Physical therapist assessing a patient's knee

Knee Pain Physical Therapy

Knee pain is one of the most common reasons people seek physical therapy, second only to back pain. Frequent knee pain affects roughly a quarter of all adults, and doesn’t discriminate by age or activity level. Maybe it’s an ache when you walk down the stairs, or perhaps you felt a pop during a pivot while playing tennis. Maybe your knee has swollen up, seemingly out of nowhere, or it just never feels quite right since that replacement surgery. Our Doctors of Physical Therapy (DPT) get you back to it: the run, the season, the stairs without the handrail.

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Physical therapist assessing a patient's knee

Determining the reason your knee hurts is the first step in treating it, and that often means looking at all of the joints in the leg. The knee is caught in the middle, taking the load handed down from your hip and up from your ankle. When either one isn’t strong enough or doing its job properly, the knee is usually where you feel it. That’s why knee pain so frequently turns out to be a hip strength matter, an ankle mobility problem, or a training-load issue. 

Our DPTs will do a comprehensive evaluation of your symptoms, medical history, and learn how the pain affects your daily activities. From there, we build a knee pain physical therapy plan that pairs manual therapy with corrective exercise. Reducing pain is the first checkpoint. The goal is getting you back to what the knee was stopping you from doing, whether that’s rebuilding mileage, getting back on the platform, or going up and down stairs without thinking about it.

What a Knee Pain Physical Therapy Session Actually Involves

Initial evaluation (45 – 60 minutes):

First comes a conversation. Your DPT will ask where the pain is, when it began, and whether it built up gradually or started with one specific incident. We will also ask what sets it off: stairs, squatting, a long car ride, or running downhill. Does it swell, catch, lock, or feel like it might give way? Each of these symptoms provides valuable information for a diagnosis and treatment plan.

Your therapist will observe how you walk, squat, step down, and balance on one leg. This shows how your hip, knee, and ankle are sharing the load. We’ll test for range of motion and check the ligaments and meniscus with hands-on special tests. Strength in the quads, hamstrings, and glutes is assessed, and we’ll palpate the knee for specific areas of heat, tenderness, or swelling.

If you have had an X-ray, CT,  MRI, or ultrasound, your DPT will include them in the evaluation, but imaging is often not necessary. For front-of-the-knee knee pain in particular, current clinical guidelines find that an MRI doesn’t always identify the problem. The working diagnosis comes from what your knee does under load, and all of these factors taken together help the DPT formulate your treatment plan.

Hands-on treatment:

Physical therapist performing manual therapy on a patient's knee

No two knee sessions look the same. What’s included depends on your evaluation findings and what works best for you:

  • Joint mobilization and manipulation: targeted movements to the knee, patella, hip, and ankle to reduce pain and restore motion
  • Myofascial release: hands-on work to the quads, hamstrings, calves, and IT band to address tissue restriction around the joint
  • Dry needling: a thin filament needle used to release trigger points in the thigh or calf that are contributing to knee pain
  • Cupping: used for tight, guarded muscles around the knee and thigh that haven’t responded to other manual work
  • Blood flow restriction (BFR) training: building quad strength using very light loads, which matters when a painful or post-surgical knee can’t tolerate heavy weights

Corrective exercise:

Every session pairs hands-on work with targeted exercises based on your assessment. For most knees, that means progressively loading your quads and glutes as well as retraining how you squat, land, and step down. This allows the knee to stop absorbing force that the hip and ankle should be sharing.

Typical plan of care:

Most patients start with 1 to 2 visits per week. A straightforward overuse condition often settles in 4 to 6 weeks. Patellofemoral pain, knee osteoarthritis, and post-surgical cases may take longer. ACL reconstruction can be a months-long return-to-sport progression rather than a short course of care. Your therapist will give you a specific timeline after your evaluation.

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Conditions That Can Benefit From Physical Therapy

  • Patellofemoral pain (runner’s knee): pain around or behind the kneecap, worse with stairs, squatting, or prolonged sitting
  • Patellar tracking issues and maltracking
  • Patellar tendinopathy (jumper’s knee)
  • Meniscus tears: including degenerative tears, which frequently respond to rehab without surgery
  • ACL injuries: both prehab before reconstruction and full post-op return-to-sport rehab; see our ACL Rehabilitation program
  • MCL and other ligament sprains
  • Knee osteoarthritis and arthritic knee pain
  • IT band syndrome: pain on the outside of the knee, common in runners and cyclists
  • Post-surgical knee pain: total and partial knee replacement, arthroscopy, and meniscal repair or debridement; see our Total Joint Programming
  • General knee stiffness and swelling that limit stairs, kneeling, or getting up from a chair

Runner’s knee is one of the most common reasons patients come in to see us. It typically shows up after a sudden jump in training volume, a new hill or speed block, or a return to running after time off. It’s often driven by hip and glute strength that hasn’t kept pace with the mileage.

Rest tends to be only a temporary fix. The pain fades while you’re off, but it often returns at the same point once training resumes. That doesn’t mean you have to stop running altogether. We typically focus by reducing the load on the knee: adjusting distance, intensity, cadence, or the routes and surfaces that provoke it. The goal of physical therapy for runner’s knee is twofold: calm the current irritation, and correct the strength and mechanics that caused it, so you can rebuild mileage without repeating the cycle.

