Contents
- Overview
- At a glance
- Symptoms
- Where it hurts (common patterns)
- What it feels like
- Common causes of knee pain
- Load related irritation (overuse)
- Patellofemoral pain (runner’s knee)
- Tendon pain (patellar or quad tendon)
- Meniscus irritation or tear
- Ligament sprain (MCL, ACL, other stabilisers)
- Knee osteoarthritis flare up
- Baker’s cyst (popliteal cyst)
- When to get it checked urgently
- What helps (early self-management)
- Treatment
- Our Mobility, Flexibility, Strength approach
- Exercises that are often safe to start (when appropriate)
- How physiotherapy helps knee pain
- What to expect at PhysioCentral (Miranda and the Sutherland Shire)
- FAQs
- Related pages
Overview
Knee pain is common, but that does not make it simple. It can creep in gradually with walking, running, gym work, or sport. Or it can start suddenly after a twist, a fall, or an awkward landing.
The tricky part is that “knee pain” is not one diagnosis. Where it hurts, what movements aggravate it, whether it swells, and whether it feels unstable all change what the best first steps should be.
This hub will help you:
- understand the most common causes and symptom patterns
- know when it is worth getting checked sooner
- take sensible, safe first steps at home
- understand what physiotherapy treatment usually involves
At a glance
Most knee pain improves with the right mix of load management and progressive strengthening.
Red flags include major trauma, inability to weight bear, rapid swelling after injury, true locking, or a hot red swollen knee with fever.
A Baker’s cyst is usually a sign of irritation inside the knee, not a separate “thing to fix” on its own.
Treatment at PhysioCentral usually follows our Mobility, Flexibility, Strength phases so you build capacity safely and avoid flare ups.
Symptoms
Knee pain can show up in different ways. Your pattern helps narrow down likely causes.
Where it hurts (common patterns)
Front of knee pain (around or behind the kneecap)
Often worse with stairs, squats, lunges, hills, or long sitting. Common in patellofemoral pain (runner’s knee) or kneecap overload.
Pain just below the kneecap
Often linked to patellar tendon irritation, especially with jumping, sprinting, or heavy gym work.
Inside of knee pain
Can relate to meniscus irritation, MCL sprain, medial joint overload, or sometimes referred load issues from hip or foot mechanics.
Outside of knee pain
Common in runners, especially with hills and speed work. Often linked to lateral overload patterns such as ITB related pain.
Back of knee tightness or “fullness”
Can be linked to a Baker’s cyst (more below), joint swelling, or protective tightness.
What it feels like
- aching, sharp pain, or a “pinch” with bending
- stiffness after sitting or first thing in the morning
- swelling or a puffy, tight feeling
- clicking, catching, or giving way
- pain with stairs, running, kneeling, squatting, or getting up from a chair
A key detail is how it behaves after activity. If it flares and stays elevated the next day, the knee is telling you the load is currently too high.
Common causes of knee pain
Knee pain most commonly falls into these groups:
1) Load related irritation (overuse or “too much too soon”)
This is the most common. A change in training volume, intensity, hills, sprinting, jumping, or gym load can irritate the kneecap, tendons, ITB (Runners Knee), or joint surfaces.
2) Patellofemoral pain
Pain around or behind the kneecap, commonly aggravated by stairs, squats, lunges, and prolonged sitting.
3) Tendon pain (patellar or quad tendon)
Typically localised pain at the tendon, often worse with jumping, heavy squats, lunges, or sudden increases in load.
4) Meniscus irritation or tear
Often linked to twisting, deep bending, or a sudden change in direction. Symptoms can include catching, sharp joint line pain, swelling, or a feeling of giving way.
5) Ligament sprain (MCL, ACL, other stabilisers)
Usually linked to a twist, contact, awkward landing, or sudden change of direction. The key symptom is often instability, especially with pivoting.
