Knee Pain: Causes, Diagnosis and Rehabilitation

Sommario

Introduzione: Anatomia e Biomeccanica del Ginocchio
Protesi di GinocchioLesione del Legamento Ginocchio nel CorridoreLesione del MeniscoDolore al Dolore al Tendinite RotuleaCase Study: Ricostruzione del LCADolore al Ginocchio: Cause e Rimedi

Crociato Anteriore (LCA)

Ginocchio dopo lo Sci
Quando Rivolgersi al Fisioterapista
Domande Frequenti (FAQ)

Introduzione: Anatomia e Biomeccanica del Ginocchio
Knee pain: The knee is the largest and one of the most complex joints in the human body. The knee is also one of the structures that most frequently brings patients into a clinical setting — from young athletes to the elderly with osteoarthritis, from amateur runners to post-surgical patients.
The knee joint is formed by the meeting of three bones: the femur, the tibia, and the patella (kneecap). Stability is ensured by a complex ligamentous system that includes the cruciate ligaments (anterior and posterior), the collateral ligaments (medial and lateral), and the capsular complex. The menisci — medial and lateral — are crescent-shaped fibrocartilaginous pads that absorb loads, distribute pressure, and contribute to joint stability.
The knee bears enormous loads during daily activities: up to 3-4 times body weight during walking and up to 7-8 times during running or jumping. This constant mechanical stress explains the frequency of pathologies affecting it. In this comprehensive guide, we will analyze the most common problems, from acute injuries to overuse pathologies, offering information on symptoms, diagnosis, and rehabilitation pathways based on the best available scientific evidence for each.

