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Knee Pain

Dr. Michael Hoiles has created this resource to help you better understand Knee Pain, including its common causes, symptoms, treatment options, recovery expectations, and when it may be appropriate to seek an assessment. Whether your symptoms started suddenly or developed gradually over time, this guide is designed to provide clear, evidence-informed information to help you make informed decisions and return to the activities you enjoy with confidence.

 

What Is Knee Pain

Knee Pain refers to discomfort or dysfunction in or around the knee joint, including the bones, cartilage, ligaments, tendons, and surrounding soft tissues. It is commonly related to overload, movement dysfunction, or degenerative changes rather than a single injury in many cases. 

The knee is a load-bearing joint that relies heavily on proper hip, ankle, and foot mechanics, making it sensitive to both local and upstream movement issues. 

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Common Causes 

  • Patellofemoral pain syndrome (kneecap tracking irritation)  

  • Meniscus irritation or degeneration  

  • Ligament sprain (ACL, MCL, LCL)  

  • Tendon overuse (patellar or quadriceps tendinopathy)  

  • Osteoarthritis (degenerative joint changes)  

  • Iliotibial (IT) band irritation  

  • Muscle imbalance or poor movement mechanics  

  • Overuse from running, jumping, or squatting  

 

Often, knee pain develops gradually due to a combination of factors rather than a single injury. 

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Common Symptoms 

  • Pain around or behind the kneecap  

  • Aching or sharp pain with squatting, stairs, or running  

  • Stiffness after rest or in the morning  

  • Swelling or mild inflammation  

  • Clicking, grinding, or catching sensations  

  • Instability or “giving way” in some cases  

  • Pain with prolonged sitting (theatre sign)  

 

Symptoms can vary depending on the tissues involved and the severity of the condition. 

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What Makes It Worse? 

  • Running, jumping, or impact activities  

  • Squatting or lunging under load  

  • Stairs (especially going down)  

  • Prolonged sitting with bent knees  

  • Sudden increases in activity or training load  

  • Poor lower limb mechanics (knee collapse inward)  

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What Helps? 

  • Activity modification (reduce aggravating loads, not full rest)  

  • Low-impact exercise (walking, cycling, swimming)  

  • Strengthening hips, quads, and glutes  

  • Improving knee alignment and movement control  

  • Ice for acute irritation or swelling  

  • Gradual return to loading and impact activities  

 

Staying active and addressing contributing factors often leads to better long-term outcomes than relying solely on passive treatments.

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How Chiropractic Can Help 

Chiropractic care may help with knee pain by: 

  • Assessing whether the knee pain is local or driven by hip/ankle dysfunction  

  • Improving joint mobility in the knee, hip, ankle, and pelvis  

  • Reducing muscle tightness contributing to altered mechanics  

  • Guiding progressive strengthening and load management  

  • Improving movement patterns (squat, lunge, gait mechanics)  

  • Supporting rehabilitation for return to sport or activity  

Knee pain is often a whole lower-limb kinetic chain issue rather than an isolated joint problem. 

 

When Is Shockwave Therapy Recommended for Knee Pain? 

For some knee conditions, Shockwave Therapy may be recommended as part of a comprehensive rehabilitation program, particularly for persistent tendon-related pain that has not responded fully to exercise and other conservative treatments. 

Shockwave therapy is most commonly used for conditions such as patellar tendinopathy (jumper's knee) and certain chronic tendon injuries around the knee. It delivers acoustic pressure waves that are thought to stimulate the body's natural healing response, improve blood flow, and reduce pain sensitivity. 

Research suggests that shockwave therapy may help reduce pain and improve function when combined with progressive strengthening exercises, manual therapy, and gradual return to activity. 

During your assessment, we'll determine whether your symptoms are arising from a tendon, joint, ligament, or another structure, and whether shockwave therapy is an appropriate part of your treatment plan. 

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Recovery Timeline 

Every case is unique, but general recovery timelines may include: 

  • Mild overuse or irritation: 1–3 weeks  

  • Tendinopathy or patellofemoral pain: 3–8+ weeks  

  • Degenerative or chronic cases: 2–6+ months  

Recovery depends heavily on load management and correction of movement mechanics. 

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Exercises Commonly Recommended 

The most appropriate exercises depend on the underlying cause of your knee pain and your stage of recovery. These examples represent exercises commonly recommended for many knee conditions but should be individualized following an assessment. 

