Knee Pain: Common Causes, Diagnosis and Non-Surgical Treatment Options

Knee pain is one of the most common musculoskeletal complaints across all age groups — from teenage runners to older adults with arthritis. Many people either push through pain or rest completely, neither of which is typically the right approach.

The Most Common Causes

Younger and Active People

• Patellofemoral pain syndrome (PFPS): Pain behind the kneecap from abnormal tracking. Most common in runners, cyclists and active adolescents.
• IT band syndrome: Lateral (outer) knee pain in runners from IT band irritation at the femoral condyle.
• Patellar tendinopathy: Pain at the inferior pole of the kneecap from tendon overload in jumping and high-load sports.
• Ligament sprains (MCL, ACL): From contact sports or pivoting injuries.
• Meniscal injuries: Twisting injuries causing pain, swelling and locking.

Older Adults

• Osteoarthritis: The most common knee condition in adults over 50 — gradual loss of articular cartilage causing pain, stiffness and reduced function.
• Pes anserine bursitis: Inflammation of the bursa at the inner upper tibia.
• Baker's cyst: A fluid-filled cyst behind the knee, usually associated with underlying joint pathology.

Treatment Principles

For almost all knee conditions, exercise rehabilitation is the cornerstone — specifically strengthening the muscles that support the knee (quadriceps, hamstrings, glutes). For most knee conditions, surgery is not the first-line intervention and in many cases produces no better outcome than well-supervised physiotherapy and exercise. Our approach combines hands-on treatment with progressive, targeted exercise to restore function.

Assessment — What Happens at a Knee Pain Consultation

A thorough knee pain assessment is more than examining the knee itself. Because many knee problems are driven by dysfunction above (hip) or below (foot and ankle) the joint, a complete lower limb assessment is essential. Your clinician will typically assess:

• Single leg squat pattern — looking for knee valgus collapse (the knee caving inward), which indicates hip abductor weakness or foot pronation
• Hip strength — particularly glute medius and external rotators, which are commonly deficient in patellofemoral pain and IT band syndrome
• Ankle dorsiflexion — restricted ankle mobility forces the knee into compensatory patterns that increase joint stress
• Patellar tracking and mobility — assessing the position and movement of the kneecap within the femoral groove
• Ligament and meniscal stress tests — to identify structural involvement in traumatic or acute presentations

Imaging (X-ray, MRI or ultrasound) is not required for the majority of knee pain presentations and should be reserved for cases where structural pathology is suspected based on clinical findings.

Returning to Sport After Knee Injury

Return to sport following significant knee injury — particularly ACL rupture or meniscal injury — should be criteria-based rather than time-based. Research consistently shows that athletes who return to sport based on time alone (the traditional 9-month guideline following ACL reconstruction) have significantly higher re-injury rates than those who return based on achieving strength symmetry, functional movement benchmarks and psychological readiness.

Key criteria typically include: quadriceps and hamstring strength symmetry of at least 90% compared to the uninjured limb, single leg hop test performance within 90% of the uninjured side, and the ability to perform sport-specific movements (cutting, landing, pivoting) without compensation or apprehension.

Knee Pain Management at Elevate Health Clinic

Prevention — Reducing the Risk of Knee Pain Recurrence

Once a knee pain presentation has been successfully managed, maintaining the gains is important. The most common reason knee pain recurs is that patients discontinue the exercises that produced the improvement — assuming the problem is fixed — before the underlying strength and movement pattern changes have become fully embedded. A maintenance programme of two targeted sessions per week — taking 20–30 minutes — is generally sufficient to sustain the improvements made during rehabilitation.

Load management remains relevant long-term, particularly for runners and athletes. Monitoring training volume using the acute:chronic workload ratio — keeping weekly load within approximately 0.8–1.3 times the four-week rolling average — significantly reduces the risk of recurrence in load-sensitive presentations like patellofemoral pain and patellar tendinopathy.

Our sports chiropractic and exercise physiology teams manage knee pain presentations ranging from acute tendinopathy and ligament sprains to chronic patellofemoral pain and post-surgical rehabilitation. Treatment combines manual therapy to address joint mobility and soft tissue restrictions with progressive loading programmes designed to restore full strength, symmetry and load tolerance. For athletes preparing to return to sport, our return-to-sport criteria-based programme ensures you are genuinely ready before resuming full training. No referral required — book an appointment at our Bella Vista clinic.

Our sports chiropractic and exercise physiology teams regularly manage knee pain across all activity levels. For a broader understanding of how injuries recur and how to break that cycle, see our article on why your injury keeps coming back. If you are returning to sport after a knee injury, our guide on exercising with pain covers how clinicians guide safe return to activity.

Frequently Asked Questions

How long does knee pain take to recover?

Recovery depends heavily on the underlying cause. Acute muscle and tendon irritation often improves within 2–4 weeks with appropriate load management. Ligament sprains may take 6–12 weeks. Tendinopathies and chronic knee pain conditions require longer structured rehabilitation — typically 3–6 months — to rebuild adequate load tolerance.

Should I exercise with knee pain?

In most cases, yes — with appropriate modification. Complete rest tends to worsen outcomes by accelerating deconditioning and sensitisation. The key is finding a load and movement range that is tolerable and building from there progressively. A clinician can identify what is appropriate for your specific presentation.

What causes pain behind the kneecap?

Pain behind the kneecap — patellofemoral pain — is most commonly caused by abnormal tracking of the patella within the femoral groove. Contributing factors include quadriceps weakness, hip muscle weakness (particularly glute medius), altered foot mechanics and rapid increases in training load. It responds well to targeted strengthening and load management.

References

1. Crossley KM, et al. (2016). 2016 Patellofemoral pain consensus statement from the 4th International Patellofemoral Pain Research Retreat. British Journal of Sports Medicine, 50(14), 839–843.
2. Ardern CL, et al. (2014). Return to sport following anterior cruciate ligament reconstruction surgery. British Journal of Sports Medicine, 48(17), 1543–1552.
3. Cook JL & Purdam CR. (2009). Is tendon pathology a continuum? A pathology model to explain the clinical presentation of load-induced tendinopathy. British Journal of Sports Medicine, 43(6), 409–416.