Knee Pain: Complete Guide

**Content Type**: CORE (Power Hub) **Stage**: PUBLICATION READY --- Knee pain affects 1 in 4 people. It makes simple movements a challenge: climbing stairs, getting up from a chair, or even walking. At Physioactif, we treat people suffering from [knee pain](https://www.physioactif.com/diagnostic-et-traitement/douleurs/au-genou) every day. [Patellofemoral syndrome](https://www.physioactif.com/guide-complet/syndrome-femoro-patellaire) is the most common knee condition in physical therapy. The good news is that most knee pain improves with the right treatment. Physical therapy and exercise are as effective as medication in relieving pain. --- ## What is knee pain (gonalgia)? Knee pain, known as gonalgia, refers to any pain in or around the knee joint. It can be mechanical (triggered when you exert yourself) or inflammatory (present at rest). It can also be acute (sudden) or chronic (lasting more than 3 months). Gonalgia affects everyone: athletes, sedentary people, young and old alike. Knee osteoarthritis (https://www.physioactif.com/guide-complet/arthrose-du-genou-gonarthrose) is the most common cause in adults over 40-50 years of age. ### Types of knee pain

Type of pain	Features	Examples
Mechanics	Appears when you exert yourself, diminishes at rest	Osteoarthritis, patellofemoral syndrome
Inflammatory	Present at rest, wakes up at night, stiff for a long time in the morning	Rheumatoid arthritis, gout
Acute	Sudden onset, often after trauma	Sprain, meniscus tear
Chronicle	Persists for more than 3 months	Knee osteoarthritis, chronic tendinitis

### Who is affected? Knee pain is extremely common in the general population: - **25% of adults** suffer from frequent knee pain - **46% of people over 50** report pain - **29% of Canadians with osteoarthritis** have knee pain - **Women are twice as likely to be affected** as men - **The risk increases significantly after age 45** --- ## How does your knee work? Your knee is the largest and most complex joint in your body. It connects the femur (thigh bone) to the tibia (shin bone) and contains two menisci that act as shock absorbers. ### Knee structures

Structure	Description	Function
Bone	Femur, tibia, patella	Form the joint, support the weight
Menisci	Crescent-shaped cushions (medial and lateral)	Absorb shocks, distribute load
Ligaments	ACL, PCL, collateral ligaments	Ensure stability
Cartilage	Smooth surface on bone ends	Frictionless sliding

Les **quatre ligaments principaux** du genou jouent un rôle crucial: - Le **ligament croisé antérieur (LCA)** empêche le tibia d'avancer - Le **ligament croisé postérieur (LCP)** empêche le tibia de reculer - Les **ligaments collatéraux** stabilisent les côtés du genou Les blessures du LCA sont fréquentes chez les sportifs. Pour en savoir plus, consultez notre [guide sur l'entorse du genou et la déchirure du LCA](https://www.physioactif.com/guide-complet/entorse-au-genou-et-dechirure-du-ligament-croise-anterieur-lca). --- Ceux qui ont le plus changé la vie de nos patients. 1 par jour, 2 min. ## Quelles sont les causes de la douleur au genou? La douleur au genou peut provenir de plusieurs sources: usure du cartilage (arthrose), blessure aux ligaments (entorse), problème de ménisque, ou tensions musculaires. L'âge, le surpoids et les traumatismes représentent les principaux facteurs de risque. ### Causes mécaniques et dégénératives **L'arthrose du genou (gonarthrose)** provoque l'usure progressive du cartilage. Dans les cas avancés, les os frottent directement ensemble. Cette condition touche: - **65% des personnes de plus de 65 ans** - **80% des personnes de plus de 80 ans** Pour comprendre comment gérer l'arthrose du genou, consultez notre [guide complet sur l'arthrose du genou](https://www.physioactif.com/guide-complet/arthrose-du-genou-gonarthrose). ### Causes traumatiques **L'entorse du genou** résulte d'une lésion ligamentaire. Un mouvement de torsion brutale ou un changement de direction rapide la provoque souvent. Le LCA est le ligament le plus touché chez les sportifs. **La lésion méniscale** survient lors d'un mouvement de torsion. Chez les jeunes: traumatisme aigu. Chez les plus âgés: usure progressive. ### Causes inflammatoires L'arthrite rhumatoïde, la goutte et la pseudogoutte causent des douleurs au genou. Ces conditions se distinguent par une douleur présente au repos et une raideur matinale de plus de 30 minutes. Pour comprendre les différents types de [douleurs articulaires](https://www.physioactif.com/guide-complet/douleur-articulaire-guide-complet), consultez notre guide dédié. ### Causes musculaires et périarticulaires

