Associate Physiotherapist · AHPRA registered · PHY0004077394

Sebastian Ignacio Oyarzo Lizama is a graduate physiotherapist with a Bachelor's degree in Physiotherapy from Universidad Del Desarrollo and a Master's in Clinical Exercise Physiology from Universidad Mayor, with a focus on musculoskeletal physiotherapy, metabolic health, and preoperative rehabilitation. With eight years of clinical experience in Santiago at Clínica Dávila and Nutrimet, he developed experience in managing obesity and metabolic syndrome through therapeutic exercise, surgical prehabilitation, and postoperative orthopaedic rehabilitation, whilst building a private practice treating sports injuries and joint trauma using manual therapy and evidence-based exercise prescription. Now practising in Sydney under AHPRA Limited Registration for Supervised Practice, he serves patients requiring chronic disease management and metabolic health optimisation, drawing on his diverse background that includes work with a national football selection team and gait analysis research at Macquarie University

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Last reviewed: 20 September 2026

Knee Pain: Causes, Diagnosis, and Treatment: What to Expect

At Physio K in Bondi Junction, we see knee pain every week: runners who cannot finish their long runs, tradespeople who cannot kneel through a full day on site, parents who cannot get down on the floor with their kids without wincing. Knee pain is discomfort in or around the knee joint, often caused by cartilage wear, inflammation, ligament strain, overuse, or changes in how the joint moves and loads. Most knee pain responds well to physiotherapy-led treatment centred on strengthening, movement retraining and gradual return to activity, with many people experiencing meaningful improvement within six to twelve weeks.

Knee Pain: Causes, Diagnosis, and Treatment: What to Expect

Understanding knee pain

Knee pain is the body's signal that something in or around the joint is under strain. The knee sits between the thigh bone and shin bone, with the kneecap at the front. Smooth cartilage covers the bone ends, allowing them to glide, while ligaments hold the joint together and control movement. Tendons attach muscles to bone, and fluid-filled sacs called bursae cushion the moving parts.

When cartilage wears thin, bones can rub together, causing pain, stiffness and swelling. This gradual wear is called osteoarthritis, one of the most common reasons for ongoing knee pain, particularly in people over 45. In younger, active people, knee pain often comes from overloading tissues: the tendon connecting the kneecap to the shin can become irritated, the band of tissue running down the outside of the thigh can rub against bone, or cartilage under the kneecap can become painful from how it tracks across the joint.

Ligament injuries from falls, tackles or sudden twists can make the knee feel unstable. Meniscal tears, damage to the crescent-shaped cartilage pads inside the joint, can cause locking, catching or deep ache. Sometimes the problem is not in the knee itself but in how the person moves: weakness in the hip or tightness in the calf can change how force travels through the leg, and the knee pays the price.

Most of the knee pain we treat here comes through two doors. The first is sport: runners, soccer and rugby players, tennis and basketball players, people who have rolled an ankle into a knee, taken a bad tackle, or ramped up training too fast and picked up a niggle that turned into something more serious. The second, and honestly more common, is the slow burn: people who have had a knee that is "not quite right" for months or years, managed it, worked around it, and finally hit a point where it has stopped them doing something they care about. That is usually what brings them in the door, not the pain itself but what it is taking from them. Someone who cannot finish their long run anymore. A tradesperson who cannot kneel through a full day on site. A parent who cannot get down on the floor with their kids without wincing. We see the full range, from weekend athletes chasing a personal best to people who just want to walk the dog without their knee locking up.

What it feels like: symptoms

• Aching or sharp pain around the front, sides or back of the knee

• Pain going up or down stairs

• Pain when squatting, kneeling or standing for long periods

• Stiffness in the morning or after sitting

• Difficulty straightening or bending the knee fully

• Swelling or warmth around the joint

• Clicking, grinding or catching sensations

• A feeling that the knee might give way

• Reduced confidence in balance or weight bearing

• Tiredness in the thigh or calf muscles

What causes knee pain and who gets it

Knee pain arises from changes in the joint itself, strain on surrounding tissues, or the way the leg moves and loads. In osteoarthritis, cartilage gradually thins, bone underneath remodels, and the joint lining can become inflamed, all of which drive pain, stiffness and reduced function. In younger people, pain more often comes from overloading tendons, irritating cartilage under the kneecap, or straining ligaments.

