Common questions about knee pain and osteoarthritis

Yes, knee osteoarthritis is a long-term condition, but that does not mean it will inevitably get worse. Symptoms often come and go, with calm spells and temporary flares linked to activity and tiredness; they may stay stable and can sometimes gradually improve. What matters most is learning to manage it: regular strengthening exercise, activity built up gradually, and weight loss where needed. Guidelines put these measures at the core of treatment, and they help ease pain and keep you moving.

Read more: Knee osteoarthritis · Source: NHS — Osteoarthritis · NICE NG226 — Osteoarthritis in over 16s: diagnosis and management (2022)

Knee osteoarthritis can cause mild swelling in the knee itself, especially after overdoing it or during a flare, and it usually settles as you pace your activity. Swelling of the foot and ankle, however, does not usually come from osteoarthritis: it has other causes, such as long standing or sitting, some medicines, varicose veins, or heart or kidney problems, so see a doctor if it persists. If one leg swells for no clear reason, or suddenly with pain or redness, or the knee is hot and red with a fever, see a doctor the same day, and call an ambulance if you are short of breath or have chest pain: 911 in Jordan or 122 in Iraq and Kurdistan.

Read more: Knee osteoarthritis · Source: NHS — Osteoarthritis · NHS — Swollen ankles, feet and legs (oedema)

In most cases it is not a danger to your general health: it is one of the most common types of arthritis and one of the most common causes of knee pain as we get older. It can limit walking, stairs and sitting on the floor, but the good news is that exercise and pacing your activity usually help ease pain and keep you moving. Watch for signs that do not fit typical osteoarthritis: pain or deformity that gets worse quickly, long morning stiffness, or pain after a recent injury need a doctor's review soon, and a hot, swollen knee with a fever needs a doctor the same day.

Read more: Knee osteoarthritis · Source: NICE NG226 — Osteoarthritis in over 16s: diagnosis and management (2022) · NHS — Osteoarthritis

Osteoarthritis pain is usually felt in and around the knee and may spread a little into the leg. A soft swelling behind the knee called a Baker's cyst sometimes comes with osteoarthritis and can cause tightness or pain there, which may be worse after walking. Numbness, or pain spreading down to the foot, is not typical of osteoarthritis and may come from elsewhere, such as the lower back, so it needs an assessment. If pain and swelling suddenly appear in the calf, it could be a blood clot or a burst cyst: see a doctor the same day, and call an ambulance if you are short of breath or have chest pain: 911 in Jordan or 122 in Iraq and Kurdistan.

Read more: Knee osteoarthritis · Source: NHS — Baker's cyst · NHS — DVT (deep vein thrombosis)

An X-ray may show osteoarthritis changes, but it is not usually needed for the diagnosis, which is mostly based on age, symptoms and examination; imaging is requested when there are unusual signs. The grades, such as grade two or grade four, describe how the joint looks on the X-ray, and they do not always match how bad the pain is: pain can be mild with a high grade, or the other way round. That is why guidelines say the plan should be based on symptoms and how well you can move, and that joint replacement should be decided by clinical assessment rather than the grade number.

Read more: Knee osteoarthritis · Source: NICE NG226 — Osteoarthritis in over 16s: diagnosis and management (2022) · NHS — Osteoarthritis

Osteoarthritis can run in families, but genes are only one factor among several, and studies have not identified a single gene responsible. Other factors include getting older, being overweight, previous knee injuries or operations, and being a woman. So it is more common after middle age, but it can appear earlier in some young people, especially after an old knee injury. It cannot be prevented completely, but strengthening your muscles, keeping a healthy weight and avoiding injuries may lower the risk.

Read more: Knee osteoarthritis · Source: NHS — Osteoarthritis

Knee osteoarthritis is a condition in which the whole joint changes slowly: the cartilage covering the ends of the bones, the bone beneath it and the tissues around it, causing pain and stiffness. It is not simply bone rubbing on bone, as many people believe, and the joint keeps its ability to adapt. It is also different from osteoporosis: osteoporosis weakens the bones and makes them more likely to break, and it is not usually painful until a bone breaks, whereas osteoarthritis is a problem of the joint itself.

