Physiotherapy Guidance on Managing Knee Pain

What is Physiotherapy and how can it help your knee pain?

Physiotherapists are experts in helping people maintain the ability to move and function throughout their lives. We use our extensive knowledge of how the body moves and what prevents the body from moving well and use this knowledge to help people of all ages to improve their wellness, mobility and independence.  Physiotherapists help people affected by injury, illness or disability through movement and exercise, manual therapy, education and advice.

Physiotherapy is a science-based profession and in its approach, considers the ‘whole person’, which includes the patient’s general lifestyle.  We encourage patient’s involvement in their own care, through empowerment and participation in their treatment.

Why do I have knee pain?

The knee joint is vulnerable to overuse and sudden injury, as it takes the full weight and force of the body, especially on running and jumping activities when it is most commonly injured. The knee joint comprises three joint compartments and is medically termed the ‘tibofemoral joint’ between the femur (thigh bone) and tibia (shin bone) and the ‘patellofemoral joint’ between the femur and patella (knee cap).  Four strong ligaments provide the stabilising scaffolding around and through the joint in various planes of movement. The muscles and cartilage act to stabilise and shock absorb through motion of the joint. Injury to any of these structures can cause pain, stiffness and discomfort, the more common causes of knee pain are listed below. In addition, some helpful tips and advice on treatment for knee pain and avoiding future knee injuries.

What are the common Knee injuries and how can they be treated?

  • Simple overuse injury – Have you recently increased your activity level or think that you’ve over done it? In most cases, reducing your level of activity for a few weeks and then building back up slowly will reduce your symptoms and enable you to return to normal function.
  • Anterior knee pain – This is the term used to describe pain at the front of your knee (on or around your knee cap). These symptoms are normally exacerbated by impact activities, prolonged sitting/standing and ascending and descending stairs. Anti-inflammatories, Ice and an appropriately prescribed muscle strengthening programme by a physiotherapist can often help to alleviate these symptoms.
  • Osteoarthritis – A condition that affects mainly older people, often develops slowly with recurrent episodes of pain. It occurs when the smooth cartilage lining the joint surface becomes thin and damaged. Your GP can advise on appropriate pain relieving medication, but avoiding excessive weight gain, doing gentle strengthening exercises daily, walking 20-30 minutes 3 times weekly and wearing appropriate footwear can all help prevent further damage and ongoing symptoms.
  • Meniscal tear – The menisci are cartilage that sit between the surfaces of the femur and tibia and act as shock absorbers. Tears are common in older people and are part of the aging process of the knee joint. However, they can also result from sudden twisting injuries resulting in pain and sometimes although uncommonly swelling in the knee. You may also experience sudden ‘giving way’ or ‘locking’ of the knee joint during weight bearing activities. Depending on the site and severity of the tear, treatment may involve rest from high impact activities with a progressive strengthening programme or in some cases, surgery is required to repair or remove the damaged cartilage.
  • Ligament injuries – The four main ligaments of the knee connect bone to bone and provide directional stability to the knee joint. Tears to these ligaments can occur with sudden twisting, forced hyperextension (over straightening) of the knee joint or trauma. You will usually experience sudden sharp pain and swelling with pain on weight bearing and sometimes at rest. If your knee feels unstable (a feeling of ‘giving way’) you should seek medical advice from your GP. Minor ligament injuries will normally resolve with rest in 6-8 weeks, but if your symptoms are severe or persistent then you should seek advice from your GP or Physiotherapist.

How should you treat your injury?

The advice for any acute injury (first 48 – 72 hours) is P.R.I.C.E. 

Protection – protect from further injury with a support or bandage.

REST – You must rest following an injury. The principle of this this is to allow the tissues to heal without further stress being applied on them. If you are unable to weight bear, seek medical advice on use of walking aids such as crutches.

ICE – It is important that you control the swelling. Swelling is part of the natural healing process, however you can prevent excessive swelling and therefore stiffness with regular application of ice. An ice pack should be applied 10-15 minutes at least 3-4 times daily in the first few days after injury. Protect your skin from ice burns by using a damp towel around the ice pack.

COMPRESSION – After removing the ice pack a compression bandage should be applied to minimise swelling. A tubigrip bandage is commonly used. Be careful that you use the correct size bandage so not to impede circulation.

ELEVATION – Elevation is the last component of the P.R.I.C.E principal.  Immediately after injury, the limb must be elevated above the level of the hip, this is to reduce blood flow to the affected area. This can be achieved with lying down and placing the foot on a pillow.

Note: For injuries that have persisted for more than 4-6 weeks, it is advised that you consult the advice of your GP or a Physiotherapist. 

Anatomy of the Knee


The Femur, tibia and back of the patella are coated in a smooth cartilage which allows friction free movement of the joint surfaces. When this surface becomes warn, the condition is termed ‘Osteoarthritis’. The other cartilage found in the knee joint is the medial and lateral menisci. These cartilages act as shock absorbers and are susceptible to tears.

HEEL SLIDES

Lying on your back with knees straight, slide the affected heel towards your buttock as you bend your knee. Hold a gentle stretch in this position and then return to original position.

10 repetitions, 3 times daily

HAMSTRING SET

Lying on your back, place a rolled towel under the heel. Let you knee relax gently towards the floor/bed. Hold that gentle stretch for as long as you can tolerate up to 10 minutes

QUAD SETS

Sit or lie on your back with leg straight. Tighten your quadriceps muscle on the front of the thigh. This movement should press the back of your knee downward. Attempt to slightly lift the heel off the floor at the peak of the contraction.

10 repetitions, 3 times daily

QUAD SET – TOWEL UNDER KNEE

Place a small towel roll under your knee, tighten your top thigh muscle to press the back of your knee downward while pressing on the towel. Attempt to lift your heel off the bed/floor.

10 repetitions, 3 times daily

STRAIGHT LEG RAISE

While lying or sitting, raise up your leg with a straight knee. Keep both knees straight the entire time.

10 repetitions, 3 times daily

With reducing pain symptoms add in the exercises below:

PARTIAL ARC QUAD – LOW SEAT

While seated with your knee in a bent position and your heel touching the ground, slowly straighten your knee as you raise your foot upwards as shown. Lower your foot back down until your heel touches the ground and then repeat.

10 repetitions, 3 times daily

STANDING HAMSTRING CURLS

While standing, bend your knee so that your heel moves towards your buttock. Keep knees together so that your exercising leg does not float forwards.

10 repetitions, 3 times daily

SIT TO STAND / STAND TO SIT

Start by sitting in a chair. Next, raise up to standing without using your hands for support.  Squeeze your buttocks as you stand and sit.

10 repetitions, 3 times daily

WALL SQUATS

Leaning up against a wall or closed door on your back. Keep your knee caps facing forwards. Slide your body downward and then return back to upright position, squeezing your buttocks as you do so. Knees should bend in line with the 2nd toe and not pass the front of the foot.

10 repetitions, 3 times daily