Knee pain is caused by an injury to any of the knee tissues like ligaments, muscle, tendon, meniscus, cartilage & bone. Knee injuries occur suddenly, usually by twisting or turning your knee. Ligaments keep your knee stable and must resist your whole body’s weight. Muscles can tear, Discs in your knee can split apart, bones can fracture and cartilage can erode. Pain & swelling around a knee joint is a problem we see at our practice daily, but it’s understanding the underlying cause that becomes tricky. Our medical professionals tests and diagnose the cause, then gives you the best proven knee pain treatment program that speeds up your recovery.

We’ll discuss all the causes & symptoms of different types of knee pain. From torn ligaments, tendinitis, fractures, dislocation & much more. You need a trained eye to test all the structures in and around your knee to determine the damage.

What causes my knee pain?

To understand where your knee pain is coming from, you’d have to determine how you injured it, or if you can remember when it started. Some are outright obvious like when you slip on the floor or your knee buckles sideways, meanwhile others are subtle and creeps up on you – getting worse day by day. So, it’s easier to establish how your pain started and changed until now. Changes in your knee pain gives us many clues to understand where your pain is coming from.

Your knee consists of various types of tissue, some elastic like tendons, or strong like cables (ligaments), some tissue can generate movement & force like muscles. We rely on your knee ligaments to keep you stable to stand, tendons to coordinate your knee movements while you walk, and muscles to generate power to run. The structures in your knee is quite vulnerable to injury, especially overuse injuries. There are more than 62 structures in your knee that can get injured, some problems are more common than others, but just to be safe – we test them all.

Here’s a breakdown of a few conditions that we frequently see, and how things go wrong to cause your knee pain:

Get to the root of your knee pain

Different structures, cause different types of knee pain, although these are not concrete it’s a good guideline to which structure produces what type of pain

  • Muscle — Dull ache or stiffness, sharp pain with contraction
  • Nerve — Numbness, tingling, weakness, electrical stabbing feeling
  • Tendon — Burning pain with certain specific movements, pain comes & goes
  • Joints — Cramp, constant stiff feeling, worse after rest, better with movement
  • Fat pad — Pinching pain, pressure increases or decreases pain immediately
  • Bursa — Pain only comes on after being active, better with rest
  • Bone — Constant pain, sharp pain with certain movements
  • Arteries — Pins & Needles, dead leg feeling, heavy feeling
  • Cartilage — Sharp pain when at certain point, painful arch of movement
  • Ligament — Pain at the end of range, unstable, clicking
  • Referral from other joints — Difficult to pinpoint pain, vague painful area

Causes of Knee pain

  • Trauma – Ligament sprain, Muscle strains, Fractures
  • Overuse – Tendonitis, arthritis
  • Pinched nerves – Sciatic nerve branches, Femoral and Lateral cutaneous nerve
  • Referral from other joints – Hip and ankle joints

Knee Pain in the …

Outside knee pain

ITB Syndrome (Iliotibial band Syndrome)

Overuse of this ITB tendon causes iliotibial band syndrome. The iliotibial band becomes painful at the outside of the thigh & knee, due to friction. ITB Syndrome develops due to bio-mechanical abnormalities. A discrepancy between the front and back forces causes the iliotibial band to desynchronize the slide forwards and backwards when the knee moves. Bending the knee, especially the first 30 degrees is painful. Knee pain usually eases with rest, only to return when you train again.

Lateral Collateral Ligament Sprain (LCL tear)

A Lateral Collateral ligament injury is tearing of the ligament on the outside of your knee. A ligament sprain is a form of overstretching of the ligament. There are several classifications in which ligament sprains can be divided, depending on the severity (Degree or Grade 1, 2 or 3). Usually traumatic accompanied by swelling on the inside or outside of your knee.

Lateral Meniscus tear

A knee meniscus is a tear of of a disc ‘spacer’ & shock absorber that sits between the Femur and Tibia. These tears are caused by the two bones hooking on a part of the cartilage, then shearing it off its normal position when your knee twists. Locking, catching & clicking of your knee joint, concentrated along the outside of your knee. Knee swelling & pain gets worse over the first few days.

Bicep Femoris tendinitis (Hamstring tendinitis)

This Hamstring tendinitis is a condition where one of the 3 hamstring tendons are inflamed due to constant irritation from repetitive overload on the tendon. This occurs either at the hamstring tendons that attach to the back of your knee. The hamstring tendons must be able to withstand the pulling force when its suddenly loaded. Usually the pain & stiffness feels worse in the mornings, then disappear as your body warms, only to return in the afternoon, or after your jog.

A Bicep femoris tendinitis may progress to become a chronic, long-term problem called tendinopathy. At later stages the tendon disintegrates and your knee pain becomes worse with exercise and improve with rest. There wouldn’t be any swelling around your knee.

Peroneal nerve injury

Peroneal nerve injury is caused by a direct impact to the outside of the knee which damages the peroneal nerve. The peroneal nerve is a branch of the Sciatic nerve that supplies the outside of your lower leg. Nerve pain can range from pins & needles, numbness and weakness to lift up your foot. Knee pain that runs the nerve pathway must be examined by a medical professional like us to determine the extent of the damage.