Read more: Knee osteoarthritis · Source: NHS — Osteoarthritis · NHS — Osteoporosis

Common signs are pain that gets worse with walking, stairs and getting up from a chair and eases with rest; short stiffness in the morning or after sitting for long; clicking or grating with movement; and sometimes mild swelling or a feeling that the knee gives way. It is usually diagnosed from your story and an examination without an X-ray, especially after middle age when the pain is linked to activity and morning stiffness is short. Long morning stiffness, or swelling in several joints, may point to another type of arthritis such as rheumatoid arthritis, so see a doctor.

Read more: Knee osteoarthritis · Source: NHS — Osteoarthritis: symptoms · NICE NG226 — Osteoarthritis in over 16s: diagnosis and management (2022)

Yes, there are effective treatments, although no treatment returns the joint exactly to how it was. Guidelines put therapeutic exercise, such as strengthening the thigh and hip muscles and gradually built-up walking, together with weight loss where needed and a good understanding of the condition, at the core of treatment, and a walking stick or comfortable shoes may also help. Medicines and injections are your doctor's decision, and surgery is considered when pain stays severe and greatly affects your life despite these measures. With regular treatment many people stay active with less pain.

Read more: Knee osteoarthritis, Knee pain · Source: NICE NG226 — Osteoarthritis in over 16s: diagnosis and management (2022) · NHS — Osteoarthritis: treatment and support

Usually yes, in easing pain and improving movement: physiotherapy is one of the most important first treatments for osteoarthritis. Its core is an exercise programme designed for you: strengthening the thigh and hip muscles, exercises for knee movement, and light aerobic activity such as walking or a stationary bike, built up gradually. Manual therapy and joint mobilisation are used alongside exercise, not instead of it. Pain may rise a little when you start, but keeping going increases the benefit over time. At Revibe we start by assessing your knee and the way you walk, then build a plan and a graded home programme with you.

Read more: Knee osteoarthritis · Source: NICE NG226 — Osteoarthritis in over 16s: diagnosis and management (2022) · NHS — Osteoarthritis: treatment and support

In most cases, no. Guidelines start with exercise, weight management and education, and the doctor decides on medicines or injections when needed. Joint replacement is considered when pain, stiffness or reduced function still greatly affects your life despite non-surgical treatment, and the orthopaedic surgeon decides after a clinical assessment, not on the X-ray grade alone. NICE advises against keyhole washout or clean-up of the joint (arthroscopic lavage or debridement) for osteoarthritis. Exercise stays useful before and after any operation.

Read more: Knee osteoarthritis, Post-surgery rehab · Source: NICE NG226 — Osteoarthritis in over 16s: diagnosis and management (2022) · NHS — Osteoarthritis: treatment and support

There is not enough scientific evidence that oils, herbs or garden cress seeds treat osteoarthritis or rebuild cartilage. NICE does not recommend supplements such as glucosamine, or rubs that only create a warm feeling. Warmth, such as wrapping the knee in wool or using a warm pack, may comfort some people for a while, but it does not treat the joint. What helps most is exercise and weight loss where needed, and ask a doctor or pharmacist before taking any supplement, especially if you take other medicines.

Read more: Knee osteoarthritis · Source: NHS — Osteoarthritis: treatment and support · NICE NG226 — Osteoarthritis in over 16s: diagnosis and management (2022)

NICE advises against dry needling and acupuncture for osteoarthritis, so at Revibe we do not use dry needling for it. It also advises against machine treatments such as electrical nerve stimulation (TENS), ultrasound and laser for osteoarthritis, because there is not enough evidence that they help. The evidence for cupping and massage is limited; some people feel short-term relief, so if they are used, it is as an extra within an exercise-based plan, never instead of it. Manual therapy is likewise used alongside exercise.

