Mechanical and Injury Related Knee Pain: Causes, Symptoms and How Chiropractic May Help

Knee pain tends to arrive in a couple of ways. Either something specific happened like a twist or an awkward landing or fall and the knee has not felt right ever since. Or nothing happened at all and you noticed that activities like going down the stairs have slowly begun to hurt. The two situations need different assessments. Knee pain describes the location of the pain rather than being a diagnosis.

The knee joint holds two menisci, four main ligaments, a kneecap in its own groove and several fluid-filled sacs (bursae) and each element produces a recognisable symptom. Getting that detail right matters because the plan for a twisting knee injury that swelled overnight is different from the plan for a sore kneecap with pain.

This page covers mechanical and injury-related knee pain. Age-related wear has its own page on knee osteoarthritis and both are covered on my leg, knee, ankle and foot pain guide along with other lower limb conditions.

“Leslie instantly put me at ease”

“I would strongly recommend this chiropractor. Being a typical man I had put off seeing anyone about my pain in my knee and lower back for some time but Leslie instantly put me at ease and I had considerable improvements even after one session.”

Paul S

What is mechanical knee pain?

Mechanical knee pain means pain coming from the structures of the knee joint and how those structures are loaded, not from a disease inside the knee. The term ‘knee pain‘ is broad and covers the majority of knee problems that I see.

The most common conditions that are related to knee pain:

Pain around or behind the kneecap, called patellofemoral pain or runner’s knee seems to be the most common.

Iliotibial band syndrome (ITBS) produces pain on the outer edge in runners and cyclists (covered in detail below).

Meniscal problems affect the two crescent shaped cartilage, at the junction between the thigh and shin bones.

Ligament sprains following a force that pushed the knee beyond its limit, commonly seen in dancers and footballers.

Bursitis is irritation of a fluid-filled sac, most often in front of the kneecap and frequently in people who kneel for work. This use to be called: “Housemaids Knee”.

A Baker’s cyst is fluid swelling behind the knee and originating from the synovial membrane of the knee joint.

Osgood-Schlatters disease irritates the growth area below the kneecap in active teenagers.

How knee pain tends to start

Most of the knees I see began in one of two ways. Knowing which one you are dealing with shapes everything that follows.

	Slow-building pain	Sudden pain
How it shows up	Creeps in over weeks, no single moment you can name	Arrives in one instant you will remember
Common triggers	More miles, a hillier route, back to the gym after a break, a job that has gone from sitting to standing	A twist with the foot planted, a knock to the outside of the knee, a bad landing
What it means	The knee did not fail. It was simply asked to do more than it was ready for	The way it happened points me to which structure took the force

Underneath both, a few things quietly add to the problem or slow the recovery:

Weak or tired thigh and hip muscles change how the kneecap glides in its groove
Stiff ankles or hips shift work onto the knee that should be shared elsewhere
An old injury that never fully healed, sometimes years back, is often the one speaking up now

And the question I am asked most: is it my weight, or just how I am built? For most knees its not. A large study that followed people before any pain began found that age, height, weight, BMI and increased body fat did not predict who developed kneecap pain.^[6] What did matter was weak quadriceps under sustained load and in younger people, surprisingly, stronger hips rather than weaker ones. Knee pain rarely has one main cause which is why I look at how the whole leg moves and loads not just the knee alone.

Explore our leg, knee, ankle and foot guides

Leg, knee, ankle or foot pain: the main guide

Heel, ankle and foot

Knee, thigh and calf

Knee pain: runner’s knee, bursitis, clicking, locking and giving way (you are here)
Knee osteoarthritis: wear and tear, bone on bone
Muscle strains of the leg: pulled hamstring, quadriceps, calf and night cramps

Related guides

When leg pain starts in the back

When leg pain starts in the hip or pelvis

Staying active

Common Knee Injuries and Where they are Felt

a photograph of a leg showing the causes of knee pain

Photograph of the front of the left knee showing the rough positions of the different knee injuries

Behind the kneecap

Runner's knee, or patellofemoral pain

A dull ache around or behind the kneecap that is hard to pinpoint. Worse going downstairs than up, worse squatting, and worse again after sitting with the knee bent through a long drive. Grinding or grating on its own is not a sign of damage.

