Knee pain

It shows up on stairs. At kilometre two of your run. Getting up from the desk after three hours. Or first thing in the morning when you put your foot on the floor and something behind the kneecap complains. Knee pain is one of the most common musculoskeletal presentations in the world — and one of the most frequently treated in the wrong place.

The numbers frame the scale of the problem clearly. The 2021 Global Burden of Disease Study, published in PLOS ONE (Chen et al., 2025), reports 374.7 million global cases of knee osteoarthritis alone, with projections approaching one billion by 2050. Adding all other knee pain presentations — patellofemoral pain syndrome, iliotibial band syndrome, meniscal pathology, ligament injuries, tendinopathy, and bursitis — somewhere between 10 and 60 percent of the general population experiences knee pain in any given year. Knee conditions are among the leading causes of reduced physical function, lost workdays, and diminished quality of life globally. They're also among the most treatable — when the entire kinematic chain is properly assessed.

How do I know what kind of knee problem I have?

The location of pain gives an initial clue, but it's not a diagnosis. The same anatomical region can be painful for very different reasons — and the same cause can produce pain in very different locations.

Anterior knee pain / behind the kneecap

Pain in the front of the knee — particularly on stairs, after prolonged sitting (the "theatre sign": pain that worsens getting up after sitting for a long time), and during squatting or running. This is the characteristic presentation of patellofemoral pain syndrome (PFPS): abnormal tracking of the patella in the femoral groove, most commonly driven by weak hip abductors or ankle overpronation rather than a problem in the knee itself.

Lateral knee pain / after running

A sharp or burning pain on the outer side of the knee that typically appears after a specific running distance (commonly 2–5 km) and eases with rest. The hallmark of iliotibial band syndrome (ITBS) — one of the most common running injuries in all populations and one of the most misunderstood. The IT band doesn't stretch. The solution is rarely at the knee.

Medial knee pain / inner side

Pain on the inner side of the knee can indicate medial collateral ligament irritation, pes anserine bursitis, medial meniscal pathology, or referred pain from a blocked sacroiliac joint — which can produce pain that feels exactly like a medial knee problem but resolves when the SIJ is treated.

Rest and night pain

Pain independent of activity, or pain that wakes you at night, can indicate osteoarthritis, bursitis, or — less commonly — inflammatory arthritis. It warrants careful assessment before treatment.

Pain during jumping, landing, or squatting

Patellar tendinopathy (jumper's knee), pes anserine bursitis, or patellofemoral stress. When landing pain is associated with anterior cruciate ligament instability, this needs orthopaedic assessment.

Knee pain following surgery

After meniscectomy, ACL reconstruction, or total knee replacement, pain and functional limitation can persist if the compensation patterns that developed in the months before surgery — in the hip, pelvis, and lumbar spine — are not also addressed. The surgery fixes the knee. The chain needs fixing too.

When to seek emergency care

Go to A&E immediately for: significant swelling with sudden loss of function following trauma (possible ligament rupture, meniscal tear, or fracture), a locked knee that cannot be straightened or bent, fever combined with a hot, swollen joint (possible septic arthritis), or visible deformity after an injury.

What to do about knee pain right now

For acute knee pain following an injury: PRICE: Protection (stop aggravating loading), Rest (brief offloading — not extended immobilisation), Ice (15–20 minutes several times daily for the first 48 hours), Compression, Elevation. If trauma was significant, medical assessment is needed before any other treatment.

For chronic or activity-related knee pain: Heat is often more helpful than ice for non-acute presentations — a heat pack on the quadriceps and hip musculature for 20 minutes improves tissue circulation. Low-impact movement — cycling at low resistance, swimming — is almost always better than rest. The joint cartilage relies on movement for its nutrient supply.

Immediate muscle work: The most immediately actionable intervention for most knee pain is hip abductor activation. Clamshell exercises lying on the side, and side-lying hip abduction, directly target the gluteus medius — the muscle most consistently weak in patients with PFPS and ITBS — without loading the knee. Begin these the same day; they are safe in virtually all knee conditions.

What tends to disappoint: Knee braces and supports can reduce pain short-term and improve proprioception. They don't address hip weakness, foot mechanics, or lumbar restriction. Pain medication masks the signal. Complete rest weakens the surrounding musculature and in most cases extends the recovery timeline. A support is a bridge; it's not a treatment.

What's causing your knee pain?

The knee as part of a chain.