Read more: Dry needling, Cupping · Source: NICE NG226 — Osteoarthritis in over 16s: diagnosis and management (2022) · NHS — Osteoarthritis: treatment and support

Not always. Some people do well with a structured rehabilitation programme alone, especially if their activities involve little turning and jumping. Surgery is usually advised for people who want to keep playing sports with turning and changes of direction, who have a very physical job, whose knee keeps giving way, who have other injuries in the knee, or who have not improved with physiotherapy. The decision belongs to the orthopaedic surgeon, together with you, and rehabilitation is the base of recovery either way, before and after surgery.

Read more: ACL injury · Source: NHS — Why ACL (anterior cruciate ligament) surgery is done · Diermeier TA et al. (2021). Treatment after ACL injury: Panther Symposium ACL Treatment Consensus Group. Br J Sports Med 55(1):14–22

No, they are two different parts inside the knee. The cruciate ligaments are strong bands of tissue that connect the thigh bone to the shin bone and keep the knee stable; there are two, the anterior (ACL) and the posterior (PCL), which cross each other like an X. The menisci are two rubbery, crescent-shaped pieces of cartilage between the two bones, one on the inner side and one on the outer side, which absorb shock and spread the load. Both can be injured in the same sports injury, which is why each part is examined separately.

Read more: ACL injury, Meniscus tear · Source: AAOS OrthoInfo — Anterior Cruciate Ligament (ACL) Injuries

Sometimes, but it cannot be predicted in advance. The ACL was long thought to have a limited ability to heal, yet MRI scans have shown some tears healing, and early research is studying a special bracing protocol started within weeks of the injury under specialist care; it is not yet standard treatment. More importantly, many people regain good knee function with structured rehabilitation, with or without surgical reconstruction of the ligament, and the orthopaedic surgeon decides the best path with you after an examination.

Read more: ACL injury · Source: Filbay SR et al. (2023). Healing of acute anterior cruciate ligament rupture on MRI and outcomes following non-surgical management with the Cross Bracing Protocol. Br J Sports Med 57(23):1490–1497 · Diermeier TA et al. (2021). Treatment after ACL injury: Panther Symposium ACL Treatment Consensus Group. Br J Sports Med 55(1):14–22

It is not usually a threat to life, but it is a significant knee injury that needs an early examination. After the pain and swelling settle, the knee may stay unstable and give way when you turn, and going back to normal activities before stability returns can worsen the instability and put other parts, such as the meniscus, at risk. That is why an early assessment and a structured rehabilitation programme matter. Go to the emergency department or call an ambulance if the knee looks deformed, or the foot becomes cold, pale or numb after the injury: 911 in Jordan or 122 in Iraq and Kurdistan.

Read more: ACL injury, Sports injuries · Source: AAOS OrthoInfo — Anterior Cruciate Ligament (ACL) Injuries · Logerstedt DS et al. (2017). Knee Stability and Movement Coordination Impairments: Knee Ligament Sprain Revision 2017 — Clinical Practice Guidelines. J Orthop Sports Phys Ther 47(11):A1–A47

Usually not, if the posterior ligament is the only structure injured. Many PCL tears are partial and can heal, and the knee usually does well without surgery, with protection, sometimes in a brace the doctor decides on, followed by rehabilitation in which strengthening the front thigh muscle is a key part. Surgery is usually advised when several ligaments are injured together, or when instability or pain continues despite treatment. This ligament is typically injured by a hard blow to the front of the bent knee, such as falling onto it.

Read more: Sports injuries · Source: AAOS OrthoInfo — Posterior Cruciate Ligament (PCL) Injuries

The tear usually happens when you turn on a planted foot, land from a jump or stop suddenly, often without any contact. You may hear or feel a pop, then the knee swells within hours and it is hard to carry on playing. How painful it is varies from person to person, and the pain may ease after a few days, but a feeling that the knee is unstable or gives way when you turn often remains. Diagnosis is based on a clinical examination, and the doctor may request an MRI to check the other parts of the knee.

