Knee Pain: Understanding the Causes and How to Fix It

Mar 31, 2025

6 min read

Knee pain is one of the most common complaints I see, and while people often assume it’s just a result of aging or “wear and tear,” the reality is far more complex. The knee is heavily influenced by what’s happening both above and below it—meaning a lack of mobility in the ankles or hips can force the knee to take on more than its fair share of work. Add in muscular imbalances, past injuries, or sudden increases in activity, and you’ve got a perfect recipe for knee pain.

The good news? There’s a lot that can be done to improve knee function, often without surgery. Let’s break it down.

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Why Do Knees Hurt?

There are several potential culprits behind knee pain, and they often overlap:

1️⃣ Quadriceps Muscle Imbalances – The quads help keep the kneecap in place. If one part is working harder than another, the kneecap can track incorrectly, leading to pain (patellofemoral pain syndrome, aka “runner’s knee”).

2️⃣ Compensating for a Lack of Mobility – If your ankles and hips are stiff, your knees end up handling more of the movement and stress. This is especially common in people who sit a lot or don’t do enough mobility work.

3️⃣ Meniscus Issues – The meniscus is like your knee’s suspension system. A tear here can cause pain, locking, or instability. Some meniscus tears can heal, while others may need specific rehab strategies.

4️⃣ Ligament Injuries (ACL, MCL, etc.) – These ligaments provide stability to the knee. Tearing one (like the ACL) is common in sports, but believe it or not, you can function without an ACL if you build strength in the right areas.

5️⃣ Biceps Femoris (Part of the Hamstring) – This muscle crosses the knee joint and can contribute to instability or pain, especially if it’s not strong enough to support the knee’s movement.

6. Patellar Tendinopathy (Jumper’s Knee)

• What it is: Inflammation or degeneration of the patellar tendon (which connects your kneecap to your shin).
• Common causes: Repetitive jumping, running, or excessive strain on the tendon.
• Symptoms: Pain just below the kneecap, especially when jumping, squatting, or going downstairs.

7. IT Band Syndrome

• What it is: Irritation of the iliotibial (IT) band, a thick band of connective tissue that runs along the outside of the thigh and attaches to the knee.
• Common causes: Weak glutes, poor hip stability, or repetitive knee bending (e.g., running or cycling).
• Symptoms: Sharp pain on the outer side of the knee, often during running or after prolonged activity.

8. Hoffa’s Fat Pad Impingement (Fat Pad Syndrome)

• What it is: Irritation or pinching of the fat pad under the kneecap.
• Common causes: Trauma (falling on the knee), hyperextension, or excessive kneeling.
• Symptoms: Pain in the front of the knee, especially when extending the leg fully.

9. Plica Syndrome

• What it is: Irritation of a fold in the joint lining (plica), which can become inflamed and painful.
• Common causes: Overuse, trauma, or excessive bending of the knee.
• Symptoms: Clicking, catching, or pain on the inside of the knee, especially with repetitive motion.

10. Osgood-Schlatter Disease (Common in Adolescents)

• What it is: Inflammation of the growth plate at the tibial tuberosity (just below the kneecap).
• Common causes: Rapid growth during adolescence, combined with sports that involve running and jumping.
• Symptoms: Pain and swelling at the top of the shin, especially after activity.

11. Baker’s Cyst

• What it is: A fluid-filled sac at the back of the knee, often linked to arthritis or a meniscus tear.
• Common causes: Knee inflammation, trauma, or underlying joint issues.
• Symptoms: Swelling and tightness in the back of the knee, sometimes causing stiffness or limited mobility.

12. Patellar Dislocation

• What it is: When the kneecap (patella) shifts out of place, often toward the outside of the knee.
• Common causes: Sudden twisting movements, weak quadriceps, or shallow grooves in the knee joint.
• Symptoms: Pain, swelling, and an obvious misalignment of the kneecap.

13. Chondromalacia Patella (Runner’s Knee)

• What it is: Softening or breakdown of the cartilage under the kneecap.
• Common causes: Poor knee tracking, muscle imbalances, or excessive kneeling.
• Symptoms: Deep aching pain in the front of the knee, worsened by prolonged sitting, squatting, or using stairs.