According to research published in the Internal Medicine Journal (2022), an estimated 1.9 million Australians were living with knee osteoarthritis in 2019, representing a 126 per cent increase since 1990. Knee pain is one of the most common reasons people seek physiotherapy, affecting people across the age range: sports injuries peak in the teens to forties, while wear-and-tear pain becomes more common from the mid-forties onward.

Extra body weight increases load through the knee with every step, and people carrying more weight are at higher risk of both developing knee pain and finding it harder to settle. Weak muscles in the thigh, hip or calf mean the knee absorbs more force than it is built for. Jobs involving kneeling, squatting, heavy lifting or long hours standing, such as trades, nursing, retail and warehousing, place repeated stress on the joint. Athletes in running, jumping and pivoting sports are at higher risk of acute ligament or meniscal injuries and overuse problems.

Age is a non-modifiable factor: cartilage changes accumulate over time, and osteoarthritis becomes more common from the mid-forties. Women are more likely to develop knee osteoarthritis than men. A history of knee injury, particularly ligament tears or fractures, increases risk of ongoing pain and earlier joint wear. Some people are born with variations in joint shape or alignment that alter how load is distributed, and genetics play a role in who develops osteoarthritis.

Pain typically worsens with prolonged walking or standing, stairs, running, jumping, kneeling, deep squatting, and carrying heavy loads. Cold weather and sitting still for extended periods can stiffen the joint. Poor sleep, stress and worry amplify the pain experience, which is why good rehabilitation programmes address not just the knee but the whole person.

How knee pain is assessed

The first thing we do is figure out whether this is genuinely a knee problem or a knee that is paying the price for something happening elsewhere. Sometimes it is straightforward: a torn or damaged meniscus, a ligament injury from a fall, a clear structural issue in the joint itself. But more often than not, especially with things like ITB syndrome, the knee is just the messenger. We will always check the lower back, pelvis and foot, because the fascia runs through all of it, and tightness or weakness in those areas almost always shows up downstream at the knee. Treating the knee in isolation in those cases just does not hold, the problem comes straight back.

So we check both static posture and how someone actually moves: how they squat, how they load through a step down, how their gait changes under fatigue. That is usually where the real story is, not in how the knee looks sitting still on the table.

We check the joint for swelling, warmth, tenderness along the joint line, and any clicking or grinding when you bend and straighten it. We test strength of the muscles controlling the knee, hip and ankle, and we look at flexibility in the calf, thigh and hip. We assess how stable the ligaments are, whether the kneecap tracks smoothly, and whether certain movements reproduce your pain.

Scans are not always needed. The biggest misconception is that knee pain means something is damaged and running or playing sport is now off the table for good. People come in assuming an MRI is the first step and that whatever it finds will be the end of their season, or worse, the end of the sport altogether. In reality, a lot of knee pain, especially the overuse kind, is a loading problem rather than a structural one. The knee is not broken, it has just been asked to do more than the tissues around it were ready for. Scans often show things like mild wear or changes that are completely normal for someone's age and activity level, and not actually the cause of their pain.

We order imaging when we need to rule out something serious, when there has been significant trauma, or when symptoms are not improving as expected despite good rehabilitation. But the scan does not dictate treatment. What matters is how the knee is functioning, what you can and cannot do, and whether we can rebuild the capacity to do the things you care about.

How knee pain is treated

Treatment centres on helping the knee tolerate load again, rebuilding strength and control, and gradually returning you to the activities that matter. Exercise is the foundation. We start with exercises that strengthen the muscles around the knee, the thigh, the hip and the calf, without aggravating pain. These might be done lying down or sitting at first, then progressing to standing, single-leg work, and eventually movements that mimic your sport or job.