Read more: ACL injury · Source: AAOS OrthoInfo — Anterior Cruciate Ligament (ACL) Injuries · Logerstedt DS et al. (2017). Knee Stability and Movement Coordination Impairments: Knee Ligament Sprain Revision 2017 — Clinical Practice Guidelines. J Orthop Sports Phys Ther 47(11):A1–A47

It is a common operation, most people who have it have no complications, and when complications happen they are usually minor and treatable. Like any operation, though, it has risks your surgeon will explain, including blood clots and wound infection, and sometimes stiffness, ongoing pain or a tear of the new graft. The harder part is the rehabilitation afterwards: recovery takes several months or longer, and returning to sport takes longer still. In physiotherapy we follow your surgeon's protocol and instructions step by step.

Read more: ACL injury, Post-surgery rehab · Source: NHS — Complications of ACL (anterior cruciate ligament) surgery · NHS — Recovering from ACL (anterior cruciate ligament) surgery

Many people can walk and do their daily activities once the swelling settles and thigh strength returns, especially if their activities involve little turning, but turning and jumping may make the knee give way. A torn ACL does not necessarily end a player's career: returning to play is possible after structured rehabilitation, with or without surgery. The return is based on tests of strength, hopping, movement control and confidence, not on time alone, and the risk of another injury remains, so continuing an injury-prevention programme may help.

Read more: ACL injury, Sports injuries · Source: Ardern CL et al. (2016). 2016 Consensus statement on return to sport from the First World Congress in Sports Physical Therapy, Bern. Br J Sports Med 50(14):853–864 · Kotsifaki R et al. (2023). Aspetar clinical practice guideline on rehabilitation after anterior cruciate ligament reconstruction. Br J Sports Med 57(9):500–514

The inner (medial) collateral ligament is the more often injured of the two side ligaments; some people mistakenly call it the side cruciate ligament. It is usually injured by a blow to the outside of the knee or a hard twist, causing pain on the inner side. When it is the only structure injured, it usually heals without surgery: easing pain and swelling, then protected movement, sometimes in a hinged brace if the doctor advises, then progressive strengthening and balance exercises. Surgery is sometimes considered for severe tears with other injuries, such as an ACL tear, and the orthopaedic doctor decides.

Read more: Knee MCL sprain · Source: AAOS OrthoInfo — Collateral Ligament Injuries · Logerstedt DS et al. (2017). Knee Stability and Movement Coordination Impairments: Knee Ligament Sprain Revision 2017 — Clinical Practice Guidelines. J Orthop Sports Phys Ther 47(11):A1–A47

The kneecap (patella) normally glides up and down in a groove at the end of the thigh bone every time you bend or straighten your knee, and painless clicking is common and normal. If the kneecap slips out of place, you feel it is about to, or the knee gives way with pain, that is instability and needs an examination. A first dislocation is usually treated with strengthening exercises for the thigh and hip muscles, sometimes with a brace, and surgery is considered if dislocations keep happening; the orthopaedic doctor decides.

Read more: Front-of-knee pain · Source: AAOS OrthoInfo — Unstable Kneecap (Patellar Instability) · NHS — Knee pain

Both are injuries that need prompt medical care. Go to the emergency department or call an ambulance (911 in Jordan, 122 in Iraq and Kurdistan) if the knee has changed shape, swells quickly, or you cannot straighten it or stand on it, and do not try to put the kneecap back yourself. A dislocated kneecap sometimes moves back into place by itself, but it still needs a check and an X-ray, then it is usually treated with exercise, and surgery is considered if it keeps dislocating. A fracture whose pieces have not moved may be treated in a cast or splint; a displaced one usually needs an operation, which the surgeon decides on. Either way, rehabilitation restores movement and strength.

Read more: Front-of-knee pain, Post-surgery rehab · Source: NHS — Dislocated kneecap · AAOS OrthoInfo — Patellar Fractures (Broken Kneecap)

It depends on where the tear is. The outer edge of the meniscus has a good blood supply, and a tear there may heal on its own or can be stitched surgically. The inner part gets little blood, and tears there do not usually knit together. But not healing does not necessarily mean the pain will continue: many cases, especially gradual tears that come with age, improve with a structured exercise programme that strengthens the muscles around the knee. The doctor decides whether an operation is needed based on your symptoms and examination, not the scan alone.