Phase 1: Reduce Pain and Restore Mobility 

The focus during the early phase is to reduce pain and swelling, maintain knee mobility, and begin gently activating the muscles that support the knee. 

  • Heel Slides  

  • Quadriceps Sets (Quad Tightening)  

  • Straight Leg Raises  

  • Short Arc Quads  

  • Calf Raises  

  • Stationary Cycling (Low Resistance, if tolerated)  

  • Gentle Hamstring and Calf Stretching  

 

Phase 2: Restore Strength and Stability 

As symptoms improve, rehabilitation shifts toward rebuilding strength, improving balance, and restoring normal movement patterns. 

  • Mini Squats  

  • Step-Ups and Step-Downs  

  • Glute Bridges  

  • Clamshells  

  • Terminal Knee Extensions with Resistance Band  

  • Single-Leg Balance Exercises  

  • Lateral Band Walks  

 

Phase 3: Return to Activity and Prevent Recurrence 

The final stage focuses on improving endurance, power, coordination, and preparing the knee for work, sport, or recreational activities. 

  • Goblet Squats  

  • Forward and Lateral Lunges  

  • Single-Leg Romanian Deadlifts  

  • Bulgarian Split Squats (if tolerated)  

  • Single-Leg Hopping and Landing Drills  

  • Agility and Direction-Change Exercises  

  • Gradual Return to Running, Hiking, or Sport-Specific Training  

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A Few Notes 

Exercises should not significantly increase pain during or after completion. Mild discomfort during strengthening exercises can be normal, but symptoms should remain manageable and settle within 24 hours. Rehabilitation is most effective when exercises are progressed gradually based on pain, strength, balance, and functional improvement.

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Can I Still Exercise? 

Yes — exercise is usually encouraged with modifications. 

Recommended: 

  • Low-impact cardio (cycling, swimming, walking)  

  • Controlled strength training (pain-free range)  

  • Glute and hip strengthening  

  • Step-ups or partial range squats (if tolerated)  

  • Balance and stability exercises  

Avoid early on: 

  • High-impact running or jumping  

  • Deep squats or lunges if painful  

  • Sudden increases in training intensity  

  • Movements causing sharp or worsening pain  

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When To Seek An Assessment 

Consider booking an assessment if: 

  • Pain lasting more than 1–2 weeks without improvement  

  • Swelling that does not settle  

  • Recurrent knee instability or “giving way”  

  • Difficulty walking, squatting, or using stairs  

  • Pain affecting work, sport, or daily function  

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Common Mistakes That Slow Recovery 

  • Continuing high-impact activity through pain  

  • Avoiding all movement for too long  

  • Ignoring hip and ankle mechanics  

  • Rapid return to running or sport  

  • Not progressively loading the knee  

  • Poor squat or landing mechanics  

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When Should I worry?  

Seek urgent assessment if you experience: 

  • Sudden major swelling after injury  

  • Inability to bear weight on the knee  

  • Visible deformity or suspected dislocation  

  • Locked knee (unable to fully bend or straighten)  

  • Severe pain following trauma  

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Summary 

✔ Knee pain is commonly related to overload, movement dysfunction, or degenerative changes affecting the joint and surrounding tissues 
✔ Common causes include patellofemoral pain, tendinopathy, meniscus irritation, and osteoarthritis 
✔ Symptoms include pain with stairs, squatting, running, stiffness, and sometimes swelling or clicking 
✔ Most cases improve with load management, strengthening, and correction of movement mechanics 
✔ Chiropractic care may help by addressing joint mobility, lower limb mechanics, and rehabilitation guidance 
✔ Red flags such as locking, major swelling, or inability to bear weight require urgent assessment 

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Ready to Get Back to Moving Comfortably?

If your knee pain pain isn't improving, keeps returning, or is preventing you from working, driving, exercising, or enjoying your daily activities, an assessment can help identify the underlying cause and determine the most appropriate treatment plan. 

Dr. Michael Hoiles is a Calgary chiropractor who provides evidence-informed care combining hands-on treatment, exercise-based rehabilitation, and practical advice to help people recover from injury, move better, and stay active. 

Book an appointment with Dr. Michael Hoiles today to start your recovery and get back to doing what you enjoy. 

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