Knee joint pain on the outside

Superior (proximal) tibiofibular joint sprain

The tibiofibular joint is the connection point, where the top of the shin bones (tibia and fibula) join. Dislocation of this joint is likely to have been caused by an impact or fall onto the knee, particularly when your knee is in a fully bent position. On the outside of your knee, the top of the fibula bone may appear more prominent than normal with swelling on the outer surface of your shin.

Synovitis

Synovitis is inflammation of the synovial membrane what lubricates your knee joint. The synovial membrane contains the synovial fluid which helps lubricate the knee. After a knee injury you’ll feel pain, swelling & stiffness along the outside of your knee.

Fibula Fractures

The Fibula is the bone on the outside of your lower leg, and its common to find Fibula head fractures after a fall onto the outside of your knee. Small cracks in the fibula cause complications if not picked up early on. It’s important to eliminate the possibility of fractures in this early stage. Our physiotherapist will send you for knee X-rays if necessary.

Inside knee pain

Medial Collateral Ligament tear

A medial collateral ligament injury or MCL sprain is an injury to the ligament that run along the inside of your knee, and occurs when the force on the ligament is too great to resist. This tears or overstretches your ligament. Usually as a result of direct impact or twisting of your knee inwards. Swelling sets in fast & pain mainly over the inside of your knee. MCL sprains usually occur with medical meniscus tears.

Inside meniscus injury

A knee meniscus is a tear of of a disc ‘spacer’ & shock absorber that sits between the Femur and Tibia. These tears are caused by the two bones hooking on a part of the cartilage, then shearing it off its normal position when your knee twists. Locking, catching & clicking of your knee joint, concentrated along the outside of your knee. Knee swelling & pain gets worse over the first few days with tenderness along the inside joint line.

Hamstring tendonitis

This Hamstring tendinitis is a condition where the two tendons on the inside of your knee are inflamed due to constant irritation from repetitive overload on the tendon. This occurs at the hamstring tendons that attach to the inside of your knee. There wouldn’t be any swelling around your knee. The hamstring tendons must be able to withstand the pulling force when its suddenly loaded. Usually the pain & stiffness feels worse in the mornings, then disappear as your body warms, only to return later.

At the back of the knee we have the hamstrings, two tendons running around the inside (Semi-membranous & Semi-tendinous) and one on the outside (Bicep femoris tendon).

Pes anserine tendonitis

The pes anserine is the point on the inside of your knee where the tendons of three muscles combine and anchor. Its a condition where the tendons attachment is inflamed due to constant irritation from repetitive overload & traction on the tendon. If the tendon is unable to heal, it’ll become degenerative, which is irrecoverable damage to your tendon. The pes anserine runs along the inside of your knee to just below the Tibia’ head.

Pes anserine bursitis

With repetitive bending & straightening of your knee triggers the bursa to get inflamed and painful on the inside of your knee. This condition occurs when the bursa becomes irritated, compressed or infected.

Synovial plica

A synovial plica is a fold in the synovial membrane which encloses the knee joint. The plica is found along the inside of your kneecap. It is sometimes confused with, or misdiagnosed as patello femoral pain syndrome as the symptoms can be similar. A Sharp pain at the front inside edge of your kneecap that radiate underneath the patella.

Knee pain in the Front

Anterior Cruciate Ligament tear (ACL sprain)

The ACL is a stabilizing ligament in your knee that prevents hyperextension and resists twisting movements of your knee. An overstretch on the ligament can cause tears in this knee ligament. 70% more common in non-contact injuries. The pressure from your body weight at a specific angle of pull pushes the ligament beyond its normal limits, causing an ACL sprain or tear. Swelling & knee pain in the front &inside of your knee when walking, but the knee will feel unstable is a far more concerning warning sign.

Knee Tendinitis

Tendons anchor the muscle and attach the muscle to the bone. Overuse & overload on the tendons that run above and below your kneecap gets irritated, inflamed, swollen, and painful. The tendons must withstand the pulling force when suddenly loaded, but if not, they start tearing the tendon apart. This causes pain on the inside & front of your knee.

In the front of your knee, you have four muscles of the quadriceps that converge to form the Supra-patellar tendon (‘Supra’ meaning above), weaving around the patella to anchor onto the front of your shin. As it passes to the front, we refer to the tendon as the infra-patellar tendon (‘infra’ meaning below). At the back of the knee, we have the hamstrings, two tendons running around the inside (Semi-membranous & Semi-tendinous), and one on the outside (Bicep femoris tendon).

Quadriceps Tendinitis

Tendinitis of the Quadriceps tendon is a condition in which the tendon of the thigh muscles becomes inflamed and irritated. The quadriceps are four large muscles in the front of the thigh just above the kneecap.

Overstretch & traction injury to the Quad tendon at the point where it attaches to the top of the kneecap or patella. The Tendon tendons must be able to withstand the pulling force when it’s suddenly loaded, but if overloaded, the Quadriceps tendon becomes painful. Knee pain when coming up from a crouched position, contracting the quadriceps muscles, or pressing in at the top of the knee.

Runner’s knee

Jumper’s knee or patellar tendonitis is an overuse injury that results in pain at the front of the knee, specifically at the bottom of the kneecap. Overuse from running or jumping causes inflammation or, more likely, degeneration of the patella tendon. This repetitive contraction with excessive force causes micro-tears in the knee tendon. The bottom & front of the kneecap will feel very tender and may seem swollen compared to the other knee. It is likely to ache and feel stiff after exercise.