Read more: Meniscus tear · Source: AAOS OrthoInfo — Meniscus Tears · Logerstedt DS et al. (2018). Knee Pain and Mobility Impairments: Meniscal and Articular Cartilage Lesions Revision 2018 — Clinical Practice Guidelines. J Orthop Sports Phys Ther 48(2):A1–A50

Treatment usually starts without surgery: easing pain and swelling, temporarily changing activities that provoke it, such as deep squats or twisting on the knee, then graded exercise. Types of exercise that usually help include tightening the front thigh muscle, standing up from a chair and sitting down slowly, stepping up onto and down from a step, and balance exercises on one leg, followed by harder exercises that suit your activity. There is no single best exercise for everyone, so at Revibe we choose the exercises and make them harder according to your examination and how your knee responds.

Read more: Meniscus tear · Source: Logerstedt DS et al. (2018). Knee Pain and Mobility Impairments: Meniscal and Articular Cartilage Lesions Revision 2018 — Clinical Practice Guidelines. J Orthop Sports Phys Ther 48(2):A1–A50 · Siemieniuk RAC et al. (2017). Arthroscopic surgery for degenerative knee arthritis and meniscal tears: a clinical practice guideline. BMJ 357:j1982

It is usually not serious, and it is one of the most common knee injuries. It can happen after a hard twist in sport, or gradually with age, even with a simple movement such as twisting as you get up from a chair. Signs include pain on the inner or outer side of the knee, swelling and stiffness that build up over a few days, and clicking or a feeling that something catches. If the knee locks so you cannot straighten it, or swells quickly or keeps giving way after an injury, see a doctor the same day.

Read more: Meniscus tear · Source: AAOS OrthoInfo — Meniscus Tears · NHS — Knee pain

In most cases, no. For gradual, age-related tears, a clinical guideline strongly recommends against keyhole surgery (arthroscopy) for nearly all patients, because exercise therapy usually gives a similar result. Surgery is usually considered for true locking that stops the knee straightening, a tear in the outer edge that may be suitable for stitching, or no improvement despite a structured programme. If surgery is chosen, it is usually keyhole, and rehabilitation after a repair takes longer than after trimming. The orthopaedic doctor decides.

Read more: Meniscus tear, Post-surgery rehab · Source: Siemieniuk RAC et al. (2017). Arthroscopic surgery for degenerative knee arthritis and meniscal tears: a clinical practice guideline. BMJ 357:j1982 · AAOS OrthoInfo — Meniscus Tears

Pain at the front of the knee around the kneecap is common in teenagers, young adults and athletes, and it usually gets worse with stairs, squats, running and long sitting with the knees bent. Guidelines put strengthening of the hip and thigh muscles together at the core of treatment, with a temporary reduction of whatever provokes the pain, then building it back gradually. Kneecap taping or shoe inserts may help some people for a short time alongside exercise, and manual therapy is used with exercise, not on its own. There is not enough evidence that herbs treat this pain.

Read more: Front-of-knee pain · Source: Willy RW et al. (2019). Patellofemoral Pain — Clinical Practice Guidelines. J Orthop Sports Phys Ther 49(9):CPG1–CPG95 · Collins NJ et al. (2018). 2018 Consensus statement on exercise therapy and physical interventions (orthoses, taping and manual therapy) to treat patellofemoral pain: recommendations from the 5th International Patellofemoral Pain Research Retreat, Gold Coast, Australia, 2017. Br J Sports Med 52(18):1170–1178

Physiotherapy starts with an assessment: we listen to the story of your pain, examine the movement of your knee, hip and ankle, your strength and the way you walk, and recognise what needs a doctor. The plan is then usually built on progressive strengthening and movement exercises as the core of treatment, with manual therapy and joint mobilisation alongside, and advice on pacing activities, stairs and prayer. At Revibe we add a clear home programme and adjust it as you improve, and we use dry needling only when the examination shows it suits you, never for osteoarthritis.

