You need to know what is causing your knee pain, or else you could be making it worse.

Knee pain is one of the most common reasons people come see us at Forte Physical Therapy in Halifax, and also one of the most mismanaged. 

A generic exercise routine off YouTube isn’t just unhelpful if applied to the wrong problem. It can actually slow down your recovery or cause further damage.

There is no one-size-fits-all approach to knee rehabilitation. Two people with knee pain may need completely opposite treatments.

Here’s how we think through it.

The 4 Questions We Typically Ask First:

Before recommending a single exercise, we need to build a picture of what’s actually going on.

1. Was the onset gradual or sudden? A slow build-up over weeks points to overuse. A sudden onset after a specific incident raises flags for structural injury.
2. Was there significant swelling, bruising, or loss of function or is it more of a nagging, achy pain? Rapid swelling within hours of an injury is an urgent sign to get assessed. A gradual dull ache suggests a different problem.
3. What movements make it worse? Jumping? Squatting? Pivoting? Prolonged running? Stairs? Each pattern points toward a different structure.
4. Does your knee click, lock, shift, or give way? Locking can indicate a loose fragment or meniscal tear. A feeling of the knee “giving out” may point to ligament instability.

Here are 5 Different Causes of Knee Pain &

 Why They Each Need a Different Approach

1. Jumper’s Knee / Runner’s Knee (Patellar Tendinopathy)

What it feels like:

• Dull or sharp pain just below the kneecap
• Comes on gradually over time, not from one single incident
• Worse with squatting, jumping, running, or stairs

How we identify it:

• Tenderness when you press directly on the patellar tendon
• Pain with resisted knee straightening
• Standard joint injury tests come back negative

The solution:

• • This is a tendon problem, not a joint problem so we load the tendon progressively.
  • Isometric exercises (holding a position without moving) are key early on to reduce pain while strengthening the tendon.
  • From there, rehabilitation builds toward full squats, running, and sport-specific movements.
• Rest alone will not fix this, tendons NEED load to heal!

2. Meniscus Injury

What it feels like:

• Pain along the inner or outer joint line, or deep in the knee
• Worse with twisting, pivoting, deep squatting, or weight-bearing rotation
• Sometimes a “locking” sensation if a torn piece catches in the joint

How we identify it:

• History of a twisting or compressive mechanism of injury
• Joint-line tenderness
• Positive McMurray’s Test
• Pain with weight-bearing rotation

The solution:

• Early rehab focuses on exercises that reduce compression through the knee joint (such as leg extensions and hamstring curls).
• Squats and lunges are introduced gradually once the tissue has had time to settle.
• Severe tears or locking symptoms may require surgical consultation.

3. ACL (Anterior Cruciate Ligament) Injury

What it feels like:

• Sudden onset, often with a loud “pop”.
• Significant swelling developing within a few hours.
• A sense that the knee is unstable or “giving way,” especially with pivoting.

How we identify it:

• Positive Lachman’s Test or Anterior Drawer Test
• History of sudden deceleration, landing, or pivoting mechanism
• MRI confirmation is needed for diagnosis

The solution:

• Whether or not surgery is needed depends on severity, lifestyle, and goals.
• Post-surgical rehab is critical, the exercise rehabilitation matter as much as the operation itself.
• Open-chain knee extension is restricted in early rehab because of stress on the healing graft, particularly between 0–45° of knee flexion However, there is zero strain on the ACL between 60-90 degrees. This is where we can re-gain quadriceps strength early on with isometric holds starting as early as on day 1 (working with a professional is essential here*).
• Closed-chain exercises like squats and leg press are generally introduced earlier because they are safer for the graft due to hamstring co-contraction and joint compressive force adding stability.

4. Patellar Subluxation or Dislocation

What it feels like:

• The kneecap slips sideways out of its groove
• Happens during a twist or direction change with the foot planted
• Immediate pain, visible deformity, and inability to straighten the knee
• After it relocates: swelling, tenderness on the inner side of the knee, and fear of it happening again

How we identify it:

• Clear history of a dislocation or subluxation event
• Tenderness over the inner side of the kneecap (where the MPFL ligament sits)
• Positive Patellar Apprehension Test, the knee “braces” when the kneecap is pushed outward
• X-ray and MRI help rule out bone injury and assess ligament damage

The solution:

• Quadriceps strengthening to improve how the kneecap tracks in its groove
• Hip strengthening — particularly the outer hip — to prevent the knee from collapsing inward.
• Patellar bracing early on to reduce apprehension and allow pain-free exercise.
• Neuromuscular training to restore stability and control of the knee.
• Surgical referral (MPFL reconstruction) is considered when instability persists, a ligament tear is confirmed on MRI, or anatomical risk factors make recurrence highly likely

5. Knee Osteoarthritis (OA)

What it feels like:

• Gradual onset of deep, achy pain — no single injury moment
• Stiffness in the morning that eases within 30 minutes
• Clicking, grinding, or swelling after activity
• Worse with stairs, prolonged walking, and getting up from a chair
• Most common in adults over 45, but can occur earlier.

How we identify it:

• Gradual onset, age, and activity history
• Reduced range of motion, crepitus (grinding), and joint-line tenderness
• Confirmed with X-ray
• Ligament and meniscal tests are typically negative

The solution:

• Exercise is the most evidence-backed treatment for knee OA — and it does not wear out the joint.
• Strengthening the quadriceps, hamstrings, calves, and hips reduces load on the joint and improves pain
• Aerobic exercise and weight management (where relevant) add further benefit
• Joint replacement is sometimes needed, but supervised physiotherapy should always come first — and is essential before and after surgery

The Bottom Line

Knee pain is not one condition…

It is a symptom with many possible causes — and the right treatment for one can be the wrong treatment for another.

If you are in Halifax and dealing with knee pain, the most important first step is getting a proper assessment so you can exercise safely and effectively.

Ready to get to the root of your knee pain?

BOOK AN APPOINTMENT WITH TANNER

By: Tanner Bishop

Physiotherapist, CSCS, MSc PT, BSc Kine, NCCP Coach