Knee Pain

Knee pain can affect walking, climbing stairs, standing, squatting, kneeling, running and many other everyday activities. Symptoms may begin after an injury or develop gradually as your activity, work or exercise changes.

At Core Physio, your physiotherapist will consider how the problem began, which movements affect it and what you need the knee to do. Treatment is then personalised around your symptoms, current physical abilities and individual goals.

Your rehabilitation may include advice, movement exercises, progressive strengthening, balance work and a gradual return to normal activity. Hands-on physiotherapy may also be used when it can support the wider treatment plan.

Understanding Knee Pain

The knee is a weight-bearing joint formed by the thigh bone, shin bone and kneecap. Ligaments, cartilage, tendons and surrounding muscles help control movement and provide support during everyday and sporting activities.

Symptoms may be felt:

At the front of the knee
Around or behind the kneecap
Along the inside or outside of the joint
At the back of the knee
Above or below the kneecap
Throughout the joint following an injury or flare-up

The location of discomfort can provide useful information, but it does not always identify one particular structure as the cause.

An assessment considers the complete presentation, including movement, strength, swelling, previous injuries, general health and the activities that influence your symptoms.

Common Symptoms

Knee problems can affect people in different ways. You may experience:

An ache during walking or standing
Sharp discomfort during a particular movement
Stiffness after sitting or resting
Pain when using stairs
Difficulty squatting or kneeling
Swelling around the joint
Clicking, cracking or grinding sensations
A feeling that the knee may give way
Reduced bending or straightening
Discomfort during running, jumping or changing direction
Loss of confidence in the affected leg

Symptoms may change during the day and according to activity. For example, walking may feel comfortable while running, prolonged sitting or descending stairs increases discomfort.

What Can Cause Knee Pain?

There are many possible causes. Some problems follow an identifiable injury, while others develop without a single event.

Possible contributing factors include:

A fall, twist or collision
A rapid increase in running or training
Repeated jumping, lifting or kneeling
Reduced strength around the knee and hip
Changes in work or everyday activity
A period of reduced physical activity
Previous injury or surgery
Tendon irritation
Osteoarthritis
Inflammatory or other medical conditions

Similar symptoms can arise from different problems. Therefore, treatment should not be based solely on an online description or the body area that hurts.

Your physiotherapist will assess whether the presentation appears suitable for routine musculoskeletal rehabilitation or whether medical investigation is required.

When May Physiotherapy Help?

Physiotherapy may be appropriate when discomfort, stiffness or weakness is limiting your normal movement and activity.

Consider arranging an assessment when:

Symptoms are not improving as expected
The problem repeatedly returns
You are unsure which activities remain appropriate
Walking or using stairs has become difficult
You have lost movement or strength
The knee feels unreliable during normal activity
You are struggling with work-related tasks
Pain is preventing exercise or sport
You are returning to activity after an injury
You need a structured rehabilitation programme

You do not need to know the exact diagnosis before booking. Understanding the likely nature of the problem and deciding on suitable next steps form part of your physiotherapy assessment.

Your Initial Physiotherapy Assessment

Your first appointment begins with a detailed discussion about the symptoms and their effect on your life.

Your physiotherapist may ask:

When the problem began
Whether there was a specific injury
Where you feel pain or discomfort
Whether the knee swells
Which movements increase or reduce the symptoms
Whether the joint catches, locks or gives way
How the problem affects walking, stairs or sleep
What your work and daily routine involve
Which exercise or sport you normally complete
Whether you have experienced a previous knee injury
What treatment or investigations you have already received
What you would like to return to doing

Bring any relevant scan reports, consultant letters or medical information to the appointment.

Your Physical Assessment

The physical examination will be adapted to your symptoms and current abilities.

Your physiotherapist may assess:

Knee bending and straightening
Hip and ankle movement
Strength of the thigh, hip and calf muscles
Swelling around the joint
Walking and stair movement
Balance and single-leg control
Squatting, stepping or lunging
Running or jumping where appropriate
Movements connected to your work or sport

Specific clinical tests may also be used when a ligament, tendon, cartilage or another structure needs to be assessed.

You will not necessarily need every test. The examination should focus on findings that are relevant to your symptoms and likely to influence treatment.

