Knee Pain: Causes, Physiotherapy Exercises and When Surgery Is Actually Needed

Knee pain is one of the most common musculoskeletal complaints in India — affecting young athletes, middle-aged professionals, and elderly patients with osteoarthritis. At Sri Anand CNC's physiotherapy department, Dr. Harisha sees knee pain across all age groups, and the approach differs significantly depending on the underlying cause.

Most Common Causes by Age Group

Young adults (15–35): Patellofemoral pain syndrome (anterior knee pain behind the kneecap — very common in runners, cyclists, and people who climb stairs); patellar tendinopathy (jumper's knee — pain at the bottom of the kneecap); iliotibial band syndrome (lateral knee pain); meniscal tears from sports injuries.

Middle age (35–60): Osteoarthritis beginning (medial compartment typically — inner knee pain with stairs and prolonged walking); meniscal degeneration; pes anserine bursitis (inner side of knee below joint — misdiagnosed as knee OA).

Elderly (60+): Knee osteoarthritis — the most common cause. Characterised by: morning stiffness under 30 minutes, crepitus (grinding), pain worse with activity and better with rest, bony enlargement of the joint.

Why Physiotherapy Is the First-Line Treatment (Not Surgery)

For knee osteoarthritis — which accounts for most knee surgery referrals — physiotherapy is as effective as arthroscopy for most patients. A landmark RCT (the METEOR trial) showed that physiotherapy produces outcomes equivalent to arthroscopic surgery for osteoarthritis. The key: quadriceps strengthening. Every 1kg of quad strength gained reduces knee compressive forces during walking by 4–8kg. Weak quads are the single most modifiable factor in knee OA progression.

Core Knee Physiotherapy Exercises

• Straight leg raise: Lying flat, tighten quad, lift leg 30cm, hold 5 seconds. 3 sets × 15 reps. Fundamental quadriceps exercise for all knee conditions
• Quad sets: Sitting or lying, press knee firmly into the floor/bed, hold 5 seconds. Activates VMO (inner quad)
• Seated knee extensions: Using resistance band or weight machine — only in pain-free range
• Step-ups: 15cm step, controlled single-leg step up and down — powerful functional quad exercise
• Swimming and cycling: Low-impact aerobic exercise that maintains quad strength without compressive joint loading

When Surgery Is Warranted

Total knee replacement is appropriate when: pain is severe and constant (including at rest); quality of life is substantially impaired; there is end-stage OA on X-ray (bone-on-bone); and a 6-month structured physiotherapy programme has not provided adequate relief. Surgery is not a shortcut — post-operative physiotherapy is essential for recovery, and patients who have strong quads before surgery recover faster.

For knee pain assessment and physiotherapy: Dr. Harisha at Sri Anand CNC, Chanda Nagar, Hyderabad. Call +91 90633 66983.