Did you know that your knees absorb about one-and-a-half times your body weight every step?
As the largest joint in our body, our knees are essential to the overall health of our bodies. Knees act as a hinge joint and permits flexion and extension. Additionally, the knee helps allow for side-to-side rotation. Knees allow us to perform horizontal movements, like running or walking, and vertically, like jumping.
Because of our reliance on knees, and its complexity, they’re often the source of many foot conditions, either directly or indirectly. As the gateway between our thighs and lower legs, all muscles run through, or adjacent to the knee, meaning prevention is absolutely necessary for overall leg health.
If you do experience pain, below are some reasons for why your knee hurts:
Common conditions
Your Knee Hurts Because…Patellofemoral pain syndrome
Patellofemoral pain syndrome, also known as runner’s knee, is the most common knee injury. Considering its nickname, it should come as no surprise that many runners and athletes experience patellofemoral pain syndrome.
Patellofemoral pain syndrome is a relatively broad term for any pain in the front of your knee. The main symptom is pain felt in front of the knee and around the kneecap.
The following activities may trigger pain:
- Walking up or downstairs
- Kneeling or squatting
- Sitting with a bent knee for long periods of time
There are a number of causes for patellofemoral pain syndrome including:
- Overuse. Repetitive activity can cause irritation under the kneecap. Running for extended periods of time, or through pain, is one common cause. Sports that involve a log of jumping can also cause patellofemoral pain syndrome.
- Muscle imbalances or weaknesses. Muscular imbalances of the hips or knees can cause overcompensation and undue stress on your knees. Weakness in the hips will cause the knees to take on more load and be prone to more injury.
Note that causes may also include acute injuries such as trauma or surgery.
Fortunately, treatment for runners knee can, for the most part, be done at home. Following the PEACE & LOVE method can be effective in keeping inflammation down and allowing your muscles to recover. PEACE & LOVE is a modern approach to managing soft tissue injuries that emphasizes both immediate care and long-term rehabilitation. PEACE—Protect, Elevate, Avoid anti-inflammatories, Compress, and Educate—applies in the first few days after injury to control swelling and protect the tissue while supporting natural healing. LOVE—Load, Optimism, Vascularization, and Exercise—guides the rehabilitation phase, encouraging gradual loading of the tissue, maintaining a positive mindset, improving blood flow through movement, and progressively strengthening the injured area to restore full function and prevent re-injury.
You can also try using a knee brace if you feel like your knee is not getting proper support.
In terms of prevention, there are a number of steps you can take:
- Strength training. Keeping your muscles that surround the knees strong is crucial. Ensure you perform each strength exercise slowly and with proper form. Otherwise, your knee will compensate for poor form, which can cause pain and lead to injury.
- Return from injury slowly. Now that you’ve rehabilitated, you’re ready to return to activity. But, your body may not be 100% ready to return to pre-injury form right away. Build up slowly, and make continuous checks of your knee to ensure you improve gradually. If you’re returning to running, follow the 10% rule which states that you should not increase your weekly mileage by more than 10% per week.
- Find the right shoes. Research the type of shoes you need for your foot type. You may be better off with motion control or stability shoes, or neutral cushioned shoes might be best. If you have any doubt, visit the clinic for a full gait analysis and we’ll put you into proper footwear.
- Warm-up. Perform dynamic stretches and light exercises before you exercise so your muscles are warmed up, and firing properly. Cold muscles can lead to poor form, and compensating in areas.
Your Knee Hurts Because…Patellar tendonitis
Patellar tendonitis is a common injury for why your knee hurts that affects the patellar tendon, the tendon that connects your kneecap to the shin bone. The tendon allows the knee to straighten and is crucial for movement and stability. Symptoms include pain and swelling under the kneecap, pain during activity or when rising from a squat.
As with many knee injuries, patellar tendonitis is often seen among runners, and pain can worsen when using stairs, excessive use, and sitting for long periods of time. Approximately 25% of knee injuries are diagnosed as patellar tendinitis.