Condition	Affected population	Location
Patellofemoral syndrome	Runners, athletes, teenagers	Front of the knee, around the kneecap
Patellar tendinitis	Jumpers, basketball players, volleyball players	Under the kneecap
Bursitis	Kneeling workers, gardeners	In front of the knee

--- ## Comment distinguer les différents types de douleur et reconnaître les signes d'alarme? La localisation et le type de douleur indiquent l'origine du problème. Douleur sur le côté: problème de ménisque. Sensation d'instabilité: atteinte des ligaments. Douleur diffuse à l'avant: problème de rotule.¹ ### Meniscal pain Meniscal pain is located in the joint space (junction between the femur and tibia), on the inner or outer side. **Symptoms:** - Cracking sounds during movement - Possible knee locking - Intermittent swelling - Pain when turning the knee ### Ligament pain Ligament damage is characterized by a feeling of instability. The knee seems to "give way" beneath you. See our [guide to ligament pain](https://www.physioactif.com/guide-complet/douleur-ligamentaire-guide-complet) for more details. ### Joint pain (osteoarthritis) Osteoarthritic pain follows a mechanical pattern. It peaks in the evening after a day of activity. Morning stiffness lasts less than 15 minutes. It does not usually wake you up at night. ### Muscle pain Muscle pain is located around the joint. It is accompanied by buckling (the knee seems to "give way") and palpable tension.

Type of pain	Location	Distinguishing features
Meniscal	Line spacing (side)	Blockages, cracking, pain when twisting
Ligamentous	Deep	Instability, evasion
Osteoarthritis	Diffuse	Brief morning stiffness, worse in the evening
Muscular	Periarticular	Palpable tensions, weakness

### Common symptoms Common symptoms include: - Localized or diffuse pain - Morning stiffness (less than 15 minutes for osteoarthritis) - Swelling (joint effusion) - Cracking or crepitus - Feeling of instability - Limited movement ### Warning signs requiring immediate consultation Consult a doctor the same day if you experience: - Very intense pain - Fever (possible sign of infection) - Swollen, red, and warm knee - Swollen knee while on anticoagulants ### When to call emergency services

Location	Action
Severe trauma	Call 911
Inability to walk	Call 911
Deformed knee	Call 911
Knee completely locked	Call 911

--- Need professional advice? Our physical therapists can assess your condition and offer you a personalized treatment plan. [Make an appointment](https://physioactif.clinicmaster.com/clinic-selection?lang=fr-CA) ## When should you see a professional? See a professional if the pain persists for more than 3 days, gradually worsens, or if your knee is red, hot, and swollen. In Quebec, you do not need a medical referral to see a [physical therapist](https://www.physioactif.com/services/physiotherapie). ### Consultation in the coming days Make an appointment if: - The pain persists after 3 days (rest, ice, painkillers) - The pain worsens - You can no longer bend or extend your knee - Swelling appears after trauma ### Direct access to a physical therapist In Quebec, you can consult a physical therapist directly, without a medical referral. The physical therapist will assess your condition, make a diagnosis, and begin treatment. If necessary, they will refer you to a doctor. **People who seek treatment quickly are 8 times less likely to develop chronic pain.** --- ## How does a physical therapist assess your knee? The physical therapist examines your knee by observing your gait, palpating the structures, and performing specific tests. This assessment identifies the source of your pain and establishes a personalized plan. To learn more, see our article on [how a physical therapy evaluation works](https://www.physioactif.com/ressources/comment-se-deroule-une-evaluation-en-physiotherapie-chez-physioactif). ### Clinical examination The assessment begins with observation: - Standing position: any deviations - Walking: analysis of gait and limping - Knee: checking for swelling Palpation identifies painful structures: bones, ligaments, menisci, muscles. ### Specific tests

Test	Detects
Lachman test	ACL tear
McMurray test	Meniscal injury
Stability tests	Collateral ligament integrity
Testing the planer	Patellofemoral syndrome

