1. Introduction / Plain Theory

Knee pain is one of the most frequent musculoskeletal complaints, affecting people of all ages and activity levels.
It can arise from acute injury, overuse, or degenerative change, and often involves a combination of mechanical stress and soft-tissue imbalance.

The knee is a complex hinge joint formed by the femur, tibia, and patella, stabilized by ligaments, menisci, and surrounding muscles. Because it links the hip and ankle, dysfunction in these areas can strongly influence knee mechanics and load distribution.

Common causes of knee pain include:

• Patellofemoral pain syndrome (“runner’s knee”)

• Meniscal irritation or degeneration

• Ligamentous strain or sprain

• Early osteoarthritis

• Overuse and muscular imbalance

• Referred pain from hip or lumbar dysfunction

Knee pain can significantly limit mobility, physical activity, and quality of life, making early assessment and individualised care essential.

2. Typical Symptoms and Functional Impact

• Localised or diffuse knee pain, often worsened by climbing stairs, squatting, or prolonged sitting.

• Stiffness or swelling around the joint.

• Clicking, catching, or locking sensations.

• Weakness, instability, or altered gait.

• Discomfort during exercise, kneeling, or after periods of rest.

Functional impact:
Knee pain often limits walking, sport participation, and daily activities. Long-term, it can lead to reduced fitness, loss of muscle strength, and compensatory strain in the hips or back.

Red flags:
Sudden trauma with inability to bear weight, rapid swelling, deformity, fever, or unexplained redness should prompt immediate medical evaluation.

3. Contributing Factors / Underlying Causes

Knee pain rarely results from a single structure alone — it’s typically multifactorial, involving both local and global influences:

• Biomechanical alignment: valgus/varus knee position, foot pronation, or hip rotation.

• Muscular imbalance: weak gluteal or quadriceps muscles altering joint load.

• Overuse or repetitive strain: running, jumping, or occupational kneeling.

• Postural and gait compensation: from hip, pelvis, or ankle restrictions.

• Degenerative changes: cartilage thinning or early osteoarthritis.

• Inflammatory or systemic causes: e.g., rheumatoid arthritis (requiring medical management).

Understanding the whole kinetic chain — from foot to pelvis — is key to addressing recurrent or persistent knee pain.

4. Osteopathic Approach

Osteopathic care for knee pain aims to restore balanced mechanics, fluid motion, and load distribution throughout the lower limb and spine.
The approach is always adapted to the individual’s presentation, diagnosis, and activity level.

An osteopathic assessment may include:

• Observation of posture, gait, and alignment of hips, knees, and ankles.

• Palpation and mobility testing of the knee joint and surrounding soft tissues.

• Evaluation of the pelvis, lumbar spine, and feet for compensatory patterns.

• Gentle joint and soft-tissue techniques to improve circulation, reduce stiffness, and relieve pain.

• Collaboration with physiotherapy or rehabilitation programs focusing on strengthening and stability.

Osteopathic treatment does not aim to replace medical or surgical interventions, but to complement conservative management by supporting optimal biomechanics, reducing pain, and enhancing recovery.

5. Scientific Evidence & References

Research supports conservative management — including manual therapy and exercise — as first-line treatment for most non-surgical knee conditions such as patellofemoral pain, early osteoarthritis, and overuse injuries.
Osteopathic techniques can aid in improving local joint mobility, soft-tissue function, and neuromuscular coordination when integrated within a holistic care plan.

References

1. Crossley KM, van Middelkoop M, Callaghan MJ, et al. Patellofemoral pain. Nat Rev Dis Primers. 2016;2:16033. Link

2. Fernandes L, Hagen KB, Bijlsma JW, et al. EULAR recommendations for the non-pharmacological core management of hip and knee osteoarthritis. Ann Rheum Dis. 2013;72(7):1125–1135. Link

3. Henschke N, Maher CG, Refshauge KM, et al. Prognosis in patients with knee pain: a systematic review. BMC Musculoskelet Disord. 2008;9:116. Link

4. Deyle GD, Allen CS, Allison SC, et al. Physical therapy treatment effectiveness for osteoarthritis of the knee: a randomized comparison of supervised clinical exercise and manual therapy. Phys Ther. 2005;85(12):1301–1317. Link

5. Abbott JH, Robertson MC, Chapple C, et al. Manual therapy, exercise therapy, or both in addition to usual care for osteoarthritis of the hip or knee: a randomized controlled trial. Osteoarthritis Cartilage. 2013;21(4):525–534. Link

6. Franke H, Fryer G, Ostelo RWJG, et al. Osteopathic manipulative treatment for musculoskeletal pain: systematic review and meta-analysis of randomized controlled trials. BMC Musculoskelet Disord. 2014;15:286. Link

7. Topp R, Woolley S, Hornyak J, et al. The effect of manual therapy on knee pain and function in older adults with osteoarthritis: a randomized clinical trial. J Geriatr Phys Ther. 2013;36(4):185–193. Link

8. Xie Y, Chen Z, Yang Z, et al. Comparative safety and efficacy of manual therapy interventions for knee osteoarthritis: a network meta-analysis. Front Med. 2024;15:1507198. Link