Knee Meniscus Tear

A knee meniscus is a tear of a disc ‘spacer’ and shock absorber that sits between the Femur and Tibia. There is one on the inside and one on the outside. These tears happen when your knee is twisted and knocked inwards, which causes the disc to be sheared off. Locking, catching, and clicking of your knee joint at a certain point brings on your knee pain. Severe swelling and knee pain get worse over the first few days.

Knee bursitis

Bursitis is inflammation of a fluid-filled sac or cushion (bursa) over the front of your knee. A bursa is a small sac of fluid that lubricates the movement between tendons and bone. This condition occurs when the bursa becomes irritated, compressed, or infected. A lump may be visible, and the kneecap may be warm to the touch. Kneeling will bring on the knee pain.

Fat pad impingement

The infrapatellar fat pad, also sometimes known as Hoffa’s pad, is a soft tissue beneath the kneecap that can get pinched, causing knee pain. A severe impact that traps the pad between the patella and femoral condyle can cause this knee injury. Tenderness at the bottom and under the kneecap can suggest this injury, and sometimes, the kneecap seems to tilt outwards because of swelling.

Osgood Schlatters

It’s a common cause of pain in the front of the knee in children between 10 to 15 years old. Pain at the top of the shin where the infra-patella tendon anchors on the Tibia, below the kneecap. Repetitive contraction with excessive force causes micro-trauma to the attachment, causing it to become swollen & painful. Usually, the pain gets worse the more active they are and improves with rest. Latent pain that lasts for days to weeks.

Sinding-Larsen-Johansson lesion

It mainly affects young athletes and children, causing pain at the front of the knee, at the lowest point of the patella or kneecap. The knee tendons and soft tissue have not adjusted to new bone growth. The bottom of the kneecap may feel tender, and the pain will get worse during and after exercise. The symptoms are similar to those of Jumper’s knee, but the injury is more like Osgood Schlatter’s disease but at different sites.

Patellofemoral pain syndrome

Causes pain in the front & around your kneecap. It happens when your patella slides out of alignment as you move. The back surface of the patella rubs against the femur bone, eroding the cartilage at the back of your patella. Dull ache with mild swelling around your knee cap. Knee pain tends to radiate towards the outside of your knee. Worse, only a few hours after the activity, like walking up & down stairs, the pain delays flaring up.

Chondromalacia patella

Chondromalacia patella is damage to the articular cartilage under the patella, which serves as a smooth gliding surface for the patella to move over the femur. When moving the knee, a grinding or clicking feeling may be felt. Symptoms are similar to patellofemoral pain at the front of the knee. The kneecap rubs on the bone underneath, causing swelling and pain under the kneecap. Pain can worsen when walking downstairs or after sitting for long periods.

Knee Osteoarthritis

It’s a progressive condition where the cartilage between your bones, in this case, the femur and tibia, degenerates over time. It is similar to getting grey hair; it is a completely normal part of aging. Knee pain caused by osteoarthritis is due to wear and tear on the cartilage of your knee joint. It causes a deep ache inside your knee accompanied by stiffness that tends to be worse in the mornings and after a period of sitting.

Pain at the behind your knee

Hamstring muscle tear

A hamstring tendon strain is a tear of one of the hamstring tendons. This is usually the biceps femoris hamstring muscle, at the point of insertion at the back of your knee. A torn hamstring muscle is very common injury in sports. Athletes put a lot of strain on hamstrings during high speed running, jumping and kicking. Cilliers & Swart offers hamstring treatment for injuries developed in an instant (single overload) or over time (repetitive muscle tearing).

You’ll feel sharp pain at the back of your knee with swelling & blue discoloration. It is important to get an accurate diagnosis and rule out a complete rupture.

Gastrocnemius tear (Calf muscle tear)

When a your calf muscle contract at a very high rate and force, this overload of ‘pulling’ on the muscle causes small microscopic tears in the muscle fibers. A combination of overload while your muscle is stretched, puts your calf muscle fibers under even more strain. The Gastrocnemius muscle anchors to the back of your thigh and has two heads (medial – on the inside and lateral – on the outside) and it crosses both your knee & ankle joints. Calf muscles can be injured or even tear due to overstretching or overuse.

Posterior Crutiate ligament tear (PCL strain)

The PCL is a stabilizing ligament inside your knee that prevents hyperextension and resists twisting movements of your knee. An overstretch to the ligament can cause tears in this knee ligament. The pressure from your body weight at a specific angle of pull, pushes the ligament beyond its normal limits causing a PCL sprain or tear. Swelling & knee pain at the back & inside of your knee when walking, but the knee will feel very unstable.

Biceps femoris tendon avulsion

An avulsion strain occurs when a tendon tears pulling a small piece of bone with it. An X-ray is needed to confirm the diagnosis. Sudden sharp pain at the back of your knee, often described as if being shot in the thigh. Severe pain that subsides quickly, may leave you thinking ‘its not that bad’, until you feel the weakness to bend your knee or stand up. Sudden swelling and tenderness at a point on the back of your knee.

Chronic pain behind your knee

Baker’s Cyst

A Baker’s Cyst or Popliteal cyst is a bubble that pushes out the back of your knee. It is often about the size of a golf ball and tends to shrink & grow depending on how much you move. You’ll feel sensation of pressure in the back of your knee,especially when you kneel & sit back to compress the bulge.