Dolore al Ginocchio: Cause e Rimedi
Knee pain is a symptom, not a diagnosis. In daily clinical practice, the first task is always to precisely identify the cause of the pain, because the therapeutic strategy entirely depends on it. The causes of knee pain are numerous and can be classified based on the mechanism (traumatic vs. overuse vs. degenerative) and the structure involved.
Traumatic causes include ligamentous injuries, meniscal injuries, and fractures, often resulting from sports trauma or accidents. Overuse pathologies include tendinopathies, bursitis, and friction syndromes, typical in those who engage in repetitive activities. Degenerative causes, primarily osteoarthritis, predominantly affect the over-50 population and represent one of the main causes of functional disability.
The location of the pain already provides a first important diagnostic clue: anterior pain suggests a patellofemoral or tendinous problem, medial pain points towards meniscopathy or collateral ligament injury, lateral pain may indicate iliotibial band syndrome. Physiotherapy assessment includes specific clinical tests, movement analysis, and, when necessary, referral for targeted instrumental investigations.
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Lesione del Menisco
The menisci are fundamental structures for knee health, and their injuries represent one of the most frequent pathologies in orthopedics. The medial meniscus, being less mobile and more exposed to shear forces, is involved approximately twice as frequently as the lateral meniscus. Injuries can be traumatic — typical in young athletes, often associated with a knee twisting mechanism under load — or degenerative, frequent after age 40.
Characteristic symptoms include localized pain at the joint line (medial or lateral), swelling, a sensation of joint locking, and giving way. A “click” or “snap” during movement is a suggestive but not pathognomonic sign. Magnetic resonance imaging (MRI) is the gold standard for diagnosis, with sensitivity and specificity exceeding 90%.
The therapeutic approach has changed radically in the last twenty years. While arthroscopic meniscectomy was once almost an automatic solution, today we know that conservative physiotherapy treatment is at least as effective as surgery in most degenerative lesions. The rehabilitation protocol focuses on strengthening the quadriceps and hamstrings, recovering proprioception, and correcting any predisposing biomechanical deficits.
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Tendinite Rotulea
Patellar tendinopathy, also known as “jumper’s knee,” is a tendinopathy that affects the patellar tendon at its insertion point on the inferior pole of the patella. It is a typical pathology in athletes who engage in activities with repeated jumping — volleyball, basketball, athletics — but can also affect runners and cyclists.
The pain is precisely localized at the inferior pole of the patella and typically manifests at the beginning of sports activity, may subside during warm-up, and reappear intensely at the end of the effort. In advanced cases, pain is also present in daily activities such as climbing stairs, getting up from a chair, or remaining seated for a long time with the knee flexed.
The management of patellar tendinopathy requires an evidence-based approach, where progressive loading plays a central role. The program of eccentric exercises on an inclined plane (adapted Alfredson protocol) and heavy isometric exercises for pain control represent the foundation of treatment. Clinical experience confirms that the key to success is correct load management: the tendon needs to be stressed to heal, but the load must be precisely dosed to avoid flare-ups.
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Dolore al Ginocchio nel Corridore
Running is a wonderful sport for cardiovascular health, but it places significant repetitive stress on the knee. Knee pain is the most common problem among runners, affecting up to 50% of amateur runners at least once in their athletic career. The most frequent pathologies in runners include patellofemoral pain syndrome, iliotibial band syndrome, patellar tendinopathy, and tibial periostitis.
Patellofemoral pain syndrome, characterized by anterior peripatellar pain, is often linked to weakness of the vastus medialis obliquus muscle, strength deficits in the hip muscles (particularly the gluteus medius), and biomechanical alterations of the foot. Iliotibial band syndrome causes pain in the lateral region of the knee, typically after a specific distance, and requires treatment aimed at flexibility and strengthening of the hip stabilizing musculature.
The physiotherapy approach to a runner with knee pain is not limited to symptom treatment but includes a biomechanical analysis of running, assessment of foot strike, and a review of the training program. Clinical experience shows that the cause of pain is almost always multifactorial: training errors, strength deficits, biomechanical alterations, and inadequate footwear choice all contribute to determining the clinical picture.
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Lesione del Legamento Crociato Anteriore (LCA)
Anterior cruciate ligament (ACL) injury is one of the most feared injuries in sports. The ACL is the primary stabilizer of the knee against anterior tibial translation and rotational movements. Its rupture typically occurs during a knee twisting mechanism with the foot fixed to the ground, a landing from a jump, or a sudden change of direction.
The moment of injury is often dramatic: the patient reports an audible “crack,” acute pain, inability to continue activity, and rapid knee swelling (hemarthrosis). Clinical diagnosis is based on the Lachman test and the anterior drawer test, and is confirmed by magnetic resonance imaging, which also allows for the evaluation of any associated injuries (meniscal, cartilaginous, ligamentous).
The decision between conservative treatment and surgical reconstruction depends on multiple factors: age, level of sports activity, presence of functional instability, associated injuries, and patient expectations. Regardless of the choice, rehabilitation is the determining factor for the final outcome. A structured rehabilitation protocol based on functional progression criteria — not rigid timelines — is essential for a safe return to sport.
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Case Study: Ricostruzione del LCA
Direct experience with real clinical cases represents a valuable learning tool. On our website, we have documented in detail the complete journey of a patient who underwent anterior cruciate ligament reconstruction, from initial assessment to full return to sports activity.
The case study illustrates the different phases of post-ACL reconstruction rehabilitation: the protection phase (weeks 0-2) with pain and edema control; the mobility recovery phase (weeks 2-6) with the goal of achieving full extension; the progressive strengthening phase (months 2-4) with closed and open kinetic chain exercises; the functional phase (months 4-6) with the introduction of sport-specific exercises; and the return to sport phase (months 6-9 and beyond) with objective functional tests for sports clearance.
This pathway demonstrates how an individualized rehabilitation approach, based on functional milestones rather than rigid timelines, can lead to excellent results. The patient met all return-to-sport criteria, including a limb symmetry index greater than 90% in strength and jump tests.
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Protesi di Ginocchio
When knee osteoarthritis reaches an advanced stage and conservative treatment can no longer ensure an acceptable quality of life, knee replacement becomes the indicated therapeutic option. In Italy, approximately 70,000 knee replacements are implanted each year, a number that is constantly growing thanks to the evolution of materials and surgical techniques.
The prosthesis can be total (replacement of all joint compartments) or partial (unicompartmental, limited to only the damaged compartment). The choice depends on the extent of joint damage, ligamentous integrity, and patient characteristics. In both cases, pre- and post-operative physiotherapy plays a decisive role in the final outcome.
Pre-operative rehabilitation (prehabilitation) significantly improves post-surgical outcomes: a stronger and more mobile knee before surgery recovers more quickly afterward. The post-operative pathway includes early mobilization, progressive recovery of range of motion, gradual muscle strengthening, and gait retraining for functional activities. The goal is to achieve a range of motion of at least 0-120° and quadriceps strength adequate for the patient’s functional needs.
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Dolore al Ginocchio dopo lo Sci
Skiing is a sport that subjects the knee to intense and often unpredictable stresses. Knee pain after a day of skiing or, worse, after a fall, is a common occurrence that should not be underestimated. Typical injury mechanisms in skiing include a forward fall with a binding that does not release (ACL injury), knee twisting in valgus (medial collateral ligament injury), and direct trauma to the patella.
But not all post-skiing pains result from acute traumatic injuries. Many amateur skiers, especially those who concentrate their activity into a few weekends a year without adequate physical preparation, develop pain from muscular, tendinous, or patellofemoral overuse. Lack of specific athletic preparation is the main modifiable risk factor for skiing injuries.
The advice for patients is to invest at least 6-8 weeks of targeted physical preparation before the ski season, with particular attention to strengthening the quadriceps, hamstrings, and hip stabilizing muscles. In case of persistent post-skiing pain, an early physiotherapy assessment is crucial to rule out structural injuries and set up the most appropriate treatment.
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Esercizi per il Ginocchio: Programma di Rinforzo e Stabilizzazione
The following exercises represent a basic program for knee strengthening and stabilization. Before starting, it is advisable to consult your doctor or physical therapist to ensure that the exercises are appropriate for your condition. In case of acute pain during execution, stop immediately.
Fase 1 — Attivazione e Controllo Muscolare