Read more: Knee pain, Your first session · Source: NICE NG226 — Osteoarthritis in over 16s: diagnosis and management (2022) · Willy RW et al. (2019). Patellofemoral Pain — Clinical Practice Guidelines. J Orthop Sports Phys Ther 49(9):CPG1–CPG95

Usually not. Most knee pain comes from overuse, a minor sprain, osteoarthritis or front-of-knee pain, and it improves with time and the right treatment; painless clicking is normal. But see a doctor the same day if the pain is severe, you cannot move the knee, it is badly swollen, locks, gives way or clicks painfully, or is hot and red with a fever. Go to the emergency department (911 in Jordan, 122 in Iraq and Kurdistan) if you cannot stand on it after an injury or it has changed shape. See a doctor if the pain has not improved within a few weeks.

Read more: Knee pain · Source: NHS — Knee pain

Usually not: knee pain normally comes from the joint itself and the muscles and tendons around it. However, kidney problems raise the chance of gout, which can cause a sudden attack of severe pain with swelling and redness in a joint, sometimes the knee, and this needs a doctor. Leg pain that comes on with walking and goes after a few minutes' rest may be a sign of narrowed arteries, which are linked to heart disease, so see a doctor. For chest pain or shortness of breath, call an ambulance straight away: 911 in Jordan or 122 in Iraq and Kurdistan.

Read more: Knee pain · Source: NHS — Gout · NHS — Peripheral arterial disease (PAD)

Sometimes. The leg works as a chain, and an ankle sprain or foot pain, such as heel pain or a corn, can change the way you walk for a while so the knee takes a different load; the same twist can also injure the knee, and if the knee swells or gives way it needs its own examination. Flat feet are common and do not usually cause problems, but in some people with front-of-knee pain, shoe inserts may ease the pain for a short time. That is why we examine the foot, ankle and hip along with the knee.

Read more: Knee pain, Ankle sprain · Source: Willy RW et al. (2019). Patellofemoral Pain — Clinical Practice Guidelines. J Orthop Sports Phys Ther 49(9):CPG1–CPG95 · NHS — Flat feet

It depends on your condition, its stage, how long you have had it and your goals: a minor sprain is different from long-standing osteoarthritis or rehabilitation after surgery. Regular home exercise between sessions is a key part of the plan, and sticking with it over time increases its benefit. After the first assessment at Revibe we explain the plan and the expected number of sessions, and adjust both according to how you respond. Prices differ between clinics and by type of treatment; you will find the details on our prices page.

Read more: Your first session, Prices · Source: NICE NG226 — Osteoarthritis in over 16s: diagnosis and management (2022)

Pain on the inner side of the knee has several common causes, and what happened before it helps tell them apart. After a blow to the outside of the knee, or the knee bending inwards, the inner (medial) collateral ligament may be sprained. After a twist with clicking or a catching feeling, it may be the meniscus. In people past middle age, with stiffness and pain that gets worse with walking and stairs and no clear injury, osteoarthritis is a common cause. An examination identifies the likely cause and the treatment plan, and a doctor may request imaging if needed.

Read more: Knee MCL sprain, Meniscus tear · Source: AAOS OrthoInfo — Collateral Ligament Injuries · NHS — Knee pain

If the pain started after extra effort or a minor sprain, ease off what provokes it for a few days, such as standing for long, and put a cold pack wrapped in a cloth on the knee for short periods. Then return to movement gradually: exercises that strengthen the thigh and hip muscles are among the most helpful ways to ease knee pain in the long run, and losing weight helps if you are overweight. Ask a doctor or pharmacist about painkillers. See a doctor if the pain has not improved within a few weeks or warning signs appear.

Read more: Knee pain, Home physiotherapy · Source: NHS — Knee pain · NICE NG226 — Osteoarthritis in over 16s: diagnosis and management (2022)