Bicep Femoris tendinitis (Hamstring tendinitis)

This Hamstring tendinitis is a condition where one of the 3 hamstring tendons are inflamed due to constant irritation from repetitive overload on the tendon. This occurs either at the hamstring tendons that attach to the back of your knee. Hamstring pain develops over time. Usually the pain & stiffness feels worse in the mornings, then disappear as your body warms, only to return in the afternoon, or after your jog.

Popliteus strain

The Popliteus is a small muscle located at the back of your knee. The muscle, or tendon tears from twisting activities. Symptoms may include sudden or gradual onset of pain behind your knee. Bending your knee whilst your tibia is turned outwards will bring on your pain.

Referred pain form the Sciatic nerve

Due to irritation of the nerves that runs along the back of your leg and provides the skin & muscle its ‘power’. Abnormal compression and irritation on the Sciatic nerves that supply your leg, will give you nerve pain running along behind your knee. The pain may be contained to the back or spread forwards, depending on the branches of the nerve that are pinched.  Nerve pain will have a tingling quality ,and feels like pins & needles, numbness or weakness. A pinched Sciatic nerve is a serious problem.

Referred pain

This is caused by an injury or problem elsewhere such as your lower back or hip joints. The pain you’re experiencing is pain that radiates from other joints nearby.

Quadriceps Muscle tear

A Quadriceps muscle stain is a tear of one of the four thigh muscles. They mainly straighten your knee, but also allow the knee to bend. Repetitive overload on the muscle will cause small tears in the quad muscle. A Quadriceps strain develops where the forces are concentrated over a specific area of the muscle. Sudden swelling & intense pain at the top of your knee.

Pes anserine bursitis

Pes anserine bursitis or tendinopathy, also known as pes anserine tendinopathy is a less common overuse injury causing pain on the inside of the knee. A bursa is a small fluid sac which sits under the tendon. Either the tendon, bursa or both may become inflamed.

Pain on the inside of your knee

Knee Meniscus Tear

A knee meniscus is a tear of a disc ‘spacer’ and shock absorber that sits between the Femur and Tibia. There is one on the inside and one on the outside. These tears happen when your knee is twisted and knocked inwards, which causes the disc to be sheared off. Locking, catching, and clicking of your knee joint at a certain point brings on your knee pain. Severe swelling and knee pain get worse over the first few days.

Patella fracture

A cracked, splintered, or fractured patella after a fall or even repetitive jarring motions can cause a hairline crack in your kneecap. This causes bone oedema to ooze out of the site, leading to obvious swelling and pain in front of your knee.

Knee Osteoarthritis

It’s a progressive condition where the cartilage between your bones, in this case, the femur and tibia, degenerates over time. It is similar to getting grey hair; it is a completely normal part of aging. Knee pain caused by osteoarthritis is due to wear and tear on the cartilage of your knee joint. It causes a deep ache inside your knee accompanied by stiffness that tends to be worse in the mornings and after a period of sitting.

Osteophytes in the knee

It occurs when a bony growth on the edges of your knee restricts normal knee range of motion. A bony spur pinches and catches onto tissue, causing knee joint pain. The tissue is pinched between the Femur and Tibia, leading to inflammation and swelling.

Femur Chondyle cartilage lesion

A cartilage lesion is an injury to the smooth white covering of the bones in your knee. It is also called an osteochondral defect (OCD) or osteochondral lesion of the Femur. “Osteo” means bone, and “chondral” refers to cartilage. A direct injury to your knee usually causes femoral cartilage lesions. If this cartilage does not heal properly following the injury, it softens and begins to break off. Sometimes, a broken piece of the damaged cartilage and bone will float around your knee.

Sudden onset of knee pain involves injury to various structures of your knee like ligaments, tendons, cartilage, discs and bone. They are usually caused by collisions or twisting your knee.  You need a trained eye to test all the structures in and around your knee to determine the damage. These type of knee injuries rarely only affect one structure, so each one must be inspected & stressed to establish all the injured sites that must be treated.

Symptoms of knee pain

Mild

  • Pain comes & goes
  • Deep, dull ache in your knee
  • Able to pinpoint your pain
  • Still able to walk without pain
  • Moving your knee into certain positions produces expected knee pain
  • Knee Stiffness
  • Redness and warmth to the touch.
  • Slightly swollen
  • Mild tenderness then pressing over the area
  • No bruising
  • Pain at the end of range

Moderate

  • Twisting movements increase your pain
  • Sharp stabbing knee pain
  • Knee Swelling (Within 24 hours)
  • Popping or crunching noises
  • Blue or bruise
  • Pain through the whole range of movement
  • Limited range of movement. You can’t move as far as you could before.
  • Weakness around your knee
  • Unstable
  • Pain worse when taking weight on the affected leg
  • Fearful to balance on one leg
  • Climbing stairs with difficulty
  • Loss of strength
  • Pins & needles, or loss of sensation, in over your knee

Serious

  • Severe, constant pain not improved by any change in position, heat, or meds
  • Pins and needles or a sensation of tingling & numbness in your knee & thigh
  • Audible Pop or crack
  • Severe and immediate swelling
  • Bruising (Blue)
  • Either no pain, or severe pain that subsides quickly
  • Sharp pains when trying to move
  • Knee feels ‘locked’ – stuck in a certain position
  • Cannot put weight on your knee – too sore
  • Cannot stand on one leg
  • Unable to climb stairs

How bad is my knee pain?

