For a knee to work well we need good function in the bones, cartilage, ligaments, tendons, and muscles attaching to the area. There are many different presentations of knee pain, each with its own set of characteristics, causes, and solutions/management options. It can be a bit of a minefield trying to find the best course of action when dealing with knee pain, so here's a breakdown of the symptoms, causes and treatment options familiar to me.
NOTE: If you are a therapist who uses acupuncture, massage and/or strength and conditioning - the treatment suggestions may be something you can integrate into your practice. If you are a sufferer of knee pain, please visit a qualified therapist who will be able to determine the best treatment for you.
Causes & Symptoms of Knee Pain
Anterior Knee Pain (Front of the Knee)
Patellofemoral Pain Syndrome (Runner’s Knee) – Dull, aching pain around the kneecap, worsens with stairs, squatting, or prolonged sitting. Often due to overuse, muscle imbalances, or poor biomechanics.
Patellar Tendinitis (Jumper’s Knee) – Sharp pain at the patellar tendon (just below the kneecap), especially when jumping or running. Caused by overuse and tendon strain.
Osgood-Schlatter Disease – Common in adolescents, causes pain and swelling just below the kneecap due to irritation at the tibial growth plate.
Medial Knee Pain (Inside of the Knee)
Medial Collateral Ligament (MCL) Injury – Pain along the inside of the knee, often after a twisting injury or direct impact. May feel instability.
Meniscus Tear (Medial Side) – Sharp or aching pain along the joint line, sometimes with locking or clicking. Usually from twisting motions.
Pes Anserine Bursitis – Pain and tenderness on the lower inside of the knee, worsens with activity or kneeling. Caused by irritation of the bursa.
Lateral Knee Pain (Outside of the Knee)
Iliotibial Band Syndrome (ITBS) – Burning or sharp pain on the outer knee, worsens with running or downhill walking. Caused by friction of the IT band over the lateral femoral condyle.
Lateral Meniscus Tear – Pain, swelling, and possible locking on the outer side of the knee, often following a twisting injury.
Posterior Knee Pain (Back of the Knee)
Baker’s Cyst – Swelling and tightness behind the knee, often from fluid buildup due to arthritis or a meniscus tear.
Hamstring Tendinopathy – Pain and tenderness at the back of the knee, worsens with stretching or running.
Posterior Cruciate Ligament (PCL) Injury – Deep knee pain, often from falling on a bent knee or a direct blow to the shin.
General or Diffuse Knee Pain
Osteoarthritis – Gradual onset of stiffness and aching pain, often worse in the morning or after activity.
Rheumatoid Arthritis – Symmetrical joint pain with swelling and stiffness, especially in the morning.
Gout – Sudden, severe pain with redness and swelling, usually due to crystal buildup in the joint.
How to Identify the Cause
Pain with movement or load-bearing → Possible ligament or cartilage injury.
Pain with prolonged sitting or stairs → Likely patellofemoral pain syndrome.
Swelling and stiffness → Possible arthritis or meniscus injury.
Sharp pain with instability → Likely ligament damage.
Burning pain on the outer knee → Suggests IT band syndrome.
Some knee issues are best diagnosed with some form of scan or specialist investigations so if in doubt, seek advice from your GP.
Treatment Options for Knee Pain
Anterior Knee Pain (Front of the Knee)
Patellofemoral Pain Syndrome (Runner’s Knee)
Acupuncture: Targets trigger points in the quadriceps, vastus medialis, and IT band to reduce tension and improve patellar tracking. Electroacupuncture can help reduce inflammation.
Massage: Focus on quadriceps, IT band, and hip flexors to relieve tension.
Other: Strengthening glutes and quads, taping to offload the kneecap, and avoiding excessive kneeling/squatting.
Patellar Tendinitis (Jumper’s Knee)
Acupuncture: Needling around the patellar tendon and quadriceps can promote healing and reduce pain.
Massage: Deep friction massage to the patellar tendon and myofascial release for quads.
Other: Eccentric loading exercises (decline squats) and ice for acute flare-ups.
