When you’re exercising (whether it’s running, training in the gym, bush walking or however you like to move) the last thing you want is knee pain! It’s unfortunately a common complaint. Knee pain can be a result of lots of different things. Different structures in your knee can become sore for different reasons.
Knowing what’s causing your knee pain is crucial if you want to recover well. You need to match the treatment to the problem to be successful in this.
Here’s some things we as physios consider when trying to diagnose knee pain that develops while exercising.
1.Where do you hurt?
The location of your pain is key. Obviously it’s your knee that’s sore – but where exactly does it hurt? Is it at the front, side back of your knee? Does it feel deep or towards the surface? Is it a small localised spot or more diffuse and spread out? Does your calf/hamstring or low back also hurt?
Some common diagnoses based on pain location patterns of knee pain that develops slowly over time… (by no means is this a sure thing. Diagnosis requires a lot more than pain location!)
- Patella Tendinopathy – Small localised (20 cent coin size) pain at the front of your knee below your knee cap.
- Patella femoral pain syndrome (PFPS) – diffuse (spread out) pain at front of your knee.
- ITB friction syndrome – diffuse pain at the outside of your knee
- Lumbar spine referred knee pain – Diffuse pain that can change locations (often associated with either pain or tightness elsewhere in the leg or your back)
- Mechanical knee pain – deep pain (can vary in location)
2. How did the pain start?
Did the pain come on all of a sudden or did it develop slowly over time? Was there a particular movement that triggered it or did it develop for no apparent reason?
One of the more common causes of knee pain while exercising is due to variations in training loads. Spikes in training load often precedes certain types of knee pain (things like patella tendinopathy or ITB friction syndrome). These spikes in load can have a bot of a time delay though. For example: you started running hills and added an extra tempo run 3-4 weeks ago and now you’re starting to notice pain at the front of your knee when descending stairs.
Knee pain that develops with a drop in training load or with an increase in sedentary activity is a more common cause of low back referred knee pain or mechanical knee pain. Think: busy work load meant more time at the office or long car trips meant extended periods in a seated posture.
Sometimes scrolling back through your calendar to see what and how much you’ve been doing over the last weeks/months can be a really useful way to know if there’s been a load spike or drop.
3. What things make it feel better or worse
Aggravating activities can tell you a lot about what’s the cause of your pain. Different types of knee pain will be aggravated by different types of activities. Some diagnoses are very consistent (every time you do this activity it hurts) some are variable (sometimes it hurts when I do this but not always).
Here’s a list of common things that aggravate the above knee diagnoses…
Generally consistent pain responses:
- Patella Tendinopathy – jumping++, running fast or downhill, 24 hours later
- Patella femoral pain syndrome (PFPS) – running, up/down stairs,
- ITB friction syndrome – bending/straightening knee (especially in the last 30 degrees of knee straightening)
Generally variable pain responses:
- Lumbar spine referred knee pain – sitting down, first few steps after rising
- Mechanical knee pain – transitioning from bent to straight
These three questions give a lot of information about the most likely cause of your knee pain. But it’s definitely not exhaustive. In a physio consultation we’ll take all this information into account and that would guide the types of tests we’d then conduct to confirm a diagnosis and then develop a management plan.