Size – The larger the area of your knee pain, is better, because muscles in your thigh stretch from your hip to below your knee. Pain tends to radiate along the thigh muscles and affect large areas. Muscles heal easier & recover faster.

Colour – Bruising in & around the outside, back and inside of your knee is quite common after a thigh tear, because of the high concentration of blood vessels in your thigh. These capillaries rupture & leak plasma that pools in your knee. Blue discoloration closer to the front of your knee is more concerning for it involves your knee ligaments.

Swelling – Swelling is your body’s way of healing itself by sending cells to heal the tissue. More swelling could mean more tissue damage, however not all knee injuries swell. Injury to tissue that develops over a few weeks doesn’t swell, because the tissue trauma is continuous and repetitive, so your body stops the inflammatory reaction. A new injury on an old problem is also possible.

Area – Knee pain at the front of your knee are more restrictive during walking, while pain at the back of your knee limits you from climbing down stairs. If your Knee pain causes you to limb you must be more concerned. Sharp pain over a small area makes it easier to pinpoint structures near your pain. Vague, dull & deep knee pain can take longer to identify the root cause. Compensatory patterns develop, sometimes it takes a while to just get rid of those.

Motion & sore knees

Stiff – Knee Stiffness followed by pain is regressing and getting worse. Seek help. Pain followed by stiffness is a good sign of tissue healing, specifically scar tissue formation. Scar tissue is hardening wound tissue that tends to shorten and pull on structures surrounding the injured site. This is more pronounced in muscle strains & tears, where the normal slide of muscles is restricted during a contraction.

Range of movement – Difficult moving your knee through its range is a big problem. A painful arch means the structure injured only takes tension over that specific range i.e Only painful when you move your knee the last 10 degrees. Knee pain over a smaller range of movement is not necessarily better. This may point to connecting joint surfaces being injured. If you feel pain only at the end of your range its less severe and easy to fix. When your knee pain stops movement completely and too painful to move you should definitely come see us as soon as possible.

Monitor over time:

Intensity – When you grade your pain from 0 – 10. You may think it’s not that bad because it’s not that painful. On the contrary, pain intensity is not a sign of how severe your tissue injury is for example, complete ruptures of ligaments are less painful than partial tears. When fibers are stressed while it’s anchors are completely loose, there’s not much pain, but fibers that are partially torn will produce severe knee pain. People have different pain thresholds, so be careful to ignore your knee injury.

Frequency – Pain that’s fleeting or intermittent, short burst of pain must not become more frequent and constant. This shows that the tissue damage is not getting any better. Pain that only lasts for a few seconds tend to heal faster, so the longer your pain lasts the faster you should get to us.

Latency – If your pain lags to come on and builds up over the day you must be very cautious. This is a sign of a relapse of your tissue pathology. It’s difficult to judge what makes it worse, because the pain only comes on a few hours after your activity, and not during.

Loading – Pushing through your knee pain while you are walking, climbing stairs and jogging is not a good idea. Putting compromised tissue under strain is dangerous. Would you tow a car with a partially torn cable? No! Because it just needs that final pull or jerk that could cause catastrophic tissue damage. Loading soft tissue without knowing what it’s able to handle is dangerous & reckless.

Diagnosis of Knee pain

Our physiotherapists know and understand the intricacy of the anatomy of your knee. There are many structures to test, and we even consider the complex biomechanics of your hip & ankle movements. We’ll accurately diagnose which structures are involved, and to what degree.

During your physiotherapy evaluation, we’ll be stretching & stressing the soft tissue structures like muscles, ligaments, nerves and tendons. This way we can diagnose muscle tears, ligament sprains, tendinitis’s and nerve irritations. We’ll test different aspects like muscle strength, range of motion, flexibility and stability in order to confirm how severe your tissue damage is, which will dictate your treatment plan.

Gathering information through our evaluation allows us to make a diagnosis based on your individual injury. Then we’ll customize the treatment to your specific needs. Therefore our physiotherapists are the best at diagnosing knee pain & knee injuries.

The Process of Diagnosis:

There is a misconception that medical practitioners are able to know exactly that’s the problem the moment we see our patients. People tend to point to their knee and say, “treat it”. As if we already know what’s the problem by just looking at it. Sorry to disappoint, but unfortunately this is not how it works. Let me explain:

Diagnosis is a process of exclusion, not inclusion. Medical professionals are taught a process of elimination and deduction to identify the most possible diagnosises for your knee pain. The better you can describe & elaborate on your pain, the better picture you’ll give your Physio to understand what’s happened as well as, what you’re feeling. We perform tests on numerous structures to get even more clarity.

The practitioner uses their skills to eliminate diagnosis’s it’s not and zoom in on your problem. This elimination brings us to only a few possibilities to what could be causing your knee pain. Then we test & assess all our possibilities to get to the root cause. In many cases your main problem is not at the site of your pain due to compensation, guarding or it’s just the last straw that breaks (in a chain of movements). We encourage you to be honest and open about what you’re feeling – to clarify, carry on or change your Physio’s approach.

Physiotherapist treatment

We have seen many patients with knee pain and provide the best possible treatment for a faster recovery. Pain and stiffness after a knee injury prevent you to move and you might feel hesitant to move, or scared you’ll damage it even more. We know that you’re anxious about the unknown, so that is why we are here to guide you and give you all the answers.

