Knee pain is one of the most common conditions that our physios treat at Central Performance. Sydney is enjoying a big rise in running popularity right now, so knee pain related to running is really common. But other causes of knee pain include a sports injury, arthritis, or post-surgery recovery. Getting a fast diagnosis and beginning treatment early really helps accelerate your recovery, so lets look at some common causes of knee pain and how we manage them.
Knee physiotherapy involves finding a clear diagnosis as quickly as possible, then working through a management plan tailored to your specific injury and goals. Most knee conditions can be managed effectively with the right physio treatment and exercise. However, if your physio feels that you need imaging like an x-ray or MRI, they will discuss this with you and provide you with a referral. Early treatment focuses on getting you back to walking and your normal daily activities without pain, then we focus on safely returning you to sport, running and exercise. The final phase focuses on strengthening to prevent future injuries or pain.
Key Takeaways
- Sydney knee physios – Central Performance provides expert management of knee pain with experienced physiotherapists
- Treatment focuses on an accurate diagnosis and fast pain relief, followed by tailored strengthening and return-to-sport exercise programs
- We also focus on preventing future knee injuries through personalised strength exercises, functional training and return-to-sport and running programs.
Anatomy of the Knee
Your knee is a complex hinge joint responsible for weight-bearing and movement. It’s made up of bones, joints, ligaments, tendons, cartilage (meniscus) and muscles working together to provide strong, stable and controlled movement.
Bones: The knee joint involves three bones: the femur (thigh bone), tibia (shin bone), and patella (kneecap). Your patella sits in front of the joint to provide protection and improve the quadriceps muscle efficiency.
Joints: The tibiofemoral joint connects the tibia to the femur, and the patellofemoral joint includes the patella and femur. These joints are cushioned by cartilage, which helps in smooth motion and absorbs shock.
Ligaments: Four primary ligaments lend stability to your knee. The medial and lateral collateral ligaments (MCL and LCL) control the sideways movements, and the anterior and posterior cruciate ligaments (ACL and PCL) regulate forward and backward movement.
Tendons: Tendons connect muscle to bone. The quadriceps tendon connects the quadriceps muscle group on the front of the thigh to the patella and is vital for knee extension, for example in running, jumping and squatting.
Muscles: The quadriceps and hamstrings are the key muscle groups influencing the knee. Your quadriceps help in straightening the leg, while the hamstrings, located at the back of the thigh, are essential for bending the knee. The glutes and calf muscles also play a supporting role in stabilising the knee and leg overall.
Understanding the anatomy of your knee can help in pinpointing the type and cause of your knee pain. It can also help you during your treatment because it allows you to understand why your pain has started, the structures that are involved, and the steps involved in your treatment program.
What Are The Most Common Types of Knee Pain
Knee pain is a frequent issue that brings athletes and non-athletes in to see a physiotherapist for treatment. Below is a list of the 5 most common types of knee pain seen by our physios, including a brief summary of the symptoms and what the common causes are.
1. Runner’s Knee – Patellofemoral Pain
Runner’s Knee, or patellofemoral pain syndrome, typically arises from the improper alignment and tracking of the patella (kneecap) over the thighbone (femur). It’s often characterised by a dull, aching pain in the front of your knee, and this may become sharper or more intense during certain activities like doing stairs, split squats, lunges and squats (especially deep). It is common in runners, hence the name “Runners Knee”, and is also more common in women than men.
There may be some swelling although this is not usually a significant feature of runners knee, and there may also become some grinding noise (crepitus) during movement. Sometimes people find that sustained sitting with the knee in a bent position, for example watching a movie or sitting at their desk at work, makes the knee sore. If this is the case they often report that straightening the knee out and moving it helps relieve their pain.
2. ITB Syndrome
Iliotibial Band (ITB) Syndrome results from irritation of the ITB as it crosses over a bony prominence (bump) on the outside of the knee. It is a common running injury, especially in runners who have recently increased their running volume. It is also more common in runners who have a crossover gait, where their feet cross the midline as they land on the ground when running.
ITB syndrome gives a sharp, burning pain on the outer side of the knee, which usually increases the more running people do. In the early stages it may have a “warm-up effect”, which is when the pain is there at the start of a run but goes away as you warm up. However, if left to progress and get worse, it doesn’t go away with warming up and instead it gets worse and causes you to have to stop running. For more information and treatment advice on ITB syndrome with running click here.
