Question 1

Do I need an MRI for knee pain?

Accepted Answer

Not necessarily. Many knee conditions -- including patellofemoral pain, iliotibial band syndrome, and patellar tendinopathy -- are diagnosed clinically without imaging. For suspected ligament or meniscal injuries, an MRI provides valuable structural information and will be recommended if the clinical assessment indicates it is warranted. It is important to note that MRI findings do not always correspond to symptoms: studies show that a significant proportion of people without knee pain have "abnormal" MRI findings including meniscal degeneration and cartilage changes. Your physiotherapist will interpret imaging in the context of your full clinical picture.

Question 2

Can physiotherapy help with a meniscus tear?

Accepted Answer

Yes, and in many cases physiotherapy is the preferred first-line treatment. The METEOR and MeTeOR trials found no significant difference in outcomes between surgical and non-surgical management for degenerative meniscal tears in middle-aged patients at 6-12 months. For acute traumatic tears in younger patients, the evidence is more nuanced and depends on the tear type and stability. A structured physiotherapy program focusing on quadriceps and hip strengthening, load management, and activity modification produces good outcomes for a large proportion of patients. Surgery is reserved for cases that fail conservative management or involve specific tear patterns that are unlikely to respond.

Question 3

Is running bad for my knees?

Accepted Answer

For most people, no. A large body of evidence -- including population studies comparing runners and non-runners -- shows that recreational running is not associated with increased rates of knee osteoarthritis. In fact, some research suggests runners may have lower rates of knee OA than sedentary individuals. If running is causing knee pain, this usually reflects a loading issue: too much volume, too quickly, without adequate muscular support. Physiotherapy addresses this through load management, strength training, gait retraining, and progressive return-to-running protocols. The goal is to build your knee's capacity to handle running -- not to stop you from doing it.

Question 4

What is patellofemoral pain syndrome?

Accepted Answer

Patellofemoral pain syndrome (PFPS) -- sometimes called "runner's knee" -- describes pain around or behind the kneecap, typically aggravated by activities that load the patellofemoral joint: running, squatting, stairs, and prolonged sitting. It is one of the most common knee conditions seen in physiotherapy. The underlying driver is usually a combination of inadequate quadriceps and hip muscle strength, altered patellar tracking, and training load that exceeds the tissue's current capacity. It responds very well to physiotherapy targeting hip abductor and external rotator strengthening, quadriceps strengthening, patellar taping or bracing, and graduated load management. Most patients see significant improvement within 6-12 weeks of consistent rehabilitation.

Question 5

What causes knee pain in teenagers?

Accepted Answer

The most common cause is Osgood-Schlatter disease -- a traction apophysitis at the tibial tubercle (the bony prominence just below the kneecap) that occurs during growth spurts in active adolescents. It is not a serious condition but can be significantly painful. It is driven by the patellar tendon pulling on the growth plate during periods of rapid bone growth, and is aggravated by loading activities like running, jumping, and squatting. Management includes load modification, quadriceps flexibility work, and progressive strengthening as symptoms allow. Most cases resolve completely with skeletal maturity. Physiotherapy helps manage symptoms, prevent prolonged restriction from sport, and guide a safe return to activity.

Question 6

When should I consider knee surgery?

Accepted Answer

Knee surgery is most clearly indicated for: acute ACL rupture in athletes wishing to return to cutting and pivoting sports; locked knees from a displaced meniscal tear; acute fractures or structural instability that cannot be managed conservatively; and end-stage knee osteoarthritis where conservative management has been exhausted and quality of life is significantly impaired. For most other knee conditions -- including degenerative meniscal tears, patellofemoral pain, tendinopathy, and mild-to-moderate OA -- the evidence supports conservative physiotherapy as the first-line option. Your physiotherapist will discuss with you whether surgery is likely to be beneficial for your specific situation, and coordinate with your orthopaedic surgeon where appropriate.

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