Esercizio 1: Contrazione Isometrica del Quadricipite
Difficulty: Easy | Equipment: Mat, rolled towel | Duration: 3 minutes

Starting position:
Lie on your back on a mat. Your legs are extended, and a rolled towel is placed under the knee to be trained. The other leg can remain extended or flexed with the foot flat on the floor.
Step-by-step execution:

Step 1: Contract the quadriceps muscle (the front of the thigh) by pressing the back of your knee against the towel, as if to flatten it towards the floor.
Step 2: Maintain maximal contraction for 5-10 seconds. The patella visibly moves upwards, and the leg stiffens.
Step 3: Slowly release the contraction over 3 seconds, without abrupt movements.

Sets and repetitions: 3 sets x 10 repetitions — 5-second pause between repetitions, 30 seconds between sets
Common errors to avoid:

Holding your breath during contraction: breathe normally
Lifting the leg off the mat instead of pressing the knee downwards
Contracting foot or ankle muscles instead of the quadriceps

How to know you are doing it correctly:
The patella clearly moves upwards during contraction. The front of the thigh becomes hard and toned to the touch. You feel a sensation of muscle work in the thigh without knee pain.

Esercizio 2: Sollevamento della Gamba Tesa (Straight Leg Raise)
Difficulty: Easy | Equipment: Mat | Duration: 5 minutes

Starting position:
Lie on your back on a mat. The non-involved leg is flexed with the foot flat on the floor. The leg to be trained is fully extended with the knee in extension.
Step-by-step execution:

Step 1: Contract the quadriceps of the extended leg, locking the knee in full extension.
Step 2: While maintaining quadriceps contraction, slowly lift the extended leg approximately 30-40 centimeters off the floor (about 30 degrees). The movement lasts 2 seconds.
Step 3: Hold the position for 3 seconds, then lower the leg in a controlled manner over 3 seconds, gently placing it on the floor.

Sets and repetitions: 3 sets x 12 repetitions per side — 45-second pause between sets
Common errors to avoid:

Not locking the knee in extension before lifting: the leg should be stiff like a board
Arching the lower back during the lift: the pelvis remains stable in contact with the mat
Lifting the leg too high, shifting the work to the hip flexor

How to know you are doing it correctly:
You feel intense muscle work in the front of the thigh. The leg remains perfectly straight throughout the movement. The lower back remains in contact with the mat.

Fase 2 — Rinforzo Funzionale

Esercizio 3: Mini-Squat al Muro (Wall Sit Parziale)
Difficulty: Intermediate | Equipment: Smooth wall, fitness ball (optional) | Duration: 5 minutes

Starting position:
Stand with your back against the wall. Your feet are advanced approximately 40 centimeters from the wall, shoulder-width apart. Your toes are slightly turned outwards. Your arms are crossed over your chest or along your sides.
Step-by-step execution:

Step 1: Slowly slide your back down the wall, bending your knees until you reach an angle of approximately 45 degrees (do not exceed 60 degrees of flexion). Your knees remain aligned with your second toe.
Step 2: Hold the position for 10-15 seconds, breathing regularly and keeping your back completely against the wall.
Step 3: Slowly return to the upright position by pushing with your heels, over 3 seconds, controlling the movement.

Sets and repetitions: 3 sets x 8 repetitions — 60-second pause between sets
Common errors to avoid:

Bringing your knees past your toes: your feet must be sufficiently advanced
Bending your knees beyond 60 degrees, which could overload the patellofemoral joint
Lifting your back off the wall during the movement

How to know you are doing it correctly:
You feel muscle work in the front of both thighs. Your knees do not go past the line of your toes. Your weight is predominantly distributed on your heels, and your back remains in contact with the wall.