Along the joint line

Meniscal problems

Pain along the joint line on one side, often with catching, clicking or a feeling that the knee might give way. Swelling builds over hours rather than immediately.

At the joint edges

Ligament sprains

Pain at once, sometimes with a pop, and swelling within the hour.

Outer knee

Iliotibial band syndrome

A sharp, well-localised pain on the outer knee that arrives at a predictable point into a run and settles quickly on stopping.

In front of the kneecap

Bursitis

A tender, boggy swelling in front of the kneecap that hurts to kneel on.

Behind the knee

Baker's cyst

A feeling of fullness behind the knee rather than sharp pain.

Below the kneecap, in teenagers

Osgood-Schlatter disease

A tender bony bump just below the kneecap that hurts with running and jumping.

Nothing tender in the knee

Referred from elsewhere

Knee pain with nothing to find in the knee itself may be referred from the hip or the lower back, which is why I examine both.

Symptoms of knee pain

Runner’s knee or Patellofemoral pain:

Runner’s knee gives a dull ache around or behind the kneecap which is hard to pinpoint. The pain is worse going downstairs than up, it worsens when squatting and is worse again after sitting with the knee bent through a long drive. Some people notice grinding or grating which on its own is not necessarily a sign of damage.

Other conditions that can cause knee pain:

Meniscal problems produce pain along the joint line on one side often with catching, clicking or a feeling that the knee might give way and swelling that builds over hours rather than being immediate. Ligament sprains hurt at once, sometimes with a pop and swell within the hour. Iliotibial band syndrome gives a sharp, well-localised pain on the outer knee at a predictable point into a run, settling quickly on stopping (see below for a detailed explanation). Bursitis in front of the kneecap is a tender, puffy swelling that hurts to kneel on. A Baker’s cyst feels like fullness behind the knee. In a teenager, a tender bony bump below the kneecap that hurts with running and jumping is usually Osgood-Schlatter disease.

Knee pain with nothing tender to find in the knee itself may be referred from the hip or lower back which is why I examine both.

Anatomy of the iliotibial band from the iliac crest and gluteus medius/TFL to the outer knee, showing the pathway involved in iliotibial band syndrome.

How the IT band connects the hip muscles to the outer knee

Iliotibial band syndrome:

This condtion gives a sharp, localised pain on the outer knee at a predictable point into a run, settling quickly on stopping. The IT band itself is a thick strip of fascia running from the iliac crest of the pelvis, gathering fibres from the gluteus medius and tensor fasciae latae muscles, down the outside of the thigh to the outer knee. Weakness or poor control in those hip muscles is a common finding in people with this pattern of pain [6], which is why my examination and any exercise plan I prescribe usually start above the knee rather than at it.

If knee pain or a knee injury is getting in the way of things you would rather be doing, come and talk it through. I offer a free 15-minute consultation, you can come in for a short no-obligation chat with no examination or treatment.

Book a free consultation

Or call for a chat on 01202 937568

How a chiropractor may help your knee pain

Exercise does most of the work in knee pain recovery and my job is to enable that exercise and to make sure it is the correct type of exercise. Alongside this, I provide soft tissue work to the quadriceps, iliotibial band (IT band), hamstrings and calf, mobilisation of the kneecap and knee joint where movement is restricted and assessment of the hip, ankle and lower back since those factors routinely drive knee symptoms in the patients I see. Taping can settle irritable kneecap pain enough to let loading begin.

The medical evidence is that the international consensus on patellofemoral pain supports exercise combining knee and hip work as the core treatment, with taping, orthotic insoles and manual techniques as short-term adjuncts rather than treatments in their own right.[2] That is how I use them. For degenerative meniscal tears in middle age, exercise-based rehabilitation was no worse than keyhole surgery for knee function at five years, an operation is not inevitable.[3] Iliotibial band syndrome responds to load management and strengthening, though the trials are small.[5] There is no strong evidence that manipulation alone resolves knee pain.

For load-related knee pain I usually expect meaningful change within six to eight weeks, with a review at four weeks to check we are on the right track. Injuries follow their own timeline. If the knee is not responding or the assessment suggests something that needs imaging, I refer you on.

