Knee pain is the second most common musculoskeletal complaint after lower back pain, affecting people of all ages and activity levels. Understanding the source of your knee pain is the critical first step — because different causes require very different treatments, and getting this wrong delays recovery significantly.
Basic Knee Anatomy
The knee is a complex hinge joint involving three bones (femur, tibia, patella), four major ligaments (ACL, PCL, MCL, LCL), two menisci (medial and lateral), cartilage surfaces and numerous bursae. Pain can arise from any of these structures — or be referred from the hip, lumbar spine or ankle.
Common Causes of Knee Pain
Patellofemoral Pain Syndrome (PFPS)
The most common knee complaint in active adults, particularly runners and cyclists. Diffuse pain around or behind the kneecap that worsens with stairs, squatting, running and prolonged sitting (the "cinema sign"). Caused by poor patellar tracking — typically from weak hip abductors allowing dynamic knee valgus, combined with tight lateral structures pulling the patella laterally. Treatment: hip strengthening, VMO activation, taping, footwear assessment.
Meniscus Tears
The menisci are C-shaped cartilage pads that cushion the knee joint and distribute load. Tears can be acute (typically from twisting under load in sport) or degenerative (age-related wear, without significant trauma). Symptoms include joint line pain, swelling, a catching or locking sensation and pain with deep flexion. Minor meniscal tears can heal with conservative management; significant tears may require surgical assessment.
Osteoarthritis
Age-related breakdown of the articular cartilage on the joint surfaces. Most common in adults over 50 but can occur earlier in people with previous knee injuries. Symptoms include morning stiffness (usually resolves within 30 minutes), crepitus (grinding), swelling after activity and progressive loss of range of motion. Exercise physiology is the most evidence-supported treatment — strengthening the muscles around the knee reduces joint stress and improves function significantly.
ACL Injury
The anterior cruciate ligament stabilises the knee against forward shear and rotation. ACL injuries are typically acute, high-energy events — a landing, cutting or contact force producing a "pop" and immediate swelling. Most active people under 40 with ACL rupture require surgical reconstruction followed by 9–12 months of rehabilitation. Older or less active patients may manage conservatively with intensive rehabilitation.
Patellar Tendinopathy (Jumper's Knee)
Degeneration of the patellar tendon at its origin on the inferior pole of the patella. Common in basketball players, volleyball players and other jumping sports athletes. Localised pain at the inferior pole of the patella, particularly with loading activities. Treated with progressive tendon loading (heavy slow resistance protocol), not rest.
Bursitis
Inflammation of the bursae around the knee — most commonly prepatellar (in front of the kneecap, from kneeling) or pes anserine (inner side of the knee, common in runners and people with osteoarthritis). Presents as localised swelling and tenderness at the specific bursal site.
How Chiropractic Care Helps Knee Pain
Many knee pain presentations have contributors from the lumbar spine, pelvis, hip or ankle — and these upstream/downstream factors are often missed when treating the knee in isolation. Our chiropractors assess the entire lower limb chain and lumbar spine, addressing:
- Lumbar and sacral restrictions contributing to altered leg mechanics
- Hip joint mobilisation for restricted hip rotation causing compensatory knee stress
- Patellofemoral joint mobilisation for tracking problems
- Proximal and distal tibiofibular joint assessment
- Soft tissue therapy for ITB, TFL, hamstrings and popliteus
Exercise Physiology for Knee Rehabilitation
Regardless of the cause, strengthening the muscles that support and control the knee is essential for both pain relief and preventing recurrence. Our exercise physiologists design progressive programs covering:
- Quadriceps strengthening (particularly VMO) — wall sits, leg press, terminal knee extensions
- Hip abductor and external rotator strengthening — reducing dynamic valgus
- Hamstring and posterior chain strengthening
- Single-leg stability and proprioception
- Progressive return to sport-specific loading
When to Seek Urgent Assessment
See a practitioner urgently if you experience:
- Significant swelling within 2 hours of injury (haemarthrosis — may indicate ACL rupture)
- Inability to bear weight
- A locking or inability to fully straighten the knee (mechanical block)
- Gross instability or giving way