The following symptoms can be a sign of patellar tendonitis:
- Pain under the kneecap
- Inflammation and tenderness in the front of the knee
- Difficulty walking or doing sports activities
- Difficulty climbing or descending stairs
- Pain when bending the knee
Common causes of patellar tendonitis include:
- Trauma
- Increased training
- Weak quadriceps muscles
To treat tendonitis:
- Follow the PEACE & LOVE method (above) for rehabilitation – do not ice the injury.
- If you’re a runner, cross-train by swimming, cycling, or using the elliptical to reduce the load on the tendon
- Seek medical advice
Like many knee injuries, preventative methods include:
- Strength training
- Stretching your quads and hamstrings to reduce the pressure on the knee, and the patellar tendon
- Foam rolling
Your Knee Hurts Because…IT Band Syndrome
IT Band syndrome (short for Illiotibial band syndrome) is a common knee injury characterized by inflammation and friction of the IT band. The IT band runs along the outside of the thigh from the hip to the knee and is crucial as a stabilizer for the knee. Symptoms include:
- Pain on the outside of the knee, which can shoot up the thigh
- Click or popping felt around the outer knee
Initially pain is felt after activity, but later can occur during activity.
IT band syndrome arises out of overuse as the band crosses back and forth. This injury is particularly prominent in:
- Long-distance running
- Those who have increased hip internal rotation and knee adduction
- Cycling
- Weight-lifting
Although the IT band extends the entirety of the leg, pain is typically felt most common on the outside of the knee, and around 30 degrees of knee flexion.
IT band syndrome, although one of the most common running injuries, can be treated with physical therapy, as well as PEACE & LOVE (PEACE – Protect, Elevate, Avoid anti-inflammatories, Compress, and Educate—applies in the first few days after injury to control swelling and protect the tissue while supporting natural healing. LOVE—Load, Optimism, Vascularization, and Exercise—guides the rehabilitation phase).
Try the following preventative and treatment methods to keep IT band syndrome at bay:
- Anti-inflammatories
- PEACE & LOVE: Protect, Elevate, Avoid anti-inflammatories, Compress, Educate & Load, Optimism, Vascularization, Exercise
- Foam rolling: self-massage your IT band by applying pressure to it with foam rolling. Avoid directly foam rolling the IT band as it can aggravate or worsen symptoms. Target foam rolling the surrounding muscles, such as the glutes, Tensor Fascia Lata and quads. Use a foam roller 3x daily for around 3-5 minutes. Read more in our complete foam rolling guide.
- Stretching: Focus on stretching the hips, glutes and thighs.
- Strength training: The most crucial step is to focus on strengthening the gluteus medius muscles to prevent the hips from collapsing inwards. You can target these areas by using a resistance band and performing some of these daily foot exercises.
Your Knee Hurts Because…Osteoarthritis
Knees are susceptible to osteoarthritis, a type of joint disease that results from cartilage breakdown between bones. Osteoarthritis (OA) is often known as wear-and tear arthritis as its associated with overuse. The knees are susceptible to OA because the cartilage between the bones of the knee joint will wear out over time and use.
You may be at higher risk of osteoarthritis if you fall into any of the following categories:
- Age: many people 70+ have osteoarthritis
- Sex: women are more likely than men to suffer from OA, especially in the knees.
- Previous trauma: joint injury can change joint alignment and cause more overuse in certain areas
- Weight: increased weight will increase the load on the joints, causing the earlier onset of osteoarthritis.
- Biomechanics: deviations in the knee joints can cause excess wear on certain joint areas, for example, genu valgum (knees come inwards) and genu varum (knees going outward).
As osteoarthritis is a progressive disease, the effects will likely worsen over the years. But, that doesn’t mean you cannot delay the onset of pain.
Some common treatment options include:
- Physical activity: light activity keeps joints and muscles lubricated. If impact sports aggravates your injury, try swimming or another form of non-weight-bearing activity.
- Anti-inflammatories
- Soft surfaces: running on grass or on the treadmill can lessen the load of sports
WebMD has a useful self-assessment tool that can offer a glimpse into why your knee may be hurting. Of course, use the tool only for reference, and do not take it as medical advice.