3. Jumper’s Knee – Patella Tendinopathy
Known as Jumper’s Knee, patella tendinopathy is an injury affecting the patellar tendon which connects the kneecap to the shin bone. This condition is common in sports that involve frequent jumping and landing such as basketball and netball, but it also happens in endurance runners and in field sports like soccer and football. The pain is usually felt just below the kneecap, which helps differentiate jumpers knee from runners knee pain, which is usually felt around or behind the kneecap.
Like many overuse-type injuries, jumper’s knee is often related to an increase in volume or intensity of exercise, running or sport. The pain usually increases with exercise, and improves with load management, i.e. reducing the volume and/or intensity of exercise for a period while some specific strength exercise is performed, then gradually increasing the volume of exercise again.
4. Osteoarthritis of the Knee
Knee Osteoarthritis, commonly just called knee OA, is a degenerative condition that involves the wearing down of the protective cartilage on the ends of your bones. Pain gradually increases over time and is commonly accompanied by stiffness after periods of inactivity, and swelling in the knee joints. Pain can be localised to are specific area of your knee, or can be fairly widespread front and back.
The term “arthritis” is often concerning to people, for example if they have a knee x-ray and the report uses words like arthritis, osteoarthritis and degeneration. However, we need to remember that osteoarthritis is a normal part of aging – we all get it to some degree in different joints, commonly the knees and hips. Sometimes it causes a lot of pain and sometimes it really doesn’t cause any symptoms at all, or very minor. So, just because you have a scan report that says arthritis this does not necessarily mean anything that significant. Talk to your physio or doctor about it so you really understand what’s happening, and you can also learn more in our Arthritis Treatment blog post.
5. Meniscus Injuries of the Knee
The meniscus are cartilage cushions that sit between the thigh bone (femur) and the shin bone (tibia). We have two – the medial (inner knee) and lateral (outer knee) meniscus. The function of the meniscus is to provide cushioning between the two bones and help maintain joint mechanics and stability.
The meniscus can be injured through both acute trauma and chronic degeneration. Acute trauma often involves a twist or pivoting movement during sport, while chronic meniscal problems generally occur with increasing age. Previous injury is also a significant contributing factor to degenerative meniscal pain later in life.
Meniscal pain is usually felt along the inner or outer joint line of the knee, but can also be felt around the back. As well as pain you may experience swelling and limited knee range of motion, often worsened by twisting or squatting movements. In some acute meniscal tears you may be unable to straighten your knee fully, and if this continues then an MRI may be required to determine if there is a tear with a displaced part of the meniscus that has moved and is blocking your movement.
Physiotherapy is the first line of treatment for all of these common knee conditions. The large majority of cases do not need any imaging (x-ray, MRI…) and can be very successfully managed without the need for any other referral. Once the cause of the problem is diagnosed a personalised treatment plan including manual therapy (hands-on treatment) and progressive exercise and strengthening is started. As you improve you will be guided through progressing back to your normal activity, sport and running, plus you will be given ongoing strength training to reduce your chance of any future problems.
What Causes Knee Pain?
Knee pain can emerge from a variety of sources and present in many different ways. The cause and onset of most knee pain can be broadly classified into three main groups.
1. Acute Knee Injury
This includes sports injuries, falls and twists. You will be able to recall a specific incident or event that caused the pain to begin.
2. Overuse Injuries
This is where the pain increase gradually without a specific event or incident. It is commonly caused by increasing your activity too quickly, for example increasing your running training rapidly when training for an event, or getting back into soccer training after not having done much running throughout the summer. However, sometimes you wont be able to identify any specific increase in your activity or training volume. In this case it may have been something that has been building very gradually over a long period, and has now become painful even though you’ve only been keeping the same exercise volume.
3. Knee Pain Due to Arthritis and Degeneration
This covers many knee pain cases that come on for no real reason. Arthritis is more common as we age, but as discussed above we need to remember that “osteoarthritis” and some degree of degeneration is just a normal part of the aging process, and it doesn’t necessarily mean that you will have pain or other symptoms. Research consistently shows that the two most important factors to consider for effective ongoing management of arthritic-type knee pain are to maintain a healthy body weight, and to be as strong as you can. Physiotherapy is effective in relieving flare-ups or acute exacerbations of pain, but once this is achieved then exercise to maximise your strength is the real focus.
