Knee Pain Treatment in Willoughby | Willoughby Physiotherapy and Chiropractic
Causes of Knee Pain, Fast Relief & Expert Rehab in Sydney’s Lower North Shore
Knee pain is one of the most common conditions we manage at Willoughby Physiotherapy and Chiropractic. With Sydney’s active lifestyle and growing interest in running, group training and highintensity sports like Hyrox and CrossFit, knee pain is becoming increasingly frequent. Our Willoughby physiotherapists see this daily, particularly in active patients from across the Lower North Shore. Presentations range from acute injuries (strains, sprains, meniscal irritation) to overuse conditions like tendinopathy, as well as osteoarthritis, post-surgical rehabilitation and traumatic sports injuries.
Accurate diagnosis and early management are key. Most knee conditions respond well to conservative care, including targeted exercise, manual therapy, and load management education. Where needed, your physiotherapist can also refer for imaging such as X-ray, ultrasound, or MRI. Treatment typically begins with pain relief and restoring movement, before progressing to strength, mobility, and finally return-to-sport/activity and long-term injury prevention.
- Willoughby Physiotherapy and Chiropractic – Our team of experienced Physiotherapists and Chiropractors provide expert management of knee pain to people in Sydney
- We provide fast and accurate diagnosis, pain relief and progressive strengthening to safely return you to the activities you love
- Care beyond your initial assessment – We provide personalised strength, running, mobility and return to sport program tailored to your needs, with a focus on preventing future injuries
Anatomy of the Knee (Why It’s Prone to Pain)
Understanding the structures of the knee helps explain why it is one of the most injury-prone joints we treat in clinic. The following overview highlights the main joints, ligaments, muscles, tendons and bursae most involved in knee pain.
The knee comprises two primary articulations:
- Tibiofemoral joint – articulation between the femoral condyles and tibial plateau, responsible for weight-bearing and hinge-like movement.
- Patellofemoral joint – articulation between the patella and femoral trochlea, critical for load distribution during knee flexion.
Cartilaginous support is provided by the menisci, two semi-lunar, wedge-shaped fibrocartilaginous structures. These increase joint congruency, aid in load transmission, absorb shock, and contribute to stability by deepening the tibial plateau.
Dynamic control of the knee is primarily provided by:
- Quadriceps femoris group – vastus lateralis, vastus medialis, vastus intermedius, rectus femoris. Function: knee extension, with rectus femoris also contributing to hip flexion (biarticular).
- Hamstrings group – semimembranosus, semitendinosus, biceps femoris. Function: knee flexion, with all three crossing the hip joint to provide hip extension (bi-articular).
Additional contributors include:
- Gastrocnemius – spans the posterior knee and ankle, assisting with knee flexion and influencing sagittal-plane stability.
- Hip musculature – abductors, external rotators, and extensors indirectly influence knee kinematics by controlling femoral rotation and valgus/varus alignment.
Ligaments are tough bands that stabilise the knee — the ACL and MCL are the most well-known because they’re commonly injured in sport. The static stabilisers of the knee include:
- Anterior cruciate ligament (ACL): resists anterior tibial translation and rotational loads.
- Posterior cruciate ligament (PCL): resists posterior tibial translation.
- Medial collateral ligament (MCL): resists valgus stress and provides medial stability.
- Lateral collateral ligament (LCL): resists varus stress and provides lateral stability.
Together, the cruciate and collateral complexes ensure multi-planar stability under load.
Tendinous structures provide force transfer from muscle to bone. The most clinically relevant is the quadriceps tendon, which anchors the quadriceps to the patella and continues distally as the patellar tendon (ligament) to insert on the tibial tuberosity. This extensor mechanism is essential for gait, stair climbing, and athletic performance.
The knee joint capsule is a fibrous structure that encloses and stabilises the joint, reinforced by surrounding ligaments and musculotendinous expansions. The capsule is lined internally by synovium, which produces synovial fluid for lubrication and nourishment of intra-articular structures. Key capsular reinforcements include:
- Anteriorly: quadriceps expansion and patellar tendon.
- Posteriorly: oblique popliteal ligament and arcuate complex, resisting hyperextension and posterior translation.
- Medially: fibres of the MCL, semimembranosus expansions, and medial retinaculum.
- Laterally: ITB fibres, LCL, popliteus tendon, and lateral retinaculum.
The capsule contributes to overall joint stability, limits excessive translation, and integrates with periarticular bursae.
Bursae are synovial fluid-filled sacs that reduce friction between tissues around the knee. There are more than 10 bursae, with the most clinically relevant being:
- Prepatellar bursa: lies between patella and skin; commonly irritated in “housemaid’s knee.”
- Superficial infrapatellar bursa: between patellar tendon and skin.
- Deep infrapatellar bursa: between patellar tendon and tibial tuberosity.
- Suprapatellar bursa: continuous with knee joint capsule, between quadriceps tendon and femur.
- Pes anserine bursa: between pes anserinus tendons (gracilis, sartorius, semitendinosus) and medial tibia; site of bursitis in overuse and OA populations.
- Semimembranosus bursa (popliteal/baker’s cyst): between semimembranosus tendon and medial gastrocnemius; often associated with meniscal pathology or joint effusion.
These bursae are clinically significant as potential pain generators in bursitis or as sites of secondary inflammation in arthritis and overuse syndromes.
The 5 Most Common Knee Pain Presentations We See – Symptoms, Treatment & Management
1) Patellofemoral Pain Syndrome (Runner’s Knee)
What it is:
- Umbrella term for pain around or behind the kneecap (patella) due to increased load on the patellofemoral joint.
- Common in runners, cyclists, gym-goers, and office workers who sit for long periods.
Key symptoms:
- Diffuse ache at the front, sides, or behind the kneecap.