Esercizio 4: Step-Up su Gradino
Difficulty: Intermediate | Equipment: Step or box 15-20 cm high | Duration: 5 minutes

Starting position:
Stand in front of a step or box 15-20 cm high. Place the entire foot of the leg to be trained on the surface of the step. The other leg remains on the ground. Your arms are along your sides or on your hips for balance.
Step-by-step execution:

Step 1: Push with the heel of the foot placed on the step and ascend by fully extending your knee, bringing your entire body onto the elevated surface. The movement lasts 2 seconds.
Step 2: Reach an upright position on the step with your weight on the working foot. The other foot lightly rests beside it. Hold for 1 second.
Step 3: Slowly descend with the opposite leg, controlling the descent over 3 seconds. The knee of the working leg guides the movement and remains aligned with the second toe of the foot.

Sets and repetitions: 3 sets x 10 repetitions per side — 60-second pause between sets
Common errors to avoid:

Pushing off with the leg on the ground instead of using the leg on the step to ascend
Deviating the knee inwards (dynamic valgus) during ascent or descent
Leaning forward with your torso, losing postural control

How to know you are doing it correctly:
You feel muscle work predominantly in the quadriceps and gluteus of the leg placed on the step. The knee remains perfectly aligned with the foot throughout the movement, without deviating inwards.

Fase 3 — Stabilita e propriocezione (capacità di percepire posizione e movimento del corpo)

Esercizio 5: Equilibrio Monopodalico
Difficulty: Intermediate | Equipment: None (chair for safety) | Duration: 4 minutes

Starting position:
Stand next to a chair or support surface for safety. Your weight is distributed on both feet, arms are along your sides. Your gaze is directed forward at a fixed point.
Step-by-step execution:

Step 1: Slowly transfer all your weight onto the leg to be trained, keeping the knee slightly flexed (about 10-15 degrees, never fully extended). Lift the other foot off the ground.
Step 2: Maintain balance for 30 seconds, trying to minimize oscillations

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Sources and Scientific References

1. Messier SP et al. (2021). Effect of High-Intensity Strength Training on Knee Pain and Knee Joint Compressive Forces Among Adults With Knee Osteoarthritis: The START Randomized Clinical Trial. JAMA. 325:646-657. DOI | PubMed
2. Artz N et al. (2015). Effectiveness of physiotherapy exercise following total knee replacement: systematic review and meta-analysis. BMC Musculoskelet Disord. 16:15. DOI | PubMed
3. Luan L et al. (2022). Knee osteoarthritis pain and stretching exercises: a systematic review and meta-analysis. Physiotherapy. 114:16-29. DOI | PubMed
4. Page CJ et al. (2011). Physiotherapy management of knee osteoarthritis. Int J Rheum Dis. 14:145-51. DOI | PubMed
5. Wei G et al. (2024). Effects of lower-limb active resistance exercise on mobility, physical function, knee strength and pain intensity in patients with total knee arthroplasty: a systematic review and meta-analysis. BMC Musculoskelet Disord. 25:730. DOI | PubMed

Frequently Asked Questions

What is the most important first step when experiencing knee pain?

Knee pain is a symptom, not a diagnosis, so accurately identifying its specific cause is crucial for effective treatment. Consulting a physical therapist or doctor is essential to pinpoint the origin of your pain and guide your personalized recovery plan.

What are the common causes of knee pain?

Knee pain can stem from various sources, including acute injuries like ligament or meniscal tears, and overuse conditions such as tendinopathies or bursitis. Degenerative conditions like osteoarthritis, especially common in individuals over 50, are also frequent causes.

Why is the knee joint so prone to pain and injury?

The knee is the largest and one of the most complex joints in the human body, enduring significant daily stress. It bears substantial loads, up to 3-4 times body weight during walking and 7-8 times during running, which explains its susceptibility to various issues.

How does a physical therapist diagnose the cause of knee pain?

A physical therapist conducts a thorough assessment, including specific clinical tests and movement analysis, to pinpoint the origin of your knee pain. The location of your pain also provides important diagnostic clues, and instrumental investigations may be recommended if necessary.

What are the typical symptoms of a meniscal injury?

Meniscal injuries often present with localized pain at the joint line, swelling, and a sensation of joint locking or giving way. You might also experience a ‘click’ or ‘snap’ during movement, particularly after a twisting mechanism under load.