The Role of Muscles in Knee Function
Your knee relies heavily on the surrounding muscles for support during activities such as running, jumping, squatting and doing stairs. The quadriceps and hamstrings muscles control the majority of the knee’s movement and stability, but many other muscles such as the calf and glutes (hip/butt) muscles also play significant roles.
Muscle imbalances or weakness can lead to poor knee joint mechanics, which can increase your risk of overuse injuries, increased chance of acute knee injuries (for example valgus or inwards-rolling of the knee during sport which can increase the risk of ACL ruptures), and can also increase you risk of pain related to arthritis and degeneration. For most knee injuries regaining your full muscle strength is a critical part of your rehab program. Even if you do not play sport, research shows that increasing the strength of your main knee muscles is vital for long term knee health and function.
The Importance of Knee Joint Stability and Mobility
Joint stability and proper knee alignment are key in maintaining knee health. Laxity or stiffness in the knee joint can predispose you to injuries. For those experiencing degenerative changes, such as arthritis, maintaining joint mobility while ensuring stability and strength through conditioning and targeted strength exercise is essential.
The Influence of Hip, Ankle, and Foot on Knee Health
The hip, knee, ankle, and foot act as a kinetic chain, i.e. they all work together in producing and controlling movement of the leg during daily activity, exercise and sport. Because they all work together, a change in one joint can affect the other joints in the kinetic chain. Dysfunction at any of these joints can alter the distribution of force through the knee, heightening the risk of knee pain and injury. Proper movement control and muscle function in all of these joints is crucial for the prevention of overloading the knee, particularly during high-impact activities or sports.
Physiotherapy Treatment for Knee Pain
Physiotherapy for knee pain needs to include a holistic approach that includes load management, customised exercise programs, and various manual therapy techniques. Once the cause of your knee pain is diagnosed, your treatment will focus on improving your knee’s mobility, strength, and function, while also managing pain and inflammation.
Load Management For Overuse-Type Injuries
Load management is crucial for many knee injuries, especially if you’re dealing with an overuse-type injury. It’s about finding the balance between activity and rest to prevent aggravating your knee, but also not reducing activity too much or for too long which can cause deconditioning and weakness. By adjusting the intensity, duration, and frequency of your activities, you can aid recovery while maintaining fitness levels and strength. Sometimes a complete break in exercise is required however, whenever possible, we try to keep you exercising in some capacity as you recover.
Custom Exercise Programs
Your physiotherapist will develop a custom exercise program tailored to your specific knee condition. This program will typically include a combination of strengthening and stretching/mobility exercises designed to improve muscle strength around your knee and enhance flexibility, which is vital for recovery and prevention of future injuries.
Manual Therapy Techniques – Hands-On Treatment
Manual therapy techniques, such as joint mobilisation and massage, can be used to increase joint flexibility and reduce pain. These hands-on treatments are performed by your physiotherapist to help restore movement in stiff joints and muscles affected by knee pain. They are often more important early in your rehab, and become less important as you improve and the focus moves to strength and conditioning exercises.
Pain Management and Inflammation Control
To manage pain and control inflammation your physiotherapist may recommend treatments like ice or compression, and other techniques such as taping, bracing or using a crutch are sometimes required. These methods are particularly useful immediately after a knee injury to minimise swelling and discomfort.
Post-Surgery Knee Rehabilitation – ACL Reconstruction and Meniscal Repair
If you’ve undergone knee surgery, such as an ACL reconstruction or knee replacement, post-surgery rehabilitation is essential. It focuses on regaining strength, mobility, and function through a structured exercise program. Your physiotherapist will guide you through each phase of rehab to ensure the best possible recovery.
Regaining your full knee strength, mobility and movement control are essential if you are returning to sport following knee surgery such as an ACL reconstruction or meniscal repair. Research shows that completing a comprehensive rehab program focusing on strength, stability, plyometric exercise and game-specific return-to-play drills are essential in not only getting you back in the game, but also for reducing your risk of future pain and injury.