14. Osteochondritis Dissecans (OCD Lesion)

• What it is: A small piece of bone and cartilage separates from the knee joint due to reduced blood flow.
• Common causes: Repetitive stress, genetics, or developmental factors.
• Symptoms: Pain, swelling, and possible locking or catching of the knee.

15. Patellar Fracture

• What it is: A break in the kneecap due to direct trauma.
• Common causes: Falls onto the knee, car accidents, or high-impact sports injuries.
• Symptoms: Severe pain, swelling, and difficulty straightening the leg.

16. Knee Bursitis

• What it is: Inflammation of one of the small fluid-filled sacs (bursae) that cushion the knee.
• Common causes: Repetitive kneeling, direct trauma, or infection.
• Symptoms: Swelling, tenderness, and warmth in the affected area.

17. Posterior Cruciate Ligament (PCL) Injury

• What it is: A sprain or tear of the PCL, which helps prevent the shin from moving too far backward.
• Common causes: Falling directly on a bent knee or car accidents where the shin hits the dashboard.
• Symptoms: Pain, swelling, and instability, though often less severe than an ACL tear.

Do You Need Knee Surgery? Maybe… Maybe Not.

The decision to have knee surgery is personal and should always involve a discussion with your surgeon. However, the success of your recovery—whether you have surgery or not—comes down to your rehab.

• If you choose not to have surgery, you can still build strength, stability, and agility to regain function. Many of my clients have avoided surgery altogether and ended up stronger than before.
• If you do have surgery, your prehab (training before surgery) will dramatically impact your recovery. The stronger you are going into surgery, the better your outcome will be afterward.

The bottom line? Knee pain doesn’t automatically mean surgery is your only option. There are effective, structured ways to regain function without going under the knife.

The “Parent vs. Sports Injury” Epidemic

While I’ve worked with plenty of athletes, I’ve also worked with a surprising number of parents who’ve torn their ACLs or injured their knees trying to relive their glory days.

Here’s how it usually happens:

➡️ You used to play sports.

➡️ You haven’t trained in years.

➡️ Your kid (or a friend) invites you into a casual game of soccer, basketball, or rugby.

➡️ Your brain remembers exactly what you used to be capable of… but your body does not.

➡️ 20 minutes in, pop—you’ve torn your ACL.

Sound familiar? If it does, I have good news: you can absolutely get back to being active again. And if this hasn’t happened to you yet, I can help you get strong enough that it never does.

The Best Training Plan for Strong, Resilient Knees

If you want to be ready for whatever life throws at you—whether it’s jumping into a soccer game or going on a long bike ride—you don’t need to spend hours in the gym. In fact, 15-20 minutes of strength training, three times a week, can make a huge difference.

Here’s what works best:

• Strength Training – Building muscle around the knee (quads, hamstrings, glutes) improves stability and reduces pain.
• Single-Leg Work – Step-ups, lunges, and Bulgarian split squats mimic real-life movements and build balance.

🔄 Mobility Work – Keeping your hips and ankles mobile reduces unnecessary stress on the knees.

• Agility & Control Drills – If you want to be able to react quickly in sports, these are essential.

The Bottom Line

Knee pain doesn’t have to sideline you forever. Whether you’re recovering from an injury, avoiding surgery, or just trying to stay ready for whatever comes your way, the right approach can help you get back to doing what you love—pain-free.

Knee pain isn’t always just “wear and tear.” It can come from overuse, muscle imbalances, poor biomechanics, or even underlying conditions. The good news is that most knee injuries can be improved (or avoided altogether) with the right rehab, strength training, and movement mechanics.

And if you’re that parent planning to jump into a game with your kid? Let’s make sure you’re prepared for it, not recovering from it.

Ways I can help you:

Check out my “Beyond the Niggle: Knee Strength Series”

For knees that aren’t “broken”—just holding you back.

This program is designed for active women dealing with the all-too-common mix of patellofemoral pain, mild tendinopathy, or a cranky medial meniscus. You’re not injured. But you do feel restricted—whether it’s during workouts, climbing stairs, or just trying to move like you used to.

Message me and lets see what path you need for movement to meet you where youre at.

The Sweat Equity Online Personal CoachHealthFitness