6) Knee osteoarthritis flare up
Common in midlife and beyond, but not exclusive to older people. Often presents as stiffness, aching with load, swelling after a bigger day, and reduced tolerance for stairs or hills.
7) Baker’s cyst (popliteal cyst)
A Baker’s cyst is a pocket of fluid at the back of the knee. It is usually caused by the knee producing extra joint fluid due to irritation inside the joint.
Common drivers include:
- osteoarthritis flare ups
- meniscus irritation or degeneration
- synovitis or joint inflammation
- overload from repeated deep knee bending
Typical symptoms:
- tightness or pressure behind the knee
- discomfort at end range bending or straightening
- swelling that comes and goes
- sometimes calf tightness or heaviness
Key point: if the underlying knee irritation is not addressed, the cyst often returns, even if it is drained.
When to get it checked urgently
Seek urgent medical attention if you have:
- significant trauma, deformity, or severe pain
- inability to bear weight (more than a few steps)
- a “pop” with immediate swelling and instability
- a hot, red, very swollen knee with fever or feeling unwell
- sudden calf swelling, redness, marked tenderness, or shortness of breath
If you have a known Baker’s cyst and the calf suddenly becomes very swollen or painful, it is important to get assessed promptly. A ruptured Baker’s cyst can mimic more serious conditions and should not be guessed at.
What helps (early self-management)
1) Reduce the specific triggers, not all movement
Most knees dislike complete rest. Instead, temporarily reduce what flares it:
- deep squats, lunges, repeated stairs
- hills, speed work, jumping
- long kneeling or heavy manual work positions
Keep what is comfortable:
- gentle walking on flatter ground
- cycling or swimming
- short, frequent movement breaks if sitting is aggravating
2) Manage swelling and irritability
- compression can help if the knee is puffy
- icing can help short term comfort if it feels hot or reactive
- elevate after activity if it helps
- avoid repeatedly “testing it” through deep bends all day
3) Use a simple response rule
A small amount of discomfort can be normal during rehab, but the knee should settle:
- during exercise, symptoms stay manageable
- swelling does not increase afterward
- pain settles back to baseline by the next day
If pain climbs and stays elevated, scale back and adjust.
Treatment
Treatment depends on the cause, but most plans include the same core pieces.
1) Settle pain and restore confidence
This may include activity modification, swelling control, gentle range work, and a clear plan so you stop guessing.
2) Restore movement
Common targets include knee extension, comfortable bending, ankle mobility, and hip control.
3) Progressive strengthening
Most knee pain improves when you rebuild strength and load tolerance in:
- quadriceps
- glutes and hip stabilisers
- calves
- single leg control and balance
4) Return to sport, running, or gym
This is where many people get stuck. A good plan rebuilds:
- tolerance to stairs and hills
- squats and hinges
- landing and change of direction
- gradual return to running volume and speed
Our Mobility, Flexibility, Strength approach (how knee rehab usually progresses)
Most knee pain improves best when rehab follows a simple sequence. The knee rarely tolerates jumping straight into heavy strengthening if it is still stiff, guarded, or reactive. We usually progress through three phases based on your symptoms, swelling, and load tolerance.
Phase 1: Mobility (settle symptoms and restore comfortable movement)
Goal: reduce pain and swelling, restore knee movement, and help you trust the knee again.
This phase often focuses on:
- getting rid of protective muscular spasm that usually develpos along the outer thigh – this pulls the kneecap out of alignment, resulting in pain around the front of the knee
- restoring comfortable knee straightening and bending
- managing swelling and irritability
- gentle quad activation and hip activation
- improving ankle mobility if it is limiting knee mechanics to reduce stress through the knee joint
- simple activity modification so you can keep moving without constant flare ups
Signs you are ready to progress:
- walking and stairs are improving
- swelling is settling rather than increasing
- the knee feels less tight or blocked in day to day movement
Phase 2: Flexibility (restore control through range)
Goal: regain confident control through the ranges that matter, like stairs, squats, lunges, getting up from chairs, and kneeling.