Osgood-Schlatter Disease (adolescents)
Acupuncture & Massage: Gentle techniques to release quadriceps tension.
Other: Activity modification (reducing running/jumping), knee padding, and stretching.
Medial Knee Pain (Inside of the Knee)
MCL Injury
Acupuncture: Local needling to reduce swelling and improve circulation.
Massage: Lymphatic drainage and gentle cross-fiber friction for healing.
Other: Bracing, gradual return to weight-bearing, and strengthening of adductors/quadriceps.
Meniscus Tear (Medial)
Acupuncture: Target ST35, Xiyan points, and medial knee joint to ease pain.
Massage: Around the joint, avoiding direct pressure on the meniscus.
Other: Strengthening hip and knee stabilizers, avoiding deep squats.
Pes Anserine Bursitis
Acupuncture: Needling at the pes anserine insertion to reduce inflammation.
Massage: Releasing hamstrings, sartorius, gracilis, and semitendinosus.
Other: Ice, anti-inflammatory diet, and correcting foot mechanics.
Lateral Knee Pain (Outside of the Knee)
Iliotibial Band Syndrome (ITBS)
Acupuncture: Needling along or adjacent to the IT band, tensor fascia lata (TFL), and glute medius muscles to release tightness.
Massage: IT band, glutes, TFL, and lateral quad release.
Other: Hip strengthening (especially glute medius), foam rolling, and gait correction - podiatrists are often a good resource here.
Lateral Meniscus Tear
Acupuncture: Electroacupuncture to lateral knee points for pain relief.
Massage: Around the joint but avoiding pressure on the meniscus itself.
Other: Partial weight-bearing if painful, strengthening quads and glutes.
Posterior Knee Pain (Back of the Knee)
Baker’s Cyst
Acupuncture: To promote fluid drainage and reduce inflammation.
Massage: Gentle lymphatic drainage massage.
Other: Address underlying cause (e.g., arthritis or meniscus tear), avoid prolonged standing.
Hamstring Tendinopathy
Acupuncture: Target hamstring attachment points to stimulate healing.
Massage: Deep tissue work for hamstrings and calves.
Other: Isometric strengthening, eccentric loading, avoiding excessive stretching.
Posterior Cruciate Ligament (PCL) Injury
Acupuncture: Needling around popliteal fossa and PCL attachment points.
Massage: Myofascial release for hamstrings and calves.
Other: Gradual strengthening and proprioceptive training.
General or Diffuse Knee Pain
Osteoarthritis
Acupuncture: Electroacupuncture for pain relief and cartilage protection.
Massage: Myofascial release for surrounding muscles.
Other: Weight management, joint mobilization, and hydrotherapy.
Rheumatoid Arthritis
Acupuncture: Helps reduce inflammation and joint pain.
Massage: Gentle lymphatic work.
Other: Avoid inflammatory foods, maintain joint mobility.
Gout/Pseudogout
Acupuncture: To reduce inflammation and support kidney function.
Massage: Avoid during flare-ups but useful in between episodes.
Other: Hydration, avoiding purine-rich foods.
What Treatment Works Best?
Acupuncture is great for pain relief, inflammation control, and restoring muscle balance. For pain relief, acupuncture can use the channel system or methods such as Dr Tan's Balance Method to reduce pain by inserting needles away from the knee area.
Massage helps release tight muscles and improve circulation to injured areas.
Exercise therapy is key for long-term recovery and preventing recurrence.
Lifestyle modifications (diet, footwear, and movement patterns) also play a big role.
Finding the most suitable treatment can be challenging when it comes to knee pain. These are options I know are successful and I either use at my clinic in York or are familiar solutions that have worked for my patients. I will suggest acupuncture and/or sports massage where appropriate and give basic exercises for strength and conditioning. If more conditioning or strengthening work is necessary there is a number of experienced physios and sports therapists at Excel Sports Clinic that I would be happy to refer you to. Often a combination of approaches is necessary to deal with the root causes, the symptoms and long term prevention of a knee injury.