Sport-Specific Rehabilitation Strategies
For athletes with a sporting injury, sport-specific rehabilitation strategies are employed to ensure a safe return to sport. This includes return to sport testing for knee pain to assess your readiness to resume sporting activities. Tailored exercises and drills that mimic your sport will be used to prepare you for a confident comeback. This step is essential to make sure you’re ready to get back in the game, plus highlights areas where you need to keep building strength and control for injury prevention in the future.
Biomechanical Assessments and Running Analysis
Biomechanical assessments analyse aspects of your movement control, strength and flexibility that may contribute to knee pain or injury. This can be especially important in cases where knee pain is recurrent or chronic, i.e. where it keeps coming back or has lasted for a long time. Having a running biomechanical assessment is especially important for running-related knee pain, and can help resolve and prevent knee injury as well as increase your running performance.
Following your biomechanical assessment a program of exercises is developed to improve balance, flexibility, and strength in the knee joint. At Central Performance our exercise physiology team are experts in strength training for knee pain, plus our running-specific strength and conditioning program allow runners of all abilities to increase their running performance and remain free from injury.
ACL Injuries: Non-Surgical Management and ACL Reconstruction Surgery
ACL injury, surgery and reconstruction is a very popular topic these days. It is a common sports injury and there is currently lots of debate about the best way to treat ACL injuries. There is now solid evidence to support conservative (i.e. physio or non-operative) management of many ACL injuries, especially if there is no damage to other structures like the meniscus or other ligaments.
Our physios and exercise physiologists are experienced in both operative and non-operative management of ACL injuries. We work with many of Sydney’s top knee surgeons and sports physicians to guide clients in a successful return to sport, exercise and daily activity. Contact us or book online to begin your ACL rehab with our experienced team.
Performance Improvement and Injury Prevention
The ultimate goal of knee physiotherapy is not only to rehabilitate but also to enhance your overall performance in various sports and running. Rehab programs that improve movement quality and build strength do much more than just rehabilitate after an injury. Research shows that they are also very effective in improving your sports performance as well as minimising your risk of future knee pain or injury.
Following your initial course of physiotherapy to guide you through the early and middle stages of your knee rehab program, many clients progress on to complete a comprehensive strength and conditioning program with our exercise physiologists. This ensures you are fully game-ready to return to play, helps you improve your sports performance by building more speed and strength, plus reduces your risk of future injury by optimising your biomechanics and movement control.
How Can You Prevent Knee Pain and Injury?
To safeguard your knees from pain and injury, it’s essential to adopt a comprehensive approach that blends strength and conditioning, load management, and balanced training principles. When running, particular attention to running technique can further reduce injury risks.
Strength Exercises and Plyometrics for Knee Pain Prevention
Incorporating lower body strength exercises into your routine is crucial. Focus on building strength in your quadriceps, hamstrings, glutes and calf muscles, which support your knees. Exercises like squats, lunges, and leg presses are beneficial.
Once you have a solid strength base, introducing plyometric exercises and sports-specific strength drills should be included in your program. This is important to optimise your muscle’s ability to produce and control the movements associated with your chosen sport, which improves sports performance as well as reduces the risk of injury.
Load Management and Training Principles
Gradual progression in any physical activity is key to preventing overuse injuries. Raise the intensity and duration of your workouts incrementally to allow your body to adjust.
- Increase training loads by no more than 10% per week is a good general guide, but this can vary a lot between different people and situations
- Incorporate rest days to enable muscle recovery
- Balance high-impact activities with low-impact exercises like swimming or cycling
- Make sure you pay attention to getting enough sleep and good nutrition to help your recovery, especially if you are training at higher volumes or intensities
Preventing Knee Pain When Running – The Central Performance Running Centre
Knee pain is one of the most common running injuries seen by our physios. There are many causes and contributing factors for knee pain in runners, and each case is unique. For more information on how to prevent and manage knee pain when running visit our Surry Hills Running Centre page. This gives you information on our specialist running services including physio for runners, running gait assessment, and strength and conditioning for runners.
Sydney Knee Physiotherapy
When you’re dealing with knee pain or looking to enhance your knee function for running and sports performance, accessing specialised care from qualified and experienced professionals is essential. Our team of skilled knee physiotherapists and exercise physiologists offer a wealth of expertise in managing all types of knee pain.