This phase often includes:
- controlled squats and sit to stands in a comfortable range
- step ups and step downs with good knee tracking
- hip control work to reduce knee overload – we need to start to work on those glutes!
- calf strength and control to improve shock absorption
- gradual re introduction of hills, longer walks, or light jog intervals when appropriate
Signs you are ready to progress:
- you can load the knee through everyday movements without flare ups
- single leg balance and control are improving
- the knee recovers well after exercise sessions
Phase 3: Strength (build load tolerance for sport, running, and gym)
Goal: make the knee robust again, not just less painful.
This phase often includes:
- progressive strengthening for quads, glutes, and calves
- deeper squat and lunge patterns when tolerated
- hopping, landing mechanics, and change of direction work for sport
- graded return to running volume, speed, and hills
- work specific conditioning for kneeling, lifting, and long days on your feet
Signs you are progressing well:
- you can train harder without spikes in pain or swelling
- confidence is back for the movements that used to trigger pain
- capacity is building week to week
Where a Baker’s cyst fits
A Baker’s cyst is usually a sign the knee has become irritated and is producing extra joint fluid. That means Phase 1 and Phase 2 matter even more early on, so we calm the knee, restore comfortable movement, then rebuild strength and tolerance so it is less reactive to load.
Exercises that are often safe to start (when appropriate)
If you have red flags, major swelling after injury, true locking, or you cannot weight bear, get assessed first. Otherwise, we typically begin with Mobility phase exercises, then progress to Flexibility and Strength as your knee stabilises and tolerates greater load.
Otherwise, these are common entry points:
- quad sets (tighten thigh with knee straight)
- straight leg raise (if comfortable)
- heel slides (gentle bend and straighten)
- calf raises (double leg)
- sit to stand from a higher chair
- step ups on a low step, slow and controlled
- glute bridge
- gentle bike 5 to 10 minutes if comfortable
The “best” starting point depends on your pain pattern, irritability, and goals.
How physiotherapy helps knee pain
Physio is not just treating the sore spot. It is about restoring knee load tolerance and making the whole system more resilient.
Depending on your presentation, treatment may include:
- assessment to clarify the likely driver (kneecap, tendon, meniscus, ligament, joint)
- reducing protective muscle tension and calming irritability
- restoring knee extension and comfortable bending
- strengthening progressions matched to your goals (stairs, running, gym, sport)
- hip, calf, and foot mechanics to share load better
- movement coaching for squats, stairs, running, and landing
- return to sport testing and planning when needed
- guidance for Baker’s cyst management by treating the underlying knee irritation
What to expect at PhysioCentral (Miranda and the Sutherland Shire)
At your first appointment we aim to take the guesswork out of it.
We typically cover:
- your history, activity goals, and what your knee needs to tolerate
- pain location and behaviour, swelling, irritability, and confidence with movement
- key tests for meniscus, ligaments, kneecap pain patterns, tendon pain, and joint irritation
- strength and control checks for quads, glutes, calves, and single leg stability
- a simple plan for the next 2 to 4 weeks, including what to modify and what to build
Knee pain is one of the top 5 most common problems we see in Miranda and across the Sutherland Shire, from weekend sport and running to osteoarthritis flare ups and work related overload.
FAQs
Do I need an X-ray or MRI?
Not always. Many knee pain presentations improve with the right rehab plan without imaging. Imaging is more useful after significant trauma, true locking, major instability, or when progress is not tracking as expected.
Why does my knee feel weak when it is swollen?
Swelling can inhibit the quadriceps, which can make the knee feel less stable. Managing swelling and restoring quad activation is often an early priority.
Should a Baker’s cyst be drained?
Sometimes drainage is used, but if the underlying knee irritation is not addressed, it often returns. In many cases, the best results come from treating the driver rather than chasing the cyst itself.
Why does it hurt on stairs but not on flat ground?
Stairs increase load through the kneecap and demand more control. Front of knee pain patterns often show up on stairs first.