Your Knee Rehabilitation Plan

Treatment will be based on the assessment rather than following one standard exercise sheet for everyone.

Your plan may include:

Education about the likely nature of the problem
Guidance for managing pain or swelling
Exercises to restore comfortable movement
Progressive strengthening
Balance and movement-control exercises
Walking or cycling
Practice of stairs, squatting or lifting
Hands-on physiotherapy where appropriate
Temporary changes to aggravating activities
A gradual return to work, exercise or sport

The programme should progress as your movement, strength and confidence improve.

Success is not judged only by a pain score. Your physiotherapist will also consider whether you can walk, use stairs, exercise or complete other meaningful activities more comfortably.

Exercise for Knee Pain

Exercise is often an important part of rehabilitation because it can improve movement, strength and the knee’s ability to tolerate physical activity.

Early exercises may focus on:

Comfortable bending and straightening
Activating the thigh muscles
Gentle weight bearing
Walking short, manageable distances
Reducing stiffness after rest

As your abilities improve, rehabilitation may progress towards:

Squats and sit-to-stand exercises
Step-ups and controlled stair work
Lunges
Calf and hip strengthening
Single-leg balance
Resistance training
Running and jumping preparation
Sport-specific movement

There is no single exercise that is best for every knee problem. The appropriate starting point and rate of progression depend on your symptoms, diagnosis and activity goals.

How Much Discomfort Is Acceptable During Exercise?

Rehabilitation does not always need to be completely pain-free. A small and manageable increase in familiar discomfort may occur when you begin moving or strengthening an affected joint.

However, exercise should be reviewed when it causes:

Severe or sharp pain
A significant increase in swelling
New instability or giving way
Loss of movement
Symptoms that continue to worsen after the session
A reaction that does not settle as expected

Your physiotherapist can help you distinguish between a manageable response to exercise and symptoms suggesting that the programme should be changed.

Anterior Knee Pain

Anterior knee pain is felt around the front of the joint or kneecap. It may affect stairs, squatting, running, jumping or sitting with the knee bent for an extended period.

The term describes the location of symptoms rather than one single injury. Several factors may influence the problem, including:

Changes in training or activity
Strength of the thigh and hip muscles
The knee’s tolerance for repeated loading
Running, jumping or squatting volume
Previous injury
Reduced confidence in movement

Rehabilitation may involve progressively strengthening the leg, adapting activity temporarily and gradually rebuilding tolerance for the movements that cause difficulty.

Knee Osteoarthritis

Osteoarthritis can cause pain, stiffness and reduced function. Symptoms may vary over time and do not necessarily worsen continuously.

People may notice:

Activity-related joint pain
Stiffness after rest
Difficulty walking or using stairs
Reduced bending or straightening
Swelling during a flare-up
Grinding or creaking sensations
Reduced confidence in the leg

Exercise is a central part of management. Your programme may include local muscle strengthening, walking, cycling and other aerobic activity appropriate for your health and physical abilities.

Some discomfort may occur when exercise begins. Nevertheless, regular and consistent activity can help improve function and support long-term management.

When weight management is relevant to your health and symptoms, appropriate support may also help reduce the physical demand placed on the joint. This should be discussed respectfully and as part of a wider treatment plan.

Meniscus and Cartilage-Related Symptoms

The menisci are cartilage structures that help distribute load within the knee. Symptoms may develop following a twisting injury or appear gradually over time.

Possible features include:

Pain along the joint line
Swelling
Difficulty squatting or twisting
Clicking or catching
Reduced confidence during weight-bearing activity

Changes involving the meniscus can also appear on scans in people without symptoms. An imaging result therefore needs to be considered alongside your history, physical examination and functional difficulties.

Many presentations can initially be managed with advice and progressive rehabilitation. However, a knee that becomes acutely locked and cannot straighten requires prompt medical assessment.

Knee Ligament Injuries

Ligaments help control movement and stability within the joint. An injury may occur during twisting, landing, changing direction, contact sport or a fall.

You may experience:

Pain following a specific incident
Rapid swelling
Difficulty bearing weight
A feeling of instability
Reduced confidence when turning or changing direction

An early assessment can determine whether routine physiotherapy is appropriate or whether imaging, bracing or specialist orthopaedic input may be required.