Expert Knee Physiotherapists – Central Performance Surry Hills
At Central Performance in Surry Hills, you’ll receive care from expert knee physiotherapists who are well-equipped to assess and treat a variety of knee issues. Our physios use advanced treatment techniques and evidence-based practice to ensure accurate diagnosis, fast recovery and effective treatment plans. Your journey towards improved knee health is supported by customised programs focusing on knee strengthening and optimising knee function. Plus for athletes and sports people your program is tailored specifically for your chosen sport and level of competition to ensure you have a safe and lasting return to exercise. Click the buttons below for more information or to book your knee physio online.
Knee Pain Physio – Summary
Your journey to recovery from knee pain starts with expert knee physiotherapy for an accurate diagnosis and fast pain relief, then progresses through to targeted strength and conditioning programs for a safe and lasting return to sport and exercise. Central Performance you have access to highly qualified physiotherapists and exercise physiologists who can offer you not just treatment but also education and ongoing exercise programming on maintaining knee health, improving sports performance and preventing future injuries.
During your sessions, expect a comprehensive assessment of your condition. This typically includes:
- Analysis of movement and gait patterns
- Muscle strength testing
- Range of motion evaluations
- Specific testing of structures including ligaments, muscles, joints and cartilage/meniscus
You personalised physio treatment program will usually consist of techniques including;
- Manual therapy (hands-on treatment)
- Targeted exercise programs
- Pain management techniques
- Education and advice on load management and progression back into exercise as you improve
- Exercises for preventing future injuries and improving sports performance
Frequently Asked Questions
When dealing with knee issues, having the right information can facilitate a faster and more effective recovery. Here, you’ll find answers to some common questions surrounding knee rehabilitation and treatment with physiotherapy.
Which exercises are recommended for rehabilitation after a knee injury?
If you’ve recently experienced a knee injury, gentle exercises such as leg lifts, wall squats, body-weight squats, light leg press and step-ups are often recommended. Range of motion exercises such as gentle bending and straightening or getting on a stationary exercise bike can be helpful in the early stages to get your knee moving. As you improve you should progress onto loaded squats, split squats/Bulgarians, RDLs and lunges. Once these exercises have rebuilt strength and stability around your knee you should progress to running, plyometrics (jumps, hops and bounds) and heavier single- and double-leg loading. This exercise progression will vary greatly depending on your injury and the type of sport or activity that you wish to return to.
How can a physiotherapist assist with knee pain management?
A physiotherapist can provide you with an accurate diagnosis so you clearly understand what has happened to cause your pain. Then a targeted treatment plan is provided that includes pain-relief strategies, manual therapy to relieve pain and restore movement, and targeted exercise to rebuild strength and control. We also focus on education so you really understand your rehab journey, and on effective return-to-sport programs to minimise your risk of future problems.
What should I consider when choosing a physio for my knee treatment?
When selecting a physio for your knee treatment, consider their specialisation in knee conditions, their experience, and the treatment methods they offer. Many knee conditions require strength exercise and specific return-to-sport training to be effective, so having an onsite gym is also essential. At Central Performance our experienced physio team work closely with our exercise physiologists to provide a complete knee rehab service, all of which can be completed in our fully equipped facility with onsite gym, treadmills, cardio and strength training equipment.
Are there specific physiotherapy techniques for post-knee replacement recovery?
Post-knee replacement recovery typically involves techniques such as manual therapy, tailored exercise programs, and modalities to reduce swelling and improve range of motion. Graded exercise to restore movement and then gradually build knee strength are essential components of treatment following total knee replacement surgery.
Is it necessary to see a GP before visiting a physio for knee issues?
It is not necessary to see a GP before visiting a physio for knee pain. Physios are first-contact health providers for knee injury, and health fund rebates are available through all health funds without a doctors referral. If your physio feels you need to see a knee specialist or surgeon, or if you need an x-ray or MRI, they will organise this referral process for you. Usually this is not required for the majority of knee injuries.
What warning signs indicate that I should seek immediate help for knee pain?
Immediate help for knee pain should be sought if you experience severe pain, significant swelling, have suffered a significant trauma, or are unable to bear weight on your knee, as these symptoms may indicate a more serious injury.
