What could be causing a dull, aching pain in my kneecap?

A frequent cause is patellofemoral pain, often called runner's knee, which tends to flare with stairs, squats, running and long periods of sitting with bent knees. Arthritis behind the kneecap can feel similar. An exam can usually tell them apart, and imaging is added if the exam or your progress calls for it.

Should I stop running if my knee hurts?

Stop the activities that make it hurt until the pain settles, and use lower-impact options like cycling or an elliptical in the meantime. When you return, build mileage and intensity gradually rather than all at once. A knee that swells, gives way or changes your stride needs to be checked before you run again.

Is walking good for a tight IT band?

Usually, as long as it doesn't bring on the pain on the outside of your knee. MedlinePlus suggests walking rather than running down hills and choosing softer surfaces, which can help a sore knee. If walking itself hurts, scale back and have it assessed.

Knee Pain Physical Therapy in Buffalo, NY | Lake Erie Physical Therapy

Q: Can physical therapy help knee arthritis?

Yes, for many people. APTA's guide to knee osteoarthritis notes that people who follow a strengthening program have less pain and better quality of life, and that physical therapy is an effective alternative for many people who want to delay or avoid surgery. It won't regrow cartilage, but it can change how much the knee limits you.

Where your knee hurts says a lot. An ache around or behind the kneecap points one way, a sharp spot on the outside of the knee points another, and pain along the joint line with catching points somewhere else again. Knee pain physical therapy at Lake Erie Physical Therapy starts by narrowing that down, then builds your knee’s capacity for whatever you ask of it, from a spring race to the stairs at home.

What the location suggests

Around the kneecap: patellofemoral pain (runner’s knee)

Patellofemoral pain is a dull ache at the front of the knee, around the kneecap. According to the American Academy of Orthopaedic Surgeons (AAOS), it typically flares with stairs, running, jumping and squatting, and after sitting a long time with your knees bent, as in a car or a movie theater. Popping or crackling on the stairs is common. It’s frequent in athletes, especially females and young adults, but plenty of non-athletes get it too.

Two things often sit behind it: a sudden jump in training (more days, longer runs, harder sessions) and weakness or imbalance in the quadriceps and hip muscles that help keep the kneecap tracking in its groove. If you’ve been told you have chondromalacia, meaning softened cartilage under the kneecap, know that cartilage itself has no nerves; the pain comes from the surrounding tissues and bone. Most patellofemoral pain is treated without surgery, though it can return if training isn’t adjusted.

Pain just below the kneecap that flares with jumping or squatting may involve the patellar tendon instead, which calls for a gradually progressed loading program.

Outside of the knee: IT band irritation

The iliotibial (IT) band is the thick band of tissue running from your hip to the outside of your knee. When it’s irritated, pain settles on the outside of the knee, a pattern most familiar to runners and cyclists. Treatment targets what’s loading it: weekly mileage, hills, recent changes in training and hip strength.

Along the joint line: meniscus irritation

The menisci are C-shaped cartilage cushions between the thighbone and shinbone. A meniscus problem tends to hurt along the inside or outside of the joint, often with twisting, and may bring swelling or catching. APTA’s guide to knee osteoarthritis cites research in which most people with a meniscus tear who were considered surgical candidates did not need surgery after trying physical therapy first. A knee that locks or won’t straighten, however, needs a physician’s look.

Stiff, achy and worse on stairs: knee osteoarthritis

Knee osteoarthritis comes from inflammation and gradual wear of the cartilage in the joint. APTA’s guide describes morning stiffness lasting less than 30 minutes, pain with stairs or getting up from a chair, stiffness after sitting, grinding or popping, and swelling after activity. It also notes that people with knee arthritis who follow a strengthening program have less pain and better quality of life, and that physical therapy is an effective alternative for many people who want to delay or avoid surgery. If you do go on to a replacement, see our knee replacement rehab page.

Get it checked by a physician first if…

Physical therapy does not replace a medical diagnosis. MedlinePlus advises contacting a provider if:

You can’t put weight on the leg, or the pain is severe even at rest
The knee buckles, locks or looks deformed
You can’t bend it, or can’t straighten it all the way
You have a fever, redness or warmth around the knee, or a lot of swelling
The calf below the sore knee is painful, swollen, numb, tingling or bluish, which can signal a blood clot and needs same-day care
The pain started with a fall, twist or other injury

If pain lingers after 3 days of home care, it’s worth an evaluation, either with us or your physician.

Knee pain physical therapy, built around load

Rest calms a sore knee down. Strength is what prepares it for stairs, runs and long days on your feet. The work is finding the amount and type of load your knee tolerates today, then raising it on purpose.

Your evaluation (wear shorts) includes:

Watching you squat, step down and balance on one leg, and talking through your running if you run
Comparing quadriceps and hip strength side to side, and checking your feet, ankles and hips
Screening your lower back. Pain from the lower back is sometimes felt in the thigh or knee, so we use the McKenzie Method (MDT) to see whether back movements change your knee symptoms, and repeated-movement testing on the knee itself where it fits

Treatment usually combines:

Progressive strengthening for the quadriceps and hip muscles, which AAOS highlights for patellofemoral pain
Training and activity adjustments, such as changing mileage, hills, surfaces or footwear, or swapping some runs for cycling or the elliptical while things settle
Hands-on manual therapy and pain-relieving modalities when indicated
Blood flow restriction (BFR) training when heavier lifting is too irritating. BFR pairs light weights with a cuff around the upper thigh and requires a safety screening first. Dr. Will Tso, PT, DPT, Cert. MDT, is Level 1 certified in BFR training.
A home program that fits around your week and changes as you progress

If you’re a runner

Dr. Ryan Mitchell, PT, DPT, one of our co-owners, ran cross country at Daemen, so expect specific questions about mileage, recent changes, shoes and race plans, and a step-by-step return-to-running plan instead of a vague “ease back in.” Appointments start at 7 AM Tuesday through Friday, which helps if you train or work early. Athletes in other sports can read about our sports physical therapy.

After discharge

Once you’re back to your usual activities, our Keep It Going program lets you keep exercising at our clinic for $10 a visit or $70 a month. It’s usually not covered by insurance and requires a prescription for maintenance exercise from your referring physician, medical clearance from your family physician and a signed waiver.

With most plans, New York lets you start physical therapy without a referral for up to 10 visits or 30 days, whichever comes first, and Medicare doesn’t require a referral to start (your physician certifies the plan of care). Call (716) 332-4838 to set up an evaluation at our Buffalo clinic, or send a request through our appointment page.

Sources

Written by the Lake Erie Physical Therapy clinical team. This page is general information, not a diagnosis; your physical therapist will assess your situation in person.

Physical Therapy for Knee Pain