Your knee pain treatment will be tailored according to various factors, but just to give you a broad idea, our focus of our treatments are. Firstly to establish which structures are injured in your knee, and how bad is it. This puts the scope of the problem into full perspective. Usually there’s a knock on effect, where more than a few structures are involved, but we must determine what’s the order of priority.

Secondly, we must protect your knee from further injury and stop it form getting worse. Thirdly, we set the ideal conditions for tissue to recover. Now we can even accelerate and speed up your recovery and get tissue to heal. The last aspect of our process is monitoring your progress as you progress, making sure you achieve the goals and milestones. Our program must change as you adapt and get better.

We explain the extent of damage & the intricate details of your knee pain & how it may cause other problems.

Well Health Pro

Our team of experts can diagnose, test and treat any kind of knee pain. We work together to get rid of your pain as fast as possible. We have the best tools, techniques and machines to make sure you get the best value for your money. Our Physios will test a lot of different possibilities why you’re feeling this knee pain in order to explain what’s going on in your body. It all depends on the results of our tests to determine what needs to be done. All our physios are specialists that can determine the slightest problem coming from your knee, thigh or lower leg, so if you’re uncertain – we can help you.

Our experts determine the priority which problems to fix first. This means that we test movements to see if you may have a muscle imbalance, weakness, instability and much, much more. This is our expertise & what we’re best at. We’ll guide you every step of the way.

Knee pain Treatments we use

What NOT to do

  • Take pain meds for longer that 7 days

  • Ignore swelling – clearly something is wrong

  • Stretch through the pain

  • Apply heat

  • Force through the pain

  • Do not ignore knee pain that gets worse (it could be a sign of a Deeper problem)

  • Treat it without a proper diagnosis, you may end up causing more harm

  • Leave it untreated

  • Walk, run, jog through the pain

What you should do

  • Follow a POLICE or PRICE protocol. (Protect, Rest, Ice, Compress)

  • Maintain the pain free range of movement

  • Make an appointment to confirm the diagnosis and determine the severity of your problem.

  • If you’re unsure what it might be – rather get an expert’s opinion

Making the knee pain worse

  • Kicking

  • Driving

  • Sitting on a chair with your knees in awkward positions

  • Jumps

  • Jogging & Running

  • Climbing stairs

  • Walking through the pain

  • Walking on gravel, grass, uneven terrain

  • Kneeling

Muscle pain

The four largest muscles in your upper thigh attaches to the top of your kneecap, namely the quadriceps muscles. These are powerful muscles that straighten your knee. The Vastus medialis muscle anchors onto the inside of your knee, while the Vastus Lateralis runs along the outside. These muscles tear from overload. Just like after ‘leg day’ at the gym. Burning, aching thighs and unable to bend your knee, stand up or even climb stairs. Your thigh muscles radiates pain over your knee that’s worse with movement, better with rest.

The hamstrings run along the back of your knee and anchor in the front, which bends your knee. 2 Tendons (Semimebrnous & Semitendinous) run along the inside of your knee and one, inside called Bicep Femoris. These muscles & tendons are vulnerable to repetitive overuse injury & hyper-extension of your knee. A hamstring tear always affects the knee’s movement.

Ligament tears

Your knee joint relies on ligaments for stability, to prevent it from buckling sideways. Knee ligaments are injured when forceful movements load them beyond their normal range while being stretched at the same time, like when you twist your knee. Ligaments are able to withstand great traction although everything has it’s breaking point.

There are 4 main ligaments.

2 Inside your knee joint – ACL (Anterior Cruciate Ligament tear) and the PCL (Posterior Cruciate Ligament) which restricts your Tibia and Femur from sliding off each other forwards & back wards. It’s quite understandable that an injury to these ligament can cause havoc and severe pain in your knee.

2 on the sides, The MCL (Medial Collateral Ligament) on the inside, and the LCL (Lateral Collateral Ligament) on the outside of your knee. Its is a loaded topic, so please see our article about knee ligament injuries for more info.

Ligament sprains occur most often in sports where there is quick change in direction or jumping, like soccer, rugby, netball and dance. This doesn’t mean that only active people have the risk of injury, miss judging a step, tripping over a rock or a fall onto your knees may all cause a knee ligament sprain.

Knee pain, Sore knees outside view

Tendon pain

The tendons above or below the kneecap can become inflamed, as well as the tendons on the sides of the knee joint. Tendons are the extension of the muscle and attaches the muscle to the bone. These tendons are mainly responsible to transfer the contraction of the muscle to the bone. With repetitive overuse or trauma, this anchor site may become inflamed, causing tendonitis of the tendon attachment.

You’ll feel pain & stiffness when your knee has rested and then starts to move, but disappears while you exercise and returns when you cool down again. The most common tendinitis in the knee is a Infrapatellar tendinitis.

In the front of your knee you have four muscles of the quadriceps that converge to form the Supra-patellar tendon (‘Supra’ meaning above), weaving around the patella to anchor onto the front of your shin, as it passes to the front we refer to the tendon as the infra-patellar tendon (‘infra’ meaning below). At the back of the knee we have the hamstrings, two tendons running around the inside (Semi-membranous & Semi-tendinous) and one on the outside (Bicep femoris tendon).

