Approach to a Patient with Knee Pain: A Physiotherapy Perspective

Introduction

Knee pain is one of the most common complaints seen in physiotherapy practice across all age groups. It may arise from injury, overuse, degenerative changes, or faulty movement patterns. A structured knee pain assessment and clinical reasoning approach is essential to identify the cause and plan effective management.

This case-based discussion outlines a simple and systematic physiotherapy approach to a patient presenting with knee pain.

Step 1: Subjective Assessment

The assessment begins with understanding the patient’s history:

• onset and duration of pain
• mechanism of injury (if any)
• location and nature of pain
• activities that aggravate or relieve symptoms
• functional limitations (walking, stairs, squatting)

Red flags such as severe trauma, locking, instability, or systemic symptoms must be ruled out early.

Step 2: Objective Assessment

Physical examination focuses on:

• observation of posture, gait, and swelling
• range of motion of the knee and surrounding joints
• muscle strength, especially quadriceps and hamstrings
• palpation for tenderness
• special tests when indicated

Assessment should also include the hip and ankle, as knee pain often reflects regional movement dysfunction.

Step 3: Clinical Reasoning

Findings are integrated to identify the primary contributors to pain. Knee pain may be driven by:

• muscle weakness or imbalance
• altered biomechanics
• overloading or poor movement control
• postural or activity-related factors

The goal is to treat the cause, not just the symptoms.

Step 4: Management Approach

Physiotherapy management typically includes:

• pain-modulating strategies when required
• exercise therapy to improve strength and control
• correction of faulty movement patterns
• activity modification and patient education

Conclusion

A structured, reasoning-based approach allows physiotherapists to manage knee pain effectively. Understanding the patient’s movement, function, and goals is central to successful rehabilitation.

Dr. Dhanalakshmi

Dr.