The knee is mechanically one of the simpler joints in the body — primarily a hinge that flexes and extends. Its vulnerability comes from its position between two highly mobile joints: the hip above and the ankle below. Dysfunction in either direction converges at the knee.

Patellofemoral Pain Syndrome (PFPS) — the most common knee diagnosis in active people

Research reports PFPS prevalence as high as 22.7 percent in the general population, making it the most common knee condition in younger and active populations. The patella tracks through a groove on the femur as the knee bends and straightens. When weak hip abductors and external rotators allow the femur to internally rotate and adduct — the "dynamic valgus collapse" visible as a knee-dives-inward pattern during running or squatting — the patella is pulled laterally and the contact pressure between it and the trochlear groove increases dramatically. The resulting pain is anterior. The cause is proximal. Treating only the knee without addressing the hip produces temporary relief and consistent recurrence.

Iliotibial Band Syndrome (ITBS / Runner's Knee)

The IT band is a thick fascial structure running from the iliac crest to the lateral tibial tubercle, passing over the lateral femoral condyle. During repetitive knee flexion-extension — in running — it moves repeatedly over this bony prominence. When hip abductor weakness allows excessive hip drop, or when stride length is too long, or when cadence is too low, friction increases and the familiar lateral pain appears after a predictable distance. The IT band cannot be stretched — it is not muscle. Aggressive foam rolling provides temporary relief without addressing the cause. Hip strengthening, cadence correction, and IASTM to the lateral knee and thigh address the actual drivers.

Knee Osteoarthritis (Gonarthrosis)

Osteoarthritis represents cartilage loss — but cartilage loss and pain are not the same thing. Many people with severe radiological OA have no symptoms; many with significant pain have unremarkable imaging. What drives the pain and disability in knee OA is primarily the surrounding muscle weakness — particularly quadriceps — and the altered loading patterns from hip dysfunction and compensatory gait changes. Exercise-based treatment that builds quadriceps and hip strength and maintains joint mobility is the evidence-based first-line approach for knee OA before surgical intervention. Conservative care delays progression, reduces pain, and improves function.

Meniscal Pathology

The menisci are the shock absorbers of the knee. Tears occur through acute trauma (twisting injuries) or through degeneration over time (especially in those over 40). Critically: not every meniscal tear causes pain, and not every meniscal tear requires surgery. Multiple high-quality randomised trials have shown that for degenerative meniscal tears in middle-aged patients, conservative management produces equivalent outcomes to arthroscopic partial meniscectomy at 12 months. Chiropractic care that restores joint mobility, addresses hip and lumbar function, and progressively loads the surrounding musculature is a legitimate and often highly effective conservative approach.

Patellar Tendinopathy (Jumper's Knee)

Pain directly below the kneecap at the patellar tendon attachment, worsened by jumping, squatting, and stair use. An overuse tendinopathy driven by volume exceeding the tendon's adaptive capacity — most common in ball sport athletes with high jump loads. Eccentric and heavy slow resistance training (decline squats, Bulgarian split squats) is the most evidence-supported conservative intervention.

The hip–pelvis–foot triad: why treating the knee alone fails

This is the clinical core of how we approach knee pain. A knee that hurts without a structural injury at the knee is almost always the downstream expression of dysfunction somewhere in the kinematic chain:

Weak hip abductors → dynamic valgus during loading → PFPS, ITBS, medial knee stress
Blocked lumbar spine or SIJ → altered pelvic position → asymmetric knee loading that mimics knee pathology
Ankle overpronation → tibial internal rotation → increased medial knee compartment load
Restricted ankle dorsiflexion → compensatory knee movement to allow heel-rise → patellar tendon overload

Treating the knee in isolation is treating the symptom. Treating the chain treats the problem.

How does a chiropractor treat knee pain in Munich?

Our assessment always begins well above the knee. Every knee patient is assessed from the lumbar spine through the sacroiliac joint, hip, knee, ankle, and foot. The treatment that follows addresses every link in the chain that is contributing.

Joint Mobilisation: Knee, Hip, SIJ, and Lumbar Spine

Chiropractic mobilisation and adjustment at the knee joint itself can restore normal intraarticular mechanics, reduce swelling via improved lymphatic drainage, and release fascial restrictions around the patella and joint capsule. Equally important — and often more immediately effective — are adjustments and mobilisations of the lumbar spine and SIJ. A blocked sacroiliac joint producing medial knee pain resolves rapidly when the SIJ is