- Worse with stairs (especially down), squats, hills, or sitting with knees bent (“theatre sign”).
- Crepitus (grinding or clicking) may be present but is usually harmless.
Why it happens:
- Multifactorial: training errors, weak quads or hip abductors, tight ITB/hamstrings, poor foot mechanics (pronation/cavus).
- Patellar maltracking or malalignment increases joint compression.
Management:
- Education + load management (avoid “too much, too soon”).
- Strengthening: quads + hip abductors/external rotators > knee alone.
- Taping or bracing may reduce pain short-term.
- Gait retraining for runners (cadence, stride, surfaces).
- Foot orthoses if symptoms clearly improve with trial.
2) Iliotibial Band Syndrome (ITB Friction Syndrome)
What it is:
- Overuse injury of the iliotibial band, where it rubs against the lateral femoral condyle.
- Very common in runners and endurance athletes.
Key symptoms:
- Sharp or burning pain on the outside of the knee.
- Often worse at a set distance into a run, then eases (“warm-up effect”) before returning with volume.
- Tenderness over the lateral femoral epicondyle.
Why it happens:
- Training load spikes, downhill running, or excessive crossover gait.
- Weak hip abductors leading to pelvic drop and femoral IR/valgus.
- Tight ITB increasing lateral pressure. Management:
- Modify training load and running surface.
- Strengthen glute medius and hip abductors.
- Address stride mechanics (reduce crossover, adjust cadence).
- Manual therapy/soft-tissue release for ITB tightness.
3) Patellar Tendinopathy (Jumper’s Knee)
What it is:
- Overuse condition of the patellar tendon, usually at the inferior pole of the patella.
- Seen in sports involving jumping, sprinting, and rapid deceleration (basketball, volleyball, football).
Key symptoms:
- Localised pain and tenderness at the bottom of the kneecap.
- Pain flares (usually with fast rate of loading) — squats, lunges, jumps, or sprints.
- Morning stiffness or pain after inactivity common.
Why it happens:
- Repeated high-load stress without adequate recovery.
- Sudden spike in training volume or intensity.
Management:
- Load modification (don’t fully rest, but avoid pain >3/10).
- Isometric quads holds for pain relief.
- Progressive tendon loading: isometric → isotonic → heavy slow resistance → plyometrics.
- Education on long-term load monitoring.
4) Osteoarthritis (OA)
What it is:
- Degenerative condition involving cartilage wear and changes in subchondral bone.
- Often affects people over 50 but can present earlier after injury.
Key symptoms:
- Morning stiffness, pain after rest (“start-up pain”).
- Fluctuating swelling and flare-ups after activity.
- Aching, grinding, or reduced walking tolerance.
Why it happens:
- Age-related cartilage changes.
- History of trauma or meniscus/ligament injury.
- Genetic predisposition, high BMI, or occupational loading. Management:
- First-line: physiotherapy + exercise (quads/hips/glutes, balance, mobility).
- Weight management, pacing strategies.
- Flare-up education (don’t fear activity).
- Adjuncts: bracing, walking aids, hydrotherapy.
- Referral for imaging or orthopaedics if severe, but conservative care is strongly supported by evidence.
5) Meniscus Irritation/Tears
What it is:
- Tears or irritation of the meniscus (C-shaped cartilage that cushions and stabilises the knee).
- Can be traumatic (twist, squat, pivot) or degenerative (age-related).
Key symptoms:
- Localised joint-line pain (inner or outer side of the knee).
- Swelling, stiffness, clicking, catching, or locking.
- Pain with twisting, deep bending, or squatting.
Why it happens:
- Acute trauma (pivot on a bent knee, contact injury).
- Gradual degeneration in older adults.
Management:
- Many cases respond to physiotherapy (strengthening, neuromuscular control, gradual loading).
- MRI indicated if persistent locking, mechanical symptoms, or poor progress.
- Surgery considered if conservative care fails or with major mechanical block.
- We use our onsite rehab equipment at Willoughby to guide progressive strengthening, balance and return to sport programs.
Frequently Asked Questions (FAQ) - Knee Pain
What is the fastest way to relieve knee pain?
Gentle movement, load modification, and strategies like ice or heat can help in the short term. For long-term relief, physiotherapy addresses the underlying cause through exercise and education.
Do I need a scan before seeing a physio?
Not usually. Physiotherapists can diagnose most knee injuries with a thorough history and physical examination. If imaging is required (X-ray, ultrasound, MRI), your physio can refer you directly.
What does physiotherapy for knee pain involve?
Treatment usually begins with pain reduction and restoring comfortable movement, before progressing to strength, mobility, flexibility, and coordination. Later stages focus on return-to-sport testing and long-term injury prevention.
Can physio help knee osteoarthritis without surgery?
Yes. Research strongly supports exercise therapy as first-line care. Physiotherapy can reduce pain, improve mobility, and delay or avoid the need for surgery.
How long until I can return to sport or running?
How long until I can return to sport or running? It depends on your diagnosis and response to treatment, but early assessment and a structured rehab plan usually lead to faster recovery. Your physiotherapist will progress you through criteriabased return-to-sport testing to ensure safety.
Ready to Fix Your Knee Pain?
Knee pain doesn’t need to stop you from running, training, or enjoying everyday life. Most conditions respond well to physiotherapy with the right balance of exercise, education and load management.
At Willoughby Physiotherapy & Chiropractic, we provide expert diagnosis, hands-on treatment and progressive rehabilitation tailored to your goals. Whether you’re recovering from surgery, managing osteoarthritis, or dealing with a sports injury, our physios will guide you every step — from pain relief to long-term prevention.
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Serving patients across Willoughby, Chatswood, Northbridge, St Leonards and Sydney’s Lower North Shore. Same-week appointments available. Health fund rebates apply.