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Knee pain is one of the most common musculoskeletal complaint that brings people to their health care provider. With today’s increasingly active society, the number of knee problems is increasing.


Knee pain usually results from:

  • Overuse
  • Poor form during physical activity
  • Not warming up or cooling down
  • Not enough stretching

Simple causes of knee pain often clear up on their own with self care. Being overweight can put you at greater risk for knee problems.

Knee pain can be caused by:

  • Anterior knee pain
  • Arthritis — including rheumatoid arthritis, osteoarthritis, and gout
  • Baker’s cyst — a fluid-filled swelling behind the knee that may occur with swelling (inflammation) from other causes, like arthritis
  • Bursitis — inflammation from repeated pressure on the knee, such as kneeling for long periods of time, overuse, or injury
  • Connective tissue disorders such as lupus
  • Dislocation of the kneecap
  • Iliotibial band syndrome — a hip disorder from injury to the thick band that runs from your hip to the outside of your knee
  • Infection in the joint
  • Knee injuries — an anterior cruciate ligament injury or medial collateral ligament injury may cause bleeding into your knee, which makes the pain worse
  • Osgood-Schlatter disease
  • Tendinitis — a pain in the front of your knee that gets worse when going up and down stairs or inclines
  • Torn cartilage (a meniscus tear) — pain felt on the inside or outside of the knee joint
  • Torn ligament (ACL tear) — leads to pain and instability of the knee
  • Strain or sprain — minor injuries to the ligaments caused by sudden or unnatural twisting

Less common conditions that can lead to knee pain include bone tumors.


Treatment and Prevention


Physical therapy is essential to the treatment, rehabilitation, and prevention of many of the conditions that affect the knee joint and its surrounding supporting structures. Physical therapy for knee pain often includes ice, elevation, and muscle-toning exercises.

Activity limitations — To speed recovery and protect against future knee damage, activities that cause pain should be avoided temporarily.

The following positions and activities place excessive pressure on the knee joint and should be limited until knee pain and swelling resolve:

  • Squatting
  • Kneeling
  • Twisting and pivoting
  • Repetitive bending (multiple flights of stairs, getting out of a seated position, clutch and pedal pushing, etc.)
  • Jogging
  • Aerobics, dancing
  • Playing stop and go sports (basketball, sports that use racquets)
  • Swimming using the frog or whip kick

The following types of exercise equipment also place excessive pressure on the knee joint and should be limited until knee pain and swelling resolve:

  • Stair stepper
  • Stationary bicycle
  • Rowing machine
  • Universal gym utilizing leg extensions

The preferred exercise equipment for the knee should provide smooth motion of the knee, maximal toning of the front and back thigh muscles (quadriceps and hamstring muscles), minimal jarring and impact to the joint, and the least amount of bending to accomplish toning. These activities are acceptable alternatives to the above:

  • Fast walking
  • Water aerobics
  • Swimming using the crawl stroke
  • Cross country ski machines
  • Soft platform treadmill

Ice and elevation — Ice is useful for the control of pain and swelling. It can be applied to the knee for 15 to 20 minutes as often as every 2 to 4 hours, particularly after physical activity. A bag of ice, frozen vegetables, or a frozen towel work well. The swollen knee should be elevated above the level of the heart while icing.

Pain relief — If needed, a non-prescription pain medication such as acetaminophen (Tylenol®), ibuprofen (eg, Advil®, Motrin®) or naproxen (eg, Aleve®) can be taken. No more than 4000 mg of acetaminophen is recommended per day. Anyone with liver disease or who drinks alcohol regularly should speak with his or her healthcare provider before taking acetaminophen.

Strengthening exercises — Rehabilitation of the knee begins with gentle strengthening exercises. These exercises are performed without bending the affected knee.

Straight leg raises — Sit on the edge of a chair or lie down on the back. Bend the opposite leg . Keep the affected leg perfectly straight and raise it 3 to 4 inches off the ground. Hold for 5 seconds. Repeat 10 to 15 times (one set). Perform a total of three sets.

As your condition improves, perform straight leg raises with weights at the ankle; begin with a 2 pound weight and gradually increase to a 5 to 10 pound weight (pennies or fishing weights in an old sock, 2 cans in a purse, or Velcro ankle weights).

Hip abduction — Lie on your side on the bed or floor. The affected leg should be on top and should be held straight. The bottom leg should be bent. Hold the top leg straight and raise it 3 to 4 inches towards the ceiling. Hold for 5 seconds then slowly release. Repeat 10 to 15 times (one set). Perform a total of three sets.

Be sure to avoid rolling forwards or backwards while lifting the leg.

Hip adduction — Lie on your side on the bed or floor. The affected leg should be on bottom and should be held straight. The top leg should be bent with the foot placed in front of the bottom leg. Lift the bottom leg 3 to 4 inches. Hold for 5 seconds then slowly release. Repeat 10 to 15 times (one set). Perform a total of three sets.

Quarter squats — Stand 18 to 24 inches from a wall and lean back against the wall. Bend both knees slightly (the buttocks should not be lower than the knees), keeping the back straight. Hold for five seconds then slowly stand up straight. Rest as needed. Repeat 10 to 15 times (one set). Perform a total of three sets. To increase the difficulty, bend the knees more deeply, hold for a longer time, and increase the speed.

Alternately, use an exercise ball to perform squats. Stand up straight, holding the ball between your back and the wall. Slowly bend the knees and lower the back (roll the ball down the wall). Hold for a count of five. Stand up. Repeat 10 to 15 times.

Stretching exercises

Hamstring stretch — Sit on the floor or bed with the affected leg extended straight out in front of you. The opposite leg may be bent or may hang off the bed. Keeping the affected leg straight, lean forward and reach for the ankle. Hold for 30 seconds but do not bounce. Sit up straight. Repeat 10 to 15 times.

Quad stretch — Stand behind a chair, holding the top of the chair with one hand. Bend the knee and grab the foot with the hand on the same side of the body. Stand up straight. Gently pull the foot towards the body. Hold for 30 seconds, holding constant pressure on the foot (do not pull-release-pull). Release the foot. Repeat 10 to 15 times.

Runner’s stretch — Face a wall and stand 18 to 24 inches away. Place hands at head height and lean into the wall, keeping legs and back straight. You can rest your head on your hands, against the wall. You should feel a stretch in the muscles in the back of the calf. Hold for 30 seconds. Repeat 10 to 15 times.


  • Increase your activity level slowly over time. For example, when you begin exercising again, walk rather than run.
  • Always warm up before exercising and cool down afterward. Stretch your quadriceps and hamstrings.

Replace your sports shoes often. Get good advice about proper footwear for your foot shape and mechanics. For example, if you land on the outside of your heel and turn your foot inward when you walk (pronate), consider anti-pronation footwear.

Dr. Hardy has treated hundreds of cases of knee conditions over the years.  Many cases of knee conditions can be traced back to faulty foot mechanics where the arch has collapsed due to a common condition known as overpronation.  Overpronation can be corrected by prescribing custom-made orthotics.  Dr. Hardy's Toronto Foot Clinic has been specializing in orthotics since 1980.  We only use high quality labs to provide our pations with high quality custom orthotics.  

If you or a loved one requires honest, competent advice or quality foot care or orthotics, please do not hesitate to contact us at 416-465-8737.


Toronto, ON Chiropodist Academy Foot and Orthotic


Across from the Broadview Subway Professional  Family  Foot  Care