Cyclists, hikers, CrossFit athletes, and anyone doing repetitive squatting or kneeling at work tend to follow the same pattern with different triggers. For more information, see Why Your Knee Hurts When You Start Running Again and How to Take Care of Your Knee Pain.

Who Performs It

Every evaluation and every treatment session is 1-on-1 with a licensed Doctor of Physical Therapy. The full visit, the same DPT, every time. No aides running your exercises. No rotating between providers who have to re-learn your knee each visit. Find a location near you on our full locations page.

Safety

Physical therapy is a safe, first-line treatment for most knee pain, and major clinical guidelines specifically recommend exercise-based care before invasive options for both patellofemoral pain and knee osteoarthritis. Occasionally, though, knee pain is a symptom of something that needs medical attention.

Seek immediate medical care before scheduling PT if you have:

  • An obvious deformity, or a knee that looks or feels out of place after an injury
  • Inability to bear any weight on the leg after a fall or twist
  • A knee that is hot, red, and swollen, especially with a fever, which can indicate joint infection
  • Rapid, significant swelling within the first hour after an injury
  • Calf pain, swelling, and warmth, which can indicate a blood clot
  • A knee that repeatedly locks and won’t fully straighten

Injections or Surgery vs. Physical Therapy for Knee Pain

One question often comes up: go straight for an injection or a surgical opinion, or start with physical therapy?

Cortisone injections can reduce inflammation and pain, sometimes substantially, but they do not address the cause. Pain relief is often temporary, and there’s a limit to how frequently and how many times they can be repeated. Compared with an injection, it can take longer to feel the benefit, but rather than masking the problem, PT builds the strength and mechanics that make the pain less likely to come back.

Surgery is the right answer for some knees, including complete ACL tears in athletes returning to cutting sports, mechanical locking from a displaced meniscus tear, and advanced arthritis that’s no longer responding to conservative care. With degenerative meniscus tears and knee osteoarthritis specifically, structured exercise therapy performs comparably to surgery in the research, which is why guidelines recommend trying it first. For knee pain from most other causes, PT provides a long-lasting, non-invasive approach. 

Physical therapy treats the load and strength problem beneath the pain. It combines a full movement assessment with manual therapy and a progressive strengthening program aimed at correcting what caused the knee to become painful in the first place. 

These modalities are not mutually exclusive. Many patients do PT before an injection, after an injection, or before/after surgery. If your knee needs a surgical opinion, we’ll tell you.

What to Expect Afterward

After your first few sessions of physical therapy, it’s common to feel some soreness. This is normal, and different from the pain that brought you in. Some discomfort in the quads and glutes as you start strengthening is expected, and a sign that the program is doing its job. For a breakdown of what’s expected, see our post, Good Sore vs. Bad Sore: When to Keep Pushing.

Frequently Asked Questions

No. Maryland allows direct access to physical therapy, so you can schedule an evaluation without a physician referral. Some insurance plans may still require one for coverage purposes; our front desk team can check your specific plan.
FX Physical Therapy is in-network with most major insurers. Coverage and any copay or deductible details depend on your specific plan. Visit our Insurance Info page or call your insurer directly to confirm your benefits.
Many patients notice improvement within the first 2 to 4 visits. Full recovery timelines vary widely depending on whether you're dealing with a recent overuse irritation, longstanding arthritis, or a post-surgical knee. Your evaluating therapist will give you a specific expected timeline.
Often, yes. Degenerative meniscus tears in particular respond well to structured strengthening and manual therapy, and research comparing exercise therapy to arthroscopic surgery for these tears has found similar outcomes. Tears that cause true mechanical locking are more likely to need surgical consultation, and your DPT will screen for that.
Runner's knee, or patellofemoral pain, is pain around or behind the kneecap, typically worse with stairs, squatting, running, or prolonged sitting. Rest usually calms it temporarily, but because it's driven by strength and loading patterns, it commonly returns when you resume the activity. Addressing the underlying hip and quad strength is what makes the improvement stick.
Physical therapy is a recommended first-line treatment for knee osteoarthritis. Strengthening the muscles around the joint reduces pain and improves function, and for many patients, it delays or removes the need for surgery. If you do end up having a knee replacement, PT before surgery (prehab) is associated with a smoother recovery afterward.
Prehab is strongly recommended. Going into ACL reconstruction with a better range of motion, less swelling, and stronger quads is consistently linked to better outcomes after surgery. See our ACL Rehabilitation program, and read about our return-to-sport ACL testing.
There's often a brief twitch or cramp as the needle finds a trigger point. That's usually followed right away by a release of tension. Most people tolerate it well, with at most mild soreness in that muscle for a day or so.
For an acute injury with swelling, ice can help manage pain in the first few days. For ongoing knee pain, ice is a comfort measure, not a treatment, and shouldn't replace loading the joint appropriately. Your therapist will tell you where it fits in your specific case.
See the Safety section above; it covers the red-flag symptoms that mean you should see a doctor first.
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Where to Get Knee Pain Physical Therapy Near You

Every FX Physical Therapy location treats knee pain. See the full locations directory to find the closest clinic and request an appointment online. We’re Built to Make You Better.

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Medically reviewed by Amanda Hodgetts, PT, DPT, Cert. DN, [July 30, 2026]

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