  1. Tendinitis is inflammation or irritation of the tendon, that is in the early phases.
  2. Tendinosis is when the healing of the tendon stops, but the damage is continued.
  3. Tendinopathy is the state of the tendon when its deteriorating and degenerating.

Meniscus

The meniscus is a collagen compound structure made up of rubbery cartilage. It is a C-shaped disc between the Tibia (shin bone) and Femur (thigh bone). The meniscus acts like a cushion to protect the bone, absorb shock and stabilize the joint. A knee meniscus tear is a common knee injury that occurs when you forcefully twist or rotate your knee.

There’s classifications for these tears, but what you must understand is that this cushioning discs are vital to keep the bones tracking on each other.  When a meniscus tears is causes locking , catching grinding in your knee, not to mention the lack of proper tracking in your knee joint. This leads to a cascade of swelling, pain and dysfunction of your knee joint. Each knee has 2 of these discs, the outer called the lateral meniscus, and the one on the inside of your knee is called the medial meniscus.

Knee joint pain

The knee joint is a synovial, hinge joint that connects the femur (thigh bone) to the tibia (shin bone).  There are two joints that work together to bend and straighten your knee. Firstly, the tibiofemoral joint, between the femur and tibia and the patellofemoral joint, between the patella (kneecap) and the femur.

The knee joint is an intricate design and interplay between three different joints, the tibio-femoral and tibio-fibular and the patella-femoral joint. All three these joints need to work in harmony to create free knee flexion and extension. Joint pain may cause grinding sounds and restricted movement.

Arthritis is a progressive condition where the cartilage between your bones degenerate over time. Lubrication from synovial fluid becomes less, the ends of the connecting bones are eroded & less smooth causing jerky movement. Knee osteoarthritis are one of these conditions that develops in stages.

Nerve pain

Like all other joints the knee is reliant on nerves for motor (allows movement) and sensory (sensation and proprioception) function. The nerves that supply the knee are branches of the sciatic nerve and femoral nerve. Injury to these nerves, due to trauma or compression, can cause numbness, pins and needles or weakness in you knee. These symptoms may also be present in lumbar radiculopathy , sciatica or piriformis syndrome. When in doubt rather have your symptoms assessed to determine the the extent of your nerve damage.

Although pinching of the Lateral femoral cutaneous nerve is a common site that causes fallout in the nerve supplying your upper thigh. This leads to abnormal knee cap tracking, which in turn causes knee pain.

Sore knee pain vie the inside of the knee

Sore Knees & Sudden knee pain?

Knee pain is extremely uncomfortable and disrupts the smallest task you must get on with. So, stop the madness. Get your knee looked at and get all the answers you need. Most knee pain don’t start after a fall or injury, but usually develops over time. Yes, it’s more obvious in sports injuries, but you’re required to carry on with work even though you have agonizing knee pain. We know what you’re going through.

If you’re suffering, rather get it checked. Please come visit our your physiotherapists if you are feeling any type of knee pain. Rather do something about it than wait with your fingers crossed and hope it goes away. If you’re expecting tomorrow will be any different than today. Stop waiting and act.

An accurate diagnosis is vital to manage your pain and treat it appropriately, because what works for one problem rarely works for another. Some conditions can take many months or even years to heal when the diagnosis is incorrect, or treatment is neglected. You could end up spending a lot more time & money to fix your problem later on. So be warned…

How to Stop chronic, daily annoying knee pain

Without injections, Without taking painkillers and

WITHOUT having to wear a Support or Brace…

If you’re living with knee pain what just won’t go away, they’re painful or they ache – it’s very easy to think that it’s “just something that comes with age”, it’s a bit of “wear and tear”, or that it’s nothing and it’ll go away on its own.

You can’t quite point your finger on why you’re feeling the pain in your knee – but it doesn’t seem to be getting any better!

If that’s happening to you, you’re not alone – we hear this type of thing all the time. In fact, knee pain is one of the most common problems that we see in our Physio practice. When it comes to living with knee pain, everybody we see wants to know the answers to these questions:

Why am I still suffering with knee pain that keeps getting worse

Most people think that when they get knee pain, it’ll eventually “ease off” and go away on it’s own. That they’ll wake up one morning and like “magic”, your knee pain will be a thing of the past… But 3 months later you’re still living with the annoying knee pain, often even worse than it was at the start. Does that sound like you?

Another scenario we see all the time in our physiotherapy practice is when people go to their Doctors, and the well-meaning Doctor tells them to “rest”, “try these painkillers” and “come back in 6 weeks if it’s no better” – but then 6 weeks later, they end up going back to the same Doctor again because it hasn’t got any better, only to be given ANOTHER prescription of even stronger pills, and maybe a knee guard/ support.

Has this ever happened to you?

Maybe you’re confused because you’ve been told different things, by different people. Maybe you think you have to rest because you’ve been told walking makes knee pain worse, or that you should be doing ‘this exercise’ and ‘that exercise’ to make it better. It’s very confusing to know exactly what to do – and that’s just to avoid making your knee pain worse, not to mention getting back to jogging and all the other things you love to do.

And because of this confusion – this often leads people to procrastinate, and put off making a decision about what to do to help fix their knee pain. Worse, many people just end up accepting it as “part of life” – as if it’s normal, as if it “has” to be that way. Is this how you feel?

We are here to tell you – this is NOT what you deserve. You are made for great things, your knee pain is just a bump in the road. Make a decision to help yourself be better.