### When is imaging necessary? Imaging is not always required. A clinical examination is often sufficient for diagnosis and treatment. **X-rays** confirm osteoarthritis. **MRI** is useful for meniscal lesions or in cases where conservative treatment has failed. --- ## How does physical therapy treat knee pain, and is it effective? Physical therapy combines manual therapy, therapeutic exercises, and education. This approach is as effective as medication for knee osteoarthritis.² ### Manual therapy - Joint mobilization to improve range of motion - Soft tissue techniques to release tension - Mulligan-type mobilization, effective for osteoarthritis A significant reduction in pain occurs after 3 weeks of manual therapy.³ Therapeutic exercises

Type	Objective	Examples
Reinforcement	Stabilize the joint	Quadriceps, glutes, hamstrings
Stretching	Maintain flexibility	Hamstrings, quadriceps, calves
Aerobics	Improve endurance	Walking, cycling, pool exercises

The benefits of exercise last up to a year. Without a maintenance program, they diminish after about 18 months. ### Education and advice - Daily pain management - Modification of problematic activities - Importance of staying active - Realistic expectations ### Complementary approaches - **Taping:** supports the joint and reduces pain - **Orthotics:** stabilize the knee - **Water exercises:** reduce joint load For osteoarthritis, treatment combines exercise, education, and, if necessary, weight loss. Every pound lost reduces the load on your knees. ### Effectiveness proven by research Studies show a 75-85% success rate for treating knee pain with physical therapy.⁴ The combination of therapeutic exercises, manual therapy, and education has proven particularly effective in reducing pain and improving function. The effectiveness of treatment depends on several factors: how early you seek consultation (earlier = better results), how diligently you do your exercises at home, the type of condition (meniscus, osteoarthritis, patellofemoral syndrome), and quadriceps strength. A comprehensive assessment allows the treatment to be tailored to your specific situation. Most patients see improvement within the first 3-4 weeks, with complete resolution in 8-12 weeks.⁵ Are you suffering from knee pain? [**Make an appointment**](https://physioactif.clinicmaster.com/clinic-selection?lang=fr-CA) for a comprehensive assessment and personalized treatment plan. --- ## What exercises help relieve knee pain? Quadriceps strengthening exercises, hamstring stretches, and balance exercises are the most beneficial. A 4- to 6-week program significantly improves pain. ### Strengthening exercises

Exercise	Description	Rehearsals
Raise your leg straight up	Lying down, raise your leg straight up to the height of your bent knee.	10-15 times on each side
Mini squats	Do not go below 90 degrees.	10 repetitions
Wall squats	With your back against the wall, lower your thighs parallel to the floor.	5-10 times, hold for 5-10 seconds

### Balance exercises

Exercise	Description	Rehearsals
Shell	Lying on your side, open the upper knee.	15 times on each side
Sideways walking	With resistance band, side steps	10 steps in each direction

### Recommended stretches **Bridge:** Lie down with your knees bent and lift your pelvis. Hold for 3 to 5 seconds. Repeat 10 to 15 times. ### Mistakes to avoid - Do not force yourself if the pain increases - Avoid deep squats beyond 90 degrees - Don't skip the warm-up - Give the program 4 to 6 weeks **Mild pain is acceptable at first. If it persists beyond 6 weeks, consult a physical therapist.** --- ### Can You Treat Knee Pain Yourself? Self-treatment can relieve mild knee pain (ice, rest, light stretching). However, without a precise diagnosis (meniscus vs. osteoarthritis vs. patellofemoral syndrome), exercises can aggravate certain conditions. Without a precise diagnosis, you risk maintaining compensations or doing counterproductive exercises that delay healing. A physical therapist uses clinical tests to identify the affected structure and adapts treatment accordingly. An evaluation helps identify the exact cause, eliminate red flags, and create a progressive treatment plan. Exercises are tailored to your specific condition, not generic. Our approach: professional evaluation + supervised home exercise program = better long-term results. Are you hesitating between self-treatment and consultation? [**Free 15-minute consultation**](https://physioactif.clinicmaster.com/clinic-selection?lang=fr-CA) to discuss your situation. ## How long does recovery take and how can recurrence be prevented? The duration depends on the cause. Minor pain: a few days. Sprain: 2 to 6 weeks. Osteoarthritis: long-term management. Early consultation reduces the risk of chronic pain by 8 times. To understand how to manage [chronic pain](https://www.physioactif.com/ressources/comprendre-la-douleur-chronique), see our guide. ### Healing times

