Knee Pain Physiotherapy Sydney | SWITCH Physiotherapy

Where exactly does your knee hurt?

Knee pain is one of those complaints where the location does a lot of the diagnostic work. Front, back, inside, outside and deep-inside pain each point toward different structures, and the answer changes what a sensible plan looks like.

Below is a plain-language guide to what each region tends to mean. It will not diagnose you, but it will help you describe the problem accurately – and that is genuinely the difference between a vague appointment and a useful one.

Pain at the front of the knee

Pain around or under the kneecap is the most common presentation we see, particularly in runners, cyclists and anyone who has recently increased their training load or started a new job on their feet.

It typically shows up going down stairs, squatting, or after long periods sitting with the knee bent. People often call it a dull ache that becomes sharp with load. It is usually a load-tolerance problem rather than structural damage, which is why it tends to respond well to a graded strength program rather than rest.

Pain at the back of the knee

Pain behind the knee has a wider range of causes than the other regions, which is why it is worth being specific about it.

A feeling of fullness or a soft swelling behind the joint, particularly when straightening fully, is often a Baker’s cyst – a fluid-filled swelling that is usually a symptom of something else going on inside the knee rather than the primary problem. We have covered that in detail in our guide to Baker’s cyst causes, symptoms and treatment.

Pain at the back that is sharper and more localised, especially with pushing off or sprinting, can involve the hamstring tendons or calf where they cross the joint. Pain behind the knee accompanied by significant calf swelling, warmth or redness needs same-day medical assessment rather than a physio appointment.

Pain on the inside of the knee

The inner side of the knee houses the medial collateral ligament, the medial meniscus and several tendon attachments. Pain here is common after a twist, an awkward landing, or a blow to the outside of the knee that forces it inward.

Inside-knee pain that came on gradually without an obvious incident is more often related to load and alignment through the hip and foot than to the knee itself, which is why an assessment usually looks well above and below the painful joint.

Pain on the outside of the knee

Outer-knee pain in runners and cyclists frequently involves the iliotibial band region, and it has a characteristic pattern: fine at rest, fine at the start of a run, then building predictably at a similar distance or time each session.

That predictability is a useful clue. Pain that arrives reliably at the twenty-minute mark behaves like a load-tolerance issue. Pain that is present from the first step behaves differently.

Pain deep inside, with catching or locking

Pain felt deep in the joint line, particularly with twisting, squatting or kneeling, and especially if the knee catches, locks or gives way, can involve the meniscus.

Worth knowing: meniscal changes are extremely common on scans in people with no knee pain at all, and they increase with age. A meniscal finding on imaging does not automatically mean surgery, and a large proportion of these presentations do well with structured rehabilitation.

ACL or MCL: how to tell the difference

These two get confused constantly, and the mechanism usually separates them.

The MCL sits on the inside of the knee and is typically injured by a force pushing the knee inward – a tackle from the side, or a slip where the leg splays out. Pain is localised to the inner side and is usually quite tender to touch directly over the ligament.

The ACL sits inside the joint and is more often injured in a non-contact twisting or landing moment – planting and pivoting, or landing awkwardly from a jump. People frequently report hearing or feeling a pop, followed by rapid swelling within a few hours and a sense that the knee is not trustworthy underneath them.

Rapid swelling within hours and a feeling of instability are the two features that most warrant prompt assessment. If you want the detail on how these are rehabilitated, our ACL injury and rehab page covers both the surgical and non-surgical pathways.

Knee pain when squatting, bending or on stairs

These three are worth separating because they load the knee differently.

Stairs, and particularly going down, load the front of the knee heavily through a small range. Deep squatting compresses the back of the joint. Bending while weight-bearing and twisting loads the meniscus. Noticing which of the three provokes you narrows the field considerably, so it is worth paying attention for a few days before your appointment.

Frequently asked questions

Should I stop running if my knee hurts?
Not necessarily, and complete rest is often counterproductive. Many knee presentations respond better to modifying load – shorter runs, flatter routes, reduced frequency – than to stopping entirely, because tendon and cartilage tissue need some load to adapt. Sharp pain, swelling or giving way are different and should be assessed.

Does knee pain mean I have arthritis?
No. Knee pain is common at every age and most of it is not osteoarthritis. Even where arthritic changes are present on imaging, they correlate poorly with how much pain someone experiences, and exercise-based management is well supported.

Is it worth getting a scan for knee pain?
Sometimes, but less often than people expect. Scans are most useful when the result would change the plan – after a significant twisting injury with swelling, or where the knee is locking. For gradual-onset pain, a scan frequently shows incidental findings that muddy the picture.

Why does my knee hurt more going downstairs than up?
Going down requires the quadriceps to control your body weight against gravity while the kneecap is loaded against the thigh bone. That is a higher demand on the front of the knee than going up, which is why descending stairs is often the first thing to become painful and the last to settle.

My knee clicks. Is that a problem?
Painless clicking or popping is very common and generally not a concern on its own. Clicking that comes with pain, swelling, catching or locking is worth having looked at.

If you want it assessed

If you have identified your pattern above and it has not settled, an assessment can confirm what is driving it. You can read how we work through knee presentations on our knee pain physiotherapy page, or book at your nearest SWITCH clinic. No referral needed.