Knee Pain: Causes, Treatment and Physiotherapy Exercises
Most knee pain in active adults comes from load related irritation of the kneecap, tendons or joint surfaces rather than structural damage. Progressive strengthening of the quadriceps, glutes and calves, combined with sensible training load, is the core of treatment.
Knees complain when the load applied exceeds the load they are prepared for. That principle explains everything from runner's knee to arthritic joint pain, and it also explains why strengthening is the mainstay of treatment.
Common causes
In younger and active people, pain around or under the kneecap, patellar or quadriceps tendon problems and meniscal irritation are most common. In older adults, osteoarthritis related pain and stiffness dominate. Acute twisting injuries with immediate swelling may involve a ligament or meniscus and should be assessed promptly.
Treatment principles
Physiotherapy focuses on offloading the irritated structure in the short term while building strength and capacity for the long term. That usually means adjusting training volume, adding progressive resistance exercise two to three times a week, and addressing hip and calf strength, which strongly influence knee load.
Knee osteoarthritis
Exercise remains a first line treatment for knee osteoarthritis. Strengthening and regular low impact activity may reduce pain and improve function. Movement does not wear the joint out, and staying active protects both the knee and general health.
Exercise programme
Work within a comfortable range. Mild discomfort is common, sharp or increasing pain is not.
1. Isometric Wall Sit
BeginnerStarting position: Back against a wall, feet a comfortable distance forwards.
- 1Slide down until your knees are bent to a comfortable angle.
- 2Hold the position while breathing normally.
- 3Stand up and rest between holds.
Suitable for: Reducing pain in irritable knees while maintaining strength.
Choose a depth that keeps pain at or below three out of ten.
2. Step Ups
IntermediateStarting position: Standing in front of a low step.
- 1Place one foot fully on the step.
- 2Press through that heel to stand up tall.
- 3Lower slowly under control.
Suitable for: Building functional strength for stairs and walking.
Use a lower step if the knee complains, and hold a rail for balance.
3. Calf Raises
BeginnerStarting position: Standing with hands lightly on a wall for balance.
- 1Rise onto the balls of both feet.
- 2Pause briefly at the top.
- 3Lower slowly over three seconds.
Suitable for: Supporting knee load through the lower leg.
Progress to single leg only when double leg is comfortable.
When to stop and get assessed
- Pain above three out of ten during the exercise.
- Knee swelling that increases after activity.
- Giving way, locking or an inability to fully straighten the knee.
When to see a physiotherapist
Book an assessment for knee pain lasting more than two weeks, recurrent swelling, instability, or knee pain that limits stairs, walking or sport.
Related physiotherapy services
Frequently asked questions
Is it safe to exercise with knee pain?+
Usually yes, with the right exercise selection and load. Mild discomfort that settles quickly is generally acceptable.
Does running damage the knees?+
Evidence does not support the idea that recreational running damages healthy knees. Sudden increases in training load are a bigger risk factor.
Should I use ice or heat for knee pain?+
Ice may help an acutely swollen knee, while heat often suits stiff, arthritic knees. Use whichever gives you relief.
How long does knee rehab take?+
Load related knee pain often improves within six to twelve weeks of consistent strengthening, depending on the diagnosis.
Medical disclaimer: this article is general education and does not replace a personal assessment. If your pain is severe, worsening, or accompanied by numbness, weakness or loss of bladder or bowel control, seek care promptly.
Book with N S Physiotherapy
In clinic in Eco Park, Centurion, or home visits across Centurion and Midrand.
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