Physiotherapy for Knee Pain
Knee pain is one of the most common reasons people come to see us, and one of the most common things they have been told about it is unhelpful: that it is just wear and tear, or just their age, or something to live with. In most cases, none of that is the full picture. Knee pain usually has an identifiable driver — joint changes, irritation around the kneecap, an unhappy tendon, or a strength deficit somewhere in the leg — and physiotherapy works by finding which of those is involved and addressing it directly.
Below are the four patterns we see most often, what tends to help each one, and when knee pain warrants a proper assessment rather than waiting it out.
Osteoarthritis and joint changes
Osteoarthritis in the knee involves changes to the joint surfaces and surrounding tissue, and it becomes more common with age. What surprises many people is that the degree of change visible on an X-ray often correlates poorly with how much pain someone experiences. Two people with similar imaging can have very different symptoms.
This matters because it means the picture is not fixed. Exercise therapy is recommended as a core treatment for knee osteoarthritis across clinical guidelines, and outcomes are generally better when exercise is combined with education about the condition than with either alone. Strengthening the muscles that support the knee — particularly the quadriceps and hip muscles — can reduce the load the joint has to absorb.
Physiotherapy does not reverse arthritis. What it can do is improve strength, movement and day-to-day function, and help you stay active. Our physiotherapy for arthritis page goes into more detail.
Pain around or behind the kneecap
Patellofemoral pain — discomfort around or behind the kneecap — is very common, with reported annual prevalence in the general population of roughly 23%. It typically shows up with stairs, squatting, running, or after sitting with the knee bent for a long stretch.
It is also a condition where the evidence points clearly toward physiotherapy. A Cochrane review found consistent evidence that exercise therapy may produce clinically important reductions in pain and improvements in function. By contrast, a systematic review of medical interventions found no demonstrated efficacy for oral anti-inflammatories or arthroscopic surgery in this population.
One caution worth knowing: more than half of people with patellofemoral pain still report symptoms twelve months later. That is not a reason for pessimism, but it does mean this is usually a condition to address properly rather than wait out.
Tendon irritation
Tendons around the knee — most often the patellar tendon just below the kneecap — can become irritated when load increases faster than the tissue adapts. This is common in people who have recently ramped up running, jumping, or a new activity.
Tendon problems respond to loading, but the loading has to be graded correctly. Too little and the tendon does not adapt; too much and it stays irritated. This is one of the areas where guided progression genuinely helps, and where shockwave therapy is sometimes used alongside exercise for persistent cases.
Strength deficits and how the leg is working
The knee sits between the hip and the foot, and it frequently absorbs problems that originate at either end. Weakness in the hip muscles can change how the knee tracks during walking and running. Foot mechanics can do something similar from below, which is occasionally where custom orthotics have a role.
This is why a knee assessment should involve more than the knee. If the driver is upstream or downstream, treating the painful spot alone tends to produce short-lived results.
When to get it looked at
Consider booking an assessment if knee pain has persisted beyond a few weeks, if it is limiting activities you would normally do, if the knee gives way or locks, or if there is significant swelling. If you experienced a clear injury with immediate swelling and difficulty weight-bearing, see a physician promptly — some knee injuries need imaging before rehabilitation begins.
If you are recovering from knee surgery, post-operative physiotherapy follows a different pathway guided by your surgeon’s protocol.
What an assessment involves
A physiotherapist will look at how your knee moves, test the strength and control of the muscles around the hip, knee and ankle, and work out which pattern fits your symptoms. You will get an explanation of what is likely driving the pain and a program built around that, rather than a generic set of knee exercises.
To arrange an assessment at our Newmarket clinic, call (905) 235-5360 or contact us here. You can also read more about our physiotherapy services. We see patients from across Newmarket and York Region.
