The Guru: when it comes to knee pain it can be pretty simple to work out what’s what and why

September 17, 2014

Hello Guru,

No idea what sparked it, but my left knee is very sore in transitions from sitting to standing or standing to walking for about 4 weeks now.

There is tenderness from halfway up my shin to halfway up my thigh. It gets much better overnight and then as the day goes on gets more and more sore. I ordered a recumbent trike just before it started. It was starting to improve when I got my trike and as I was getting into it I twisted and hurt it again. The actual pedalling does not hurt, but afterwards it is sore again.

I do have osteo arthritis in my knees, but this does not feel like joking pain. After I have been sitting for some time (I work in IT) walking is very painful and I have to take tiny steps and try not to bend my knee for a few yards then it eases a little and I can walk a little more normally.

Sometimes I cannot step through with my other leg and can only step up to my bad leg.

All help gratefully received

September 17, 2014

Hi  Elle

Sometimes it’s the simple things that can be the most trickiest.

Knee pain, on the whole, is pretty simple to work out what’s what and why. You’ve got some classic movement patterns that suggest that you’ve got an issue with the way your kneecap sits on the front of your thigh bone. The only slightly un-classic bit is where you feel the pain. Tracking issues give you knee pain, not up and down the shin/thigh pain. It can do but it’s not classic.

On a bike not an issue and the pain after is suggestive of your joint swelling lightly and the bone tissue becoming painful. What is of a clue is that you want to step up on your bad leg, ands this is really suggestive of a tight quad – the muscle at the front.

If I now put this stiffness in the muscle, large pain expanse and a limitation to walk, I’m thinking that your OA could be giving you issues today – that in itself is not an issue, and its a pretty common diagnosis, but it doesn’t have to be painful.

As long as you don’t have any swelling, giving way or locking I think I’d suggest that you try a hot water bottle, start doing x50/75 straight leg lifts, then progress to small lunges and squats (in a pain free range) and some (initially) gentle quad stretches. If you can try taking a small course (3 days) of anti inflammatories (if you’re OK to take them) to see if this combination of therapy makes a difference.

I know it’s a fairly flimsy response, but try the above for 3 days – if you feel and improvement from day 4+ then carry on stretching and getting stronger. If it feesl the same or worse then I’d suggest going to see someone who could be more precise.

All is not lost!

The Guru

Six Physio

Elle responded that the pain is in one place:

Thanks Guru.

I forgot to mention that the pain is in a specific area. It is only on the inside of my left knee. I will do as you suggest. Straight leg raises are a bit of a challenge pain wise. My lower leg just doesn’t seem to like to hang and pulls on my knee. I have been using a bit of ice which seems to soothe it.

Best wishes


The Guru replied:


That changes everything.

This is a patella tracking issue, if the pain is focused where your describe.

Don’t do any SLR or heat. All rehab must be pain free.

Use anti inflams, small squats, lunges and controlled glut work. Improve the length of your quads and if you’ve got a foam roller do some release on your ITB.

Classic after all!

Guru Responded

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