significant ligament or meniscus tears, can take longer. If your knee pain is persistent or keeps returning, an assessment can help clarify what is going on.

When should I worry about knee pain?

Most knee pain is not a sign of anything serious. Seek prompt medical assessment if your knee locks or cannot straighten, you cannot put weight through it after an injury, it becomes hot, red and swollen alongside a fever, or you develop new calf pain, swelling or warmth. Otherwise, pain that is persistent, recurring or limiting your activity is worth having assessed.

Do I need a scan such as an X-ray or MRI for knee pain?

Not usually. Most knee pain can be assessed from your history and a physical examination, and a scan does not always change the plan. Imaging is more useful in specific situations, such as after a significant injury or when symptoms are not settling as expected.

Is it safe to exercise with knee pain?

For most people, appropriate movement and loading are part of recovery rather than something to avoid. The right type and amount depends on what is driving your pain, which is where a tailored assessment helps. The aim is to find a comfortable starting point and gradually build from there.

Should I rest or keep moving with knee pain?

Usually neither complete rest nor pushing through severe pain. Staying gently active within comfortable limits tends to help, while repeatedly aggravating the knee can slow progress. A short-term flare-up does not mean you have caused damage; what matters is the overall trend over the following weeks.

Can physiotherapy help knee pain?

Physiotherapy is a common, evidence-based approach for many causes of knee pain. It usually combines a clear assessment and diagnosis with a progressive exercise plan, practical advice on activity and load, and accompanying treatments such as manual therapy, myofascial release, dry needling, taping or laser therapy where they help.

About the Author

Daniel da Cruz (BPhysT) is a Sandton-based physiotherapist who has been in practice since 2018, working from Medical on Maude in Sandown. He treats the full range of knee problems, from osteoarthritis and patellofemoral pain (often called runner’s knee) to ligament injuries such as ACL and MCL tears, meniscus tears and tendon-related pain.

His approach is assessment-led and evidence-based. Because knee pain rarely comes down to a single cause, every plan begins with a thorough assessment and is built around what tends to make the biggest difference: clear education, hands-on treatment where it helps, and a progressive, individualised exercise programme. The aim is to help you understand what is driving your symptoms and rebuild the strength, movement and confidence to get back to the activities that matter to you.

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References

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2. Nguyen US, Zhang Y, Zhu Y, Niu J, Zhang B, Felson DT. Increasing prevalence of knee pain and symptomatic knee osteoarthritis: survey and cohort data. Annals of Internal Medicine. 2011;155(11):725-732. https://doi.org/10.7326/0003-4819-155-11-201112060-00004
3. Xie P, István B, Liang M. The relationship between patellofemoral pain syndrome and hip biomechanics: a systematic review with meta-analysis. Healthcare (Basel). 2023;11(1):99. https://doi.org/10.3390/healthcare11010099
4. Lucidi GA, Solaro L, Grassi A, Alhalalmeh MI, Ratti S, Manzoli L, Zaffagnini S. Current trends in the medial side of the knee: not only medial collateral ligament (MCL). Journal of Orthopaedics and Traumatology. 2024;25(1):69. https://doi.org/10.1186/s10195-024-00808-9
5. Stausholm MB, Naterstad IF, Joensen J, Lopes-Martins RÁB, Sæbø H, Lund H, Fersum KV, Bjordal JM. Efficacy of low-level laser therapy on pain and disability in knee osteoarthritis: systematic review and meta-analysis of randomised placebo-controlled trials. BMJ Open. 2019;9(10):e031142. https://doi.org/10.1136/bmjopen-2019-031142
6. Liu XG, Cheng L, Song JM. Effects of low-level laser therapy and eccentric exercises in the treatment of patellar tendinopathy. International Journal of Photoenergy. 2014;2014:785386. https://doi.org/10.1155/2014/785386
7. Tumilty S, Munn J, McDonough S, Hurley DA, Basford JR, Baxter GD. Low level laser treatment of tendinopathy: a systematic review with meta-analysis. Photomedicine and Laser Surgery. 2010;28(1):3-16. https://doi.org/10.1089/pho.2008.2470