Condition	Deadline
Minor pain	A few days
Mild sprain	2-4 weeks
Moderate sprain	4-6 weeks
Meniscal injury (conservative)	6-12 weeks
Post-meniscus surgery	4-6 weeks
ACL reconstruction	6-12 months
Osteoarthritis	Long-term management

### Factors influencing recovery - Severity of the injury - Age - Physical condition - Adherence to the exercise program - Time of consultation ### How to prevent knee pain Maintain a healthy weight: every extra pound adds 4 kg of pressure on your knees. Stay active, strengthen your muscles, warm up. Movement nourishes cartilage. **Weight management:** - Every extra pound puts 4 kg of additional pressure on your knees. - Losing 5 kg reduces the load by 20 kg with every step. - Weight loss reduces pain and prevents the progression of osteoarthritis. **Exercise and physical activity:** Movement nourishes cartilage via synovial fluid. It prevents stiffness and strengthens muscles. A program 2 to 3 times a week protects your knees. **Warm-up and recovery:** - Warm up for 5 to 10 minutes before activity - Prepare your joints gradually - Allow yourself time to recover **Limit activities that cause pain. If in doubt, consult a physical therapist.** --- ## What are some frequently asked questions about knee pain? ### Should I apply heat or cold? Apply cold for acute injury, inflammation, or swelling (48-72 hours). Apply heat for stiffness, muscle tension, or chronic pain. If in doubt, cold is safer. ### Is it normal for my knee to crack? Cracking without pain is harmless. If there is pain, swelling, or locking, consult a professional. Cracking is common with osteoarthritis but does not predict worsening of the condition. ### Can I exercise with knee pain? Yes, adjust the intensity. Mild pain is acceptable. Avoid exercises that significantly increase pain. Movement promotes healing. ### Can knee osteoarthritis improve? Cartilage does not regenerate, but symptoms improve. Exercise and education are as effective as medication. Weight loss also has benefits. Find out why [it's not always osteoarthritis that causes pain](https://www.physioactif.com/ressources/est-ce-reellement-votre-arthrose-qui-vous-fait-mal). ### Do I need an MRI? Not necessarily. A clinical examination is often sufficient. An MRI confirms meniscal lesions or in cases where conservative treatment has failed. For osteoarthritis, an X-ray is sufficient. ### Is physiotherapy reimbursed in Quebec? Private insurance generally covers it. The RAMQ does not cover it, with some exceptions. The CNESST and SAAQ cover it in their respective contexts. ### How many sessions are needed? A typical program includes 6 to 12 sessions. Home exercises are essential. Maintenance follow-up may be recommended for osteoarthritis. --- **References** 1. Crossley KM, Stefanik JJ, Selfe J, et al. [2016 Patellofemoral pain consensus statement from the 4th International Patellofemoral Pain Research Retreat](https://pubmed.ncbi.nlm.nih.gov/27343863/). Br J Sports Med. 2016;50(14):839-843. doi:10.1136/bjsports-2016-096384 2. Fransen M, McConnell S, Harmer AR, et al. [Exercise for osteoarthritis of the knee](https://pubmed.ncbi.nlm.nih.gov/26425881/). Cochrane Database Syst Rev. 2015;1:CD004376. doi:10.1002/14651858.CD004376.pub3 3. Deyle GD, Henderson NE, Matekel RL, et al. Effectiveness of manual physical therapy and exercise in osteoarthritis of the knee. https://pubmed.ncbi.nlm.nih.gov/10720869/. Ann Intern Med. 2000;132(3):173-181. doi:10.7326/0003-4819-132-3-200002010-00002 4. Collins NJ, Barton CJ, van Middelkoop M, et al. [2018 Consensus statement on exercise therapy and physical interventions for patellofemoral pain from the 5th International Patellofemoral Pain Research Retreat](https://pubmed.ncbi.nlm.nih.gov/29925502/). Br J Sports Med. 2018;52(18):1170-1178. doi:10.1136/bjsports-2018-099397 5. Skou ST, Roos EM, Laursen MB, et al. [A randomized, controlled trial of total knee replacement](https://pubmed.ncbi.nlm.nih.gov/26398750/). N Engl J Med. 2015;373(17):1597-1606. doi:10.1056/NEJMoa1505467 --- *This guide was written by the Physioactif team. For a personalized assessment, [make an appointment](https://physioactif.clinicmaster.com/clinic-selection?lang=fr-CA) with one of our physical therapists.*