Rehabilitation commonly progresses from restoring movement and basic strength towards running, jumping, landing and changing direction where these activities are relevant.

Patellar and Quadriceps Tendon Pain

Tendons connect muscles to bones and transfer force during movement. Symptoms around the patellar or quadriceps tendon may be associated with running, jumping, squatting or repeated physical loading.

Rehabilitation may involve:

Temporarily adjusting aggravating activity
Progressive tendon-loading exercises
Strengthening the thigh and surrounding muscles
Gradually rebuilding jumping or running tolerance
Reviewing recent changes in training

Complete and prolonged rest may reduce symptoms temporarily without preparing the tendon for future demand. A graded programme can help restore physical capacity more effectively.

Knee Swelling

Swelling can develop following an injury, increased activity or irritation within the joint.

Mild swelling may settle as the problem improves. However, marked or rapidly increasing swelling requires appropriate assessment, particularly after trauma.

Seek urgent medical advice when swelling occurs with:

Severe pain
An inability to bear weight
A change in the shape of the joint
Significant restriction of movement
Redness or heat
A high temperature or feeling generally unwell

Do not massage a hot, red or unexplained swollen joint before the cause has been assessed.

Clicking, Cracking and Grinding

Knees commonly make noises during movement. Clicking, cracking or grinding without pain, swelling or loss of function is not necessarily a sign of damage.

An assessment may be useful when joint noise is accompanied by:

Pain
Swelling
Locking or catching
Reduced movement
Instability
Symptoms following an injury

Physiotherapy focuses on how the knee moves and functions rather than attempting to eliminate every normal joint sound.

Locking and Giving Way

People use the term “locking” to describe several different experiences.

Sometimes pain briefly makes movement feel difficult. In other cases, the joint may become mechanically stuck and cannot fully bend or straighten.

A knee that becomes acutely locked, particularly following an injury, needs prompt medical assessment.

Giving way may also have different causes. It can relate to pain, reduced muscle control, weakness or ligament instability.

When the knee repeatedly collapses or causes you to fall, arrange an appropriate assessment rather than continuing normal activity without advice.

Remaining Active

Symptoms can make complete rest feel like the safest option. A short period of reduced activity may be appropriate after an injury or severe flare-up, but prolonged inactivity can contribute to stiffness and loss of strength.

Where it is safe, you may be advised to:

Continue comfortable movement
Take short walks
Change position regularly
Temporarily reduce aggravating exercise
Use a manageable alternative activity
Gradually rebuild your normal routine

Your physiotherapist can help identify an appropriate starting level and avoid repeatedly alternating between complete rest and doing too much at once.

Knee Pain at Work

Symptoms may affect both physically demanding and desk-based occupations.

Work can involve:

Prolonged standing or walking
Climbing stairs or ladders
Kneeling or squatting
Lifting and carrying
Driving
Sitting with the knee bent for long periods
Repeated changes of direction

Your rehabilitation can consider the actual demands of your role rather than focusing only on exercises performed in the clinic.

This may involve temporary adjustments, gradually increasing work-related activity and building the strength and endurance required for more demanding duties.

Returning to Running and Sport

Reduced pain does not always mean that the knee is immediately ready for full training or competition.

Depending on your activity, rehabilitation may need to restore:

Strength through both legs
Single-leg balance and control
Running tolerance
Jumping and landing ability
Acceleration and deceleration
Changing direction
Confidence during sport-specific movements
The ability to tolerate repeated physical effort

The programme can progress from controlled exercises towards faster and less predictable activity as your abilities improve.

A gradual return helps bridge the gap between basic rehabilitation and the actual demands of your chosen sport.

Hands-On Physiotherapy

Hands-on treatment may be used when your physiotherapist believes it can support movement or symptom management.

Techniques may include:

Joint mobilisation
Soft-tissue treatment
Massage techniques
Guided movement
Patellar mobilisation where appropriate

Manual treatment is not essential for every knee problem and cannot independently rebuild strength or prepare the joint for demanding activity.

Where it is included, it should complement exercise and active rehabilitation rather than replace them.