Strengthening the muscles that straighten the knee is particularly important, because those muscles support the joint and take pressure off the cartilage. Hip strengthening matters too, especially for runners and people with pain at the front of the knee, because weak hips change the way the leg aligns and load the knee unevenly. Calf work helps with balance, shock absorption and pushing off when you walk or run.

We also work on flexibility where needed, particularly in the calf and the muscles at the front and back of the thigh, and on balance and coordination, so the knee stays stable under load. Neuromuscular training, exercises that challenge your balance and teach the muscles to fire in the right order, is especially useful for people returning to sport or anyone who feels their knee might give way.

A 2023 systematic review published in Arthroscopy, Sports Medicine, and Rehabilitation found that structured exercise therapy produces approximately 20 to 30 per cent improvement in pain and function for knee osteoarthritis, with definite evidence of benefit. That same review found knee braces, when appropriately selected and used, can reduce pain by around 10 to 25 per cent, and topical or oral anti-inflammatory medications provide roughly 20 to 30 per cent pain reduction.

Manual therapy, hands-on techniques to mobilise the joint and release tight tissues, can support pain relief and movement, but it is not a standalone solution. We use it to help you move better so you can do the exercises that will actually change the problem. Taping the kneecap or the joint can provide short-term support and feedback. Heat or ice can ease pain and stiffness.

Education is essential. Understanding what is happening in your knee, what pain means and does not mean, how to pace your activity, and how to manage flares gives you control over the problem. Load modification, adjusting your training volume, work tasks or movement strategies, is often the difference between a knee that settles and one that does not.

Your GP may recommend paracetamol or non-steroidal anti-inflammatory drugs, either as tablets or creams, to help manage pain while you rebuild strength. In some cases, a corticosteroid injection into the joint can provide short-term relief, usually lasting four to six weeks, which can be a useful window to engage with rehabilitation. Surgery, most often knee replacement or joint-preserving procedures, is considered when pain and functional limitation remain severe despite well-delivered conservative care.

Different approaches at Physio K

At Physio K, we offer both physiotherapy and massage therapy, and the two work well together for knee pain. Physiotherapy focuses on assessment, diagnosis, exercise prescription and progressive loading: we work out what is driving the pain, build a strengthening and movement programme tailored to your knee and your goals, and guide you back to the activities you need or want to do.

Massage therapy complements that by addressing muscle tension, tightness and trigger points in the thigh, calf, hip and lower back, all of which can contribute to how the knee moves and feels. Tight muscles can alter joint mechanics and increase load on the knee, and releasing that tension can improve your movement quality and reduce pain, making it easier to engage with the exercise programme. Massage also supports recovery, reduces muscle soreness after training or rehabilitation sessions, and helps maintain tissue health.

Many patients benefit from both: physiotherapy to rebuild capacity and control, and massage therapy to keep the surrounding tissues supple and responsive. The two approaches work toward the same goal from different angles, and we coordinate care so each supports the other.

What the research shows

The evidence for exercise-based physiotherapy in knee pain, particularly knee osteoarthritis, is strong and consistent. The Australian Commission on Safety and Quality in Health Care (2025) recommends that all adults aged 45 years and over with suspected knee osteoarthritis receive core non-surgical care including education, exercise, weight management and pain relief, with timely consideration of joint replacement only after optimised conservative management. This national clinical care standard places physiotherapy at the centre of first-line treatment.

According to a narrative review published in the Journal of Orthopaedic Experience & Innovation (2022), strong or moderate evidence supports strengthening and self-management programmes, low-impact aerobic exercise, neuromuscular education, weight loss where body mass index is above 25, and anti-inflammatory medications as core non-surgical treatments for knee osteoarthritis.

