Knee pain is one of the most common presentations we see in clinic. It can range from a mild overuse irritation to a more significant structural injury, and understanding the most common causes helps clarify when professional assessment is needed and what recovery typically involves. The knee is a complex joint with several important structures responsible for load-bearing across almost every activity — which is why there are many potential diagnoses, each with different causes, pain patterns, and recovery timelines.
At BeFit Training Physiotherapy, our team assesses and manages knee injuries at both our Edgecliff and Coogee clinics. This guide covers the most common presentations we see and when to seek physiotherapy assessment.
Patellofemoral Pain Syndrome (Runner’s Knee)
Patellofemoral pain syndrome, commonly known as runner’s knee, produces a diffuse, dull aching pain around or behind the kneecap. It is typically worse when going up or down stairs, squatting, running downhill, or after prolonged sitting. It is one of the most common overuse injuries in recreational and competitive runners.
Common contributing factors include sudden increases in training load or intensity, repetitive impact activities such as running and jumping, poor patella tracking through the knee joint, and muscle imbalances — particularly weakness in the hip abductors and quadriceps. Management focuses on load modification, targeted strengthening, and addressing any movement pattern inefficiencies contributing to excess patellofemoral stress.
Iliotibial Band Syndrome
Iliotibial band syndrome is another overuse presentation, characterised by pain on the outer side of the knee. Current evidence describes it primarily as a compression-based condition, where the iliotibial band compresses the fat pad and soft tissue at the lateral femoral epicondyle during repetitive knee flexion and extension — rather than a simple friction or inflammatory condition as was previously understood.
It is most common in runners and cyclists, and contributing factors frequently include rapid increases in training volume, gluteal weakness causing excessive hip adduction during loading, and tight hip flexors or lateral structures that increase compressive forces at the knee. Addressing gluteal strength and running or cycling mechanics is central to effective management.
Meniscal Injuries
The menisci are two semi-circular pieces of fibrocartilage that sit between the thigh and shin bones, acting as shock absorbers and providing stability for the knee joint. Meniscal injuries can occur acutely through twisting or pivoting movements under load, or gradually through degenerative wear over time — the latter being more common in older adults even without a specific injury event.
Common symptoms include sharp, localised pain during specific movements, clicking or popping sensations, and in more significant cases, locking of the knee joint. The appropriate management pathway depends on the type, location, and severity of the meniscal injury, as well as the individual’s age, activity level, and goals — physiotherapy assessment is the right starting point for determining this.
Ligament Injuries
The knee is stabilised by four main ligaments — the ACL, PCL, MCL, and LCL. Ligament injuries range from mild sprains to complete tears and are typically caused by contact or non-contact mechanisms involving sudden changes of direction, hyperextension, or direct impact. The ACL is the most commonly reconstructed ligament in sport, but MCL sprains from valgus stress are also frequently seen across field sports and skiing.
Ligament injuries vary significantly in severity and management requirements. Minor sprains often respond well to physiotherapy rehabilitation without surgery. More significant tears, particularly of the ACL, may require surgical reconstruction followed by a structured rehabilitation programme of nine to twelve months or more before return to sport.
Referred Pain From the Hip and Lumbar Spine
Not all knee pain originates from the knee itself. Several structures in the hip and lumbar spine can refer pain into the knee region. Lumbar nerve root irritation, including sciatica, can produce pain that travels down the leg and presents at the knee. Hip joint pathology such as osteoarthritis or labral tears can also refer pain distally due to shared nerve supply and the interconnected nature of the hip and knee kinetic chain.
A thorough physiotherapy assessment will differentiate between knee-originating pain and referred pain from higher structures — which is important because the management of each is fundamentally different. Treating the knee when the source of pain is the lumbar spine or hip will not produce lasting results.
When to See a Physiotherapist for Knee Pain
Early assessment generally leads to better outcomes and faster recovery. A physiotherapy assessment is appropriate if you experience persistent knee pain lasting more than seven to ten days, pain that is affecting daily activities such as walking, stairs, or getting up from a chair, swelling that does not settle within 48 to 72 hours of onset, instability or a feeling that the knee may give way, locking or catching sensations during movement, or night pain that disrupts sleep.
These presentations warrant assessment rather than a wait-and-see approach. An accurate diagnosis, a clear understanding of contributing factors, and a targeted rehabilitation programme are significantly more effective than rest alone for most knee conditions.
Common Questions About Knee Pain
Should I rest or keep moving if my knee hurts?
It depends on the nature and severity of the injury. For most overuse presentations such as patellofemoral pain or ITB syndrome, relative rest — modifying activity rather than stopping entirely — is more appropriate than complete rest. For acute ligament or meniscal injuries, assessment before continuing activity is important. Your physiotherapist will guide you on what level of activity is appropriate for your specific presentation.
Do I need an MRI for knee pain?
Not necessarily in the early stages. Many knee conditions can be assessed and managed effectively on the basis of a thorough clinical examination without imaging. Your physiotherapist will advise whether imaging is clinically indicated based on your symptoms, history, and how you respond to initial management. If imaging is warranted, we can refer you directly for the appropriate investigation.
How long does knee pain take to resolve?
This varies significantly depending on the diagnosis, severity, and how quickly rehabilitation begins. Mild overuse presentations such as patellofemoral pain or ITB syndrome can resolve within four to eight weeks with appropriate management. Ligament injuries vary from two to four weeks for minor sprains to nine to twelve months or more for ACL reconstruction and return to sport. Your physiotherapist will give you a realistic timeline after your initial assessment.
Can I prevent knee injuries?
Many common knee injuries are associated with modifiable risk factors — training load errors, strength deficits, movement pattern inefficiencies, and footwear. Addressing these proactively through structured strength training, sensible load progression, and regular movement assessment significantly reduces injury risk. A physiotherapy assessment does not require an existing injury — it can be a proactive tool for identifying risk factors before they cause problems.
Do I need a referral to see a physiotherapist at BeFit?
No referral is required. You can book directly at either our Edgecliff or Coogee clinic. If you have any relevant imaging or specialist letters, bring these to your first appointment.
Further Reading
Managing a knee injury after ACL reconstruction? Our guide on why ACL rehabilitation requires more than strength training covers neuromuscular control, psychological readiness, and what complete return to sport actually involves. For the early recovery phase, see our guide on what to expect in the first six weeks after ACL reconstruction.
How BeFit Can Help
At BeFit Training Physiotherapy, our team assesses and manages the full range of knee injuries at our Edgecliff and Coogee clinics — from overuse presentations to post-surgical rehabilitation. Assessment, diagnosis, and a targeted rehabilitation programme are available at both locations. No referral is required.
Book an appointment at BeFit Training Physiotherapy — no referral needed.
Edgecliff: (02) 9327 7749 | Coogee: (02) 7205 2805
References
Fairclough J, et al. The functional anatomy of the iliotibial band during flexion and extension of the knee: implications for understanding iliotibial band syndrome. J Anat. 2006;208(3):309-316.
Crossley KM, et al. 2016 Patellofemoral pain consensus statement from the 4th International Patellofemoral Pain Research Retreat. Br J Sports Med. 2016;50(14):839-843.
Beaufils P, Pujol N. Management of traumatic meniscal tear and degenerative meniscal lesions. Save the meniscus. Orthop Traumatol Surg Res. 2017.
Australian Physiotherapy Association. Clinical guidelines. physiotherapy.asn.au.
