Knee Pain Causes and Treatments: What Works Based on Your Symptoms
Not All Knee Pain Is the Same
Knee pain is a common complaint among both young athletes and older populations. It can interfere with training, limit mobility, and hold you back from the activities you enjoy most.
But here’s the key: not all knee pain is the same, and it shouldn’t be treated the same way. The approach you take depends on what’s causing the pain; whether it's joint-related, tendon-based, or something else entirely.
If Your Knee Feels Stiff or Limited: Think Joint Mechanics
This type of pain often shows up as stiffness or reduced range of motion, especially after sitting for long periods or when trying to squat or kneel.
The Best Approach: Mobilize, Then Strengthen
To restore smooth, pain-free motion in the joint:
Use articulation exercises to gently move the joint through its available range. This helps stimulate synovial fluid and reduce stiffness.
Add strengthening work to help control and support this new range. Without stability, the joint will revert to stiffness as a form of protection.
If Your Knee Hurts During Activity: Think Tendon Load
Common in runners, lifters, and athletes, tendon pain usually stems from overload, when tissues like the patellar tendon are asked to do more than they can tolerate.
The Best Approach: Strategic Loading
Rather than avoiding movement altogether, the key is strategic loading:
Target supporting muscles to take stress off the painful tendon.
Begin with isometric exercises—static holds that activate the muscles without aggravating symptoms.
Over time, progress to dynamic strengthening, always staying within a tolerable pain range.
If Bending Feels Blocked: Check Tibial Rotation
One often-overlooked reason your knee might feel “blocked” during bending is restricted tibial rotation—the internal rotation of your shin bone.
When you bend your knee, your tibia must internally rotate to glide smoothly under the femur. If this can’t happen, you may feel stiffness or pinching despite having strong muscles or healthy cartilage.
What you can do:
Assess tibial rotation: How much does your shin rotate when your knee bends?
Use passive techniques: Gently rotate the shin manually (or with a practitioner’s help) to increase range and lubricate the joint.
Train active control: Practice rotating the tibia using your own muscles with slow, controlled repetitions.
Start loading: Once rotation improves, load the joint in a safe range to reinforce mobility and build resilience.
When Tendons Hurt, Look at Muscle Activation
When tendons hurt, the deeper issue is often underactive muscles that fail to absorb load.
A Common Example: Patellar Tendinopathy
This condition affects the tendon that connects your kneecap to your shin. Pain here often signals that your quadriceps aren’t contracting efficiently, forcing the tendon to do too much.
What You Can Do
Experiment with loading angles to find positions that are challenging but not painful.
Start with isometric holds to activate your quads without stressing the joint.
Progress gradually by increasing load, introducing movement, and extending hold times.
Final Thoughts: Match the Strategy to the Source
These are just a few examples of how different knee issues require tailored approaches. Other common causes—like ligament injuries, meniscus damage, or bursitis—also demand specific treatment plans.
The Bottom Line
To manage knee pain effectively:
Don’t rely on generic solutions.
Get a thorough assessment and movement history.
Build a program that matches your specific condition and goals.
If you're unsure what type of knee pain you're dealing with or you're frustrated by a lack of progress, book a personalized assessment. With the right strategy, you'll be back to moving freely and confidently.
Meet Colin Trigellis-Smith
Colin is an Osteopathic Practitioner with a background in working with a wide range of clients from professional athletes to everyday individuals managing chronic pain or recovering from injury. His approach combines hands-on manual therapy with personalized movement programming to restore mobility, alleviate discomfort, and foster long-term physical resilience.