A position statement from Exercise & Sports Science Australia (2022) states that clinical practice guidelines for hip and knee osteoarthritis consistently identify physical activity and structured exercise as fundamental components of evidence-based management, and support physiotherapist-led programmes to deliver these interventions. The statement emphasises that exercise is not just for mild disease: it is effective across the spectrum of severity, and should be offered before considering surgery.

Typical timelines vary by condition and individual, but many people experience meaningful improvements in pain and function over six to twelve weeks of consistent, progressive rehabilitation, with ongoing gains over several months. Some people improve faster, particularly if they engage early and the problem is mainly one of load management. Others, especially those with more advanced osteoarthritis or multiple contributing factors, may take longer to reach their goals, but most still gain function and reduce pain enough to avoid or delay surgery.

When to seek urgent help

Most knee pain is not an emergency, but certain symptoms require prompt medical assessment. Seek urgent help if you experience sudden severe pain and swelling after trauma, particularly if you cannot bear weight or the knee feels very unstable. Inability to straighten the knee, or a locked feeling where it will not move, can indicate a meniscal tear or loose body in the joint and should be assessed promptly.

A hot, swollen, red knee with fever or feeling acutely unwell may signal infection or inflammatory arthritis and requires same-day medical review. Severe night pain unrelieved by rest, unexplained weight loss, or a history of cancer warrant urgent investigation to rule out serious underlying pathology. Numbness, tingling, weakness or colour change in the leg or foot may indicate nerve or blood vessel involvement and should be assessed immediately.

If you are unsure whether your symptoms are urgent, contact your GP or call Healthdirect on 1800 022 222 for 24-hour advice.

Cost and funding in Australia

Physiotherapy for knee pain is typically funded through several pathways. If you have a chronic condition, your GP can prepare a Chronic Disease Management Plan, which may allow you to access up to five Medicare-rebated allied health sessions per calendar year. A gap payment usually applies, as the Medicare rebate does not cover the full consultation cost.

If you hold private health insurance with extras cover, you may be able to claim part of the cost of physiotherapy and massage therapy, depending on your level of cover and any waiting periods or annual limits. Check with your insurer before your first appointment.

For work-related knee injuries, WorkCover may fund your treatment if your claim is accepted. If you are an NDIS participant, physiotherapy may be funded under your plan where it is reasonable and necessary to meet your goals.

Self-funded appointments are also available. Contact Physio K to discuss current fees, rebate arrangements and payment options.

Common questions

Is my knee going to get worse if I exercise on it?

No, appropriate exercise does not wear the joint out. In fact, the opposite is true: controlled, progressive loading strengthens the muscles that support the knee, improves joint nutrition, and reduces pain. A lot of knee pain, especially the overuse kind, is a loading problem rather than a structural one. The knee is not broken, it has just been asked to do more than the tissues around it were ready for. We start with exercises you can tolerate, then gradually build from there, monitoring your response and adjusting the load as you improve.

Is there any point trying physiotherapy if I have "bone on bone" arthritis?

Yes, absolutely. Even when X-rays show significant cartilage loss, exercise and physiotherapy can reduce pain, improve function and help you stay active. Scans often show things like mild wear or changes that are completely normal for someone's age and activity level, and not actually the cause of their pain. Strengthening the muscles around the knee takes pressure off the joint, improves how it moves, and gives you better control and confidence. Many people with advanced osteoarthritis on imaging respond well to rehabilitation and avoid or delay surgery for years.

Will rest fix my knee pain?

The other misconception is that rest is the answer. People stop running or stop playing entirely, wait for the pain to go away, and then get straight back into full training the moment it settles, which is exactly how the same issue comes straight back. Getting better is not about avoiding load, it is about rebuilding capacity in the right way and at the right pace, so the knee can handle what you are asking of it again. We use relative rest, meaning you modify or reduce the activities that aggravate the pain while maintaining other movement and starting a targeted strengthening programme.

This article is for general information only and is not a substitute for personal medical advice. If you have concerns about your health, please consult a qualified clinician or your GP.