Why is your knee pain lasting longer than it should?

You thought your pain would go away on its own, but it didn’t

Your doctor told you to rest and take painkillers. The painkillers relieved the pain, but didn’t heal your injury. As soon as the painkillers wore off, your knee pain returned.

A friend told you that “everybody experiences knee pain as they grow older, you should just accept it”.

Other healthcare professional’s advice and treatment didn’t help.

YouTube exercises and home remedies didn’t help relieve the pain, or in some cases made your knee pain ten times worse

You thought enough rest would eventually heal the problem. However, afterwards your knee feels even more stiff and tight than before

Does this sound like you?

If any of these have happened to you – we would love to help you. The fact that you’ve tried any or all of these things already is actually a good thing, because when you know what doesn’t work – you are closer to finding the thing that does!

We invite you to come and see us. Why? Because we do things differently. We’ll do a thorough assessment and test all the possible causes. After we’ve diagnosed your problem, and explained what it’s going to need to heal, we’ll make sure you understand why this is happening.

If you’re looking for solid advice on how to start solving your problem, click the link below to book a FREE phone call. The phone call is complimentary and there is no obligation to book any appointments with us after the call is over. This is an opportunity to get an expert’s advice about your situation. Our goal is to help you make the right decision about what to do next.

What you can do to get rid of your knee pain quickly?

Decide to get help

So many people rest for weeks, hoping that the pain will ‘just go away with time’, but 6 weeks down the line they’re still putting up with it, and nothing’s changed… Or the pain & swelling gets even worse. You may even cause other problems. Lack of treatment could end up costing you more time (for recovery) & money the longer you wait.

Do the right exercises

One of the best things to help ease your knee pain is to do the right series of progressed exercises- as advised by your Physiotherapist. The right kind of activities can reduce your pain, and help your healing. Above all, exercises ensure that problems don’t come back. However, the wrong kind of exercises have the potential to increase the pain in your knee even more.

Get hands-on Physio treatment

Physiotherapy is proven to improve the lives of people suffering from knee pain. Knee pain could be affecting your physical performance in a professional or private capacity, you may not even notice. It could even threaten your independence or get in the way of spending quality time with your family & friends. Physiotherapy can enable you to live the life you desire as quickly as possible.

Ask our knee experts

If you would like to know how the Physiotherapy team at Cilliers & Swart can help you, we invite you to book a FREE, no-obligation, risk-free “Call me back” phone call.

Note: This Free Call is a service we offer to people who are nervous or unsure. You might not know if Physiotherapy is the right treatment for you. If you are unsure, please fill out our online form. We will contact you to find out what is wrong and how we can help. There is no financial obligation or risk on your part. You have nothing to lose except your pain.

Choose to see a Well Health Pro Physiotherapist to help you Get rid of your knee pain – in the next few days?

  • We quickly put an end to the cycle of pain and stiffness.

  • We’ll find and treat the origin of your knee pain.

  • Pain can rob you of sleep & rest. We can help you to enjoy sleeping at night and living with more energy each day

  • We will provide you with the perfect set of exercises that will speed up your recovery

  • Using painkillers in the long-term can be harmful to your health. We help you lower or completely stop your need for painkillers to manage pain

  • Our physiotherapists help you avoid dangerous & costly surgeries, and painful injections

  • We reduce visits to specialists or doctors

  • Knee pain can limit the activities you enjoy with your family & friends. We can help you get back to enjoying quality time with family & friends that knee pain has taken from you.

  • We can help you to finally return to walking up & down the stairs, and getting out and about without that annoying knee pain stopping you

In short, our Team at can help you get back to living life free from knee pain. For information about costs and availability, click the button below:

What your patients say:

This was my first time visiting a physiotherapist. I received very professional service from everyone involved and can definitely recommend this practice to anyone struggling with Knee pain.

W Cornelius

After battling with knee pain for months I finally decided to seek out medical assistance and I wish I had done so sooner. They offer a professional service, are centrally located. They are very warm and welcoming. Nina was quickly able to diagnose the cause after just a few tests as well as other imbalances that I wasn’t aware of. I am very happy with her treatment plan for my knee and highly recommend them.

K Nieman

I’m a dancer with a knee ligament tear & meniscus tear with a great deal of pain, I started with Renier the day I got out of hospital. My surgeon told me, I would probably have to change carreers and that regardless, it would take me a minimum of 24 months rehabilitation before even thinking about trying a dance class again. Thankfully my Physios knew better. After 10 months of regular knee treatments and following the advice and rigorous rehabilitation procedure. I started dancing again – and haven’t stopped. Came back stronger and haven’t looked back since. I’ve been on a long journey. They are amazing!

T Vogel

I’ve been receiving excellent knee pain treatment from Nina. She is a skilled, knowledgeable and gifted therapist. Her treatment produces amazing results! Thank you, Nina!! You’re the best of the best!! I would highly recommend Nina.

M Laas

“The best in the business”

These Physios are very professional and knowledgeable. Struggled with knee pain for weeks, after 1 week of doing the physio exercises I could feel a big difference. Now I know cause of my problems and received the best advice and exercises to fix it.

L McLaren

Was in agony, never mind pain. He was professional and really helped to alleviate my knee pain. I enjoyed being “educated” every step of the way regarding the treatment and the progress. Definitely recommended the practice to family and friends. They are the best.

M v Rensburg