Do I Need an X-Ray or MRI?

Not every knee problem requires imaging before physiotherapy can begin.

Scans can identify structural changes, but these do not always explain the level of pain or difficulty someone experiences. Some findings are also common in people without symptoms.

Imaging may be considered when:

A fracture or significant injury is suspected
The knee has become mechanically locked
Symptoms suggest infection or another medical condition
The result is likely to change treatment
Specialist or surgical assessment is being considered
Progress is different from what would normally be expected

Your physiotherapist can explain whether treatment appears appropriate or whether further medical investigation should be requested.

Managing a Flare-Up

A temporary increase in symptoms does not always mean that new damage has occurred.

Flare-ups can follow unusual activity, a sudden increase in exercise, reduced sleep, illness or a change in work demands.

During a flare-up, it may help to:

Reduce particularly aggravating activity temporarily
Continue comfortable movement where possible
Use exercises previously recommended for you
Break larger tasks into manageable stages
Gradually return to your normal routine
Seek advice when symptoms are unusual or worsening

Your physiotherapist can help you develop a practical plan for future episodes without becoming unnecessarily inactive.

When Should I Seek Urgent Medical Advice?

Contact NHS 111 or an urgent treatment service when:

The knee is very painful
You cannot move the joint
You cannot bear weight through the affected leg
The knee is badly swollen
The joint has changed shape
It becomes locked and cannot straighten
It repeatedly gives way
There is painful clicking following an injury
The knee is hot or red and you have a high temperature or feel generally unwell

Attend A&E or call 999 following a serious accident, an obvious dislocation, loss of sensation after an injury or another potentially life-threatening emergency.

Do not wait for a routine physiotherapy appointment when urgent symptoms are present.

Physiotherapy for Knee Pain at Core Physio

Core Physio provides personalised assessment and rehabilitation for knee pain, stiffness, reduced movement, sports-related problems and selected cases of osteoarthritis.

Your programme may include education, movement exercises, progressive strengthening, balance work and preparation for normal activity or sport.

Physiotherapy is available at our London Bridge clinic and East Dulwich clinic.

You can also explore our broader Physiotherapy service and the other Medical Conditions We Treat.

Frequently Asked Questions

Do I need a GP referral?

You can normally arrange private physiotherapy directly without first seeing your GP. Some private health insurers may require authorisation or a referral before agreeing to cover treatment.

Should I stop walking?

Complete rest is not normally necessary for every knee problem. However, the amount of weight bearing may need to be reduced temporarily following an injury or severe flare-up. Seek urgent advice when you cannot walk or bear weight.

Will I need a scan?

Not necessarily. Many knee problems can be assessed clinically. Imaging may be appropriate when a fracture, significant injury or another condition requiring specialist care is suspected.

Can physiotherapy help knee osteoarthritis?

Physiotherapy can provide tailored therapeutic exercise, strength training, activity advice and support with managing symptoms. Exercise is an important part of osteoarthritis care.

Is clicking normal?

Painless clicking or cracking is common and does not automatically indicate damage. Seek advice when clicking is painful or accompanied by swelling, locking, instability or an injury.

Will I receive strengthening exercises?

Most rehabilitation programmes include progressive strengthening. The exercises will be selected according to your symptoms, abilities and the activities you want to resume.

Can I continue using the gym?

This depends on the problem and how the knee responds. Some exercises may continue normally, while others may need to be modified temporarily.

Can I continue running?

Running may need to be reduced or paused when it causes significant pain or swelling. Your physiotherapist can help you rebuild running gradually once the knee is ready.

Does physiotherapy include massage?

Massage or other hands-on techniques may be used when appropriate. However, they are normally combined with exercise and active rehabilitation rather than provided as the only treatment.

How many appointments will I need?

The number varies according to the problem, how long it has been present, your physical goals and how you respond to rehabilitation. The recommended plan will be discussed after your assessment.

What should I wear?

Wear comfortable clothing that allows the knee and surrounding leg to be assessed. Shorts are usually helpful.

When should I seek urgent help?

Seek urgent assessment for severe pain, inability to move or bear weight, major swelling or deformity, acute locking, repeated giving way, or a hot and red knee accompanied by fever or feeling unwell.