Red flags: reasons to seek medical attention

Most knee pain is mechanical and settles with sensible management.

A few situations need a doctor first. A hot, red, swollen knee with fever needs same-day assessment because this may indicate joint infection. A knee that swells dramatically within an hour of an injury may suggests bleeding inside the joint and a knee that locks and cannot be straightened needs orthopaedic assessment. After an injury, the Ottawa knee rule is the standard guide to who needs an X-ray and a negative result reliably excludes a fracture.[4] It points towards imaging if you are fifty-five or over, cannot bear weight for four steps, cannot bend the knee to ninety degrees or are tender over the kneecap or the head of the fibula. If any apply, go to A&E. Unexplained weight loss, night pain that wakes you or a limping child with a normal-looking knee all need a GP appointment first, since a child’s knee pain can come from the hip.[1]

Your first visit to Bournemouth Chiropractic

At your first full visit to see me I take a full history covering how the knee pain started, what you were doing beforehand and whether the knee swells, catches or gives way. I then examine the joint, test the ligaments and menisci, watch you squat and walk and check the hip, ankle and lower back. I will tell you what I think the pattern is, whether chiropractic care is likely to help and what the plan involves, including the work you would need to do between appointments.

Frequently Asked Questions

Can a chiropractor help with knee pain?

Often, yes a chiropractor can help with knee pain. Manual therapy to the knee and the joints above and below it, with a graded strengthening programme, may help reduce pain and improve function in mechanical knee problems. It is not the right answer for every knee and part of my job referring you onto a GP or an orthopaedic specialist if need be.

Do I need a scan for my knee to find out why it hurts?

Usually there is not always a need for a scan for knee pain, not at first. Knee problems are diagnosed largely from the history and examination and scans of pain-free knees often show meniscal and cartilage changes causing nothing.[1] Imaging becomes useful when the knee locks, gives way, fails to improve or a fracture needs excluding after an injury.

Does a torn knee cartilage always need an operation?

No, knee surgery is not always the case for a torn knee cartilage . For the degenerative tears common from middle age onwards, structured exercise produced knee function no worse than keyhole surgery over five years.[3] Larger traumatic tears in younger people and knees that lock are a different situation and will need a surgical opinion.

Should I stop running or going to the gym because of the pain in my knee?

Totally resting a sore knee tends to leave it weaker and no less sore. The usual approach is to reduce the aggravating load to a level the knee tolerates, keep the rest going and build back up as symptoms allow. Listen to your body. Pain that settles within a day is generally acceptable. Pain that lingers means you went too far with the exercise.

When should I go to A&E rather than book an appointment for knee pain?

Go to A&E if you cannot put weight through the leg after an injury, if the knee locked and will not straighten or if it swelled dramatically within an hour. A hot, red, swollen knee with a fever needs same-day medical attention, not a chiropractic appointment.

Whatever may be behind your knee pain, come and find out

A knee that clicks, catches or gives way on the stairs is a worry and most people want to know two things before anything else: is this something serious and is it going to stop me doing what I enjoy. At a first full appointment I will take a full medical history, examine the knee properly and look at the hip, pelvis and lower back as well, because how you load through the leg above the knee often has a great deal to do with what the knee is complaining about.

Knee pain is one a common reasons people book in to see me here in Bournemouth and Poole. Patients range from runners and walkers to people who simply noticed pain creeping in over a few months to a person who may have suffered an injury recently

Where the knee is irritated as part of a wider mechanical picture or after a minor sports injury, hands-on care alongside the loading and strengthening work that carries the strongest evidence is a well-tolerated option worth considering and I will explain to you what I think will help in your case when I see you. Some knees need an orthopaedic opinion and a true locking or repeatedly unstable knee is one of them. If that is what I find, I will help you get to the right person who can help you further.

Book an appointment online and you can choose what suits you: a first appointment, which is the full visit with a detailed history, examination and treatment where appropriate or a free 15 minute consultation, which is simply a no-obligation chat about your problem with no examination and no treatment. If you are not sure which you need please call the clinic on 01202 937568 and we will work it out.

Call or message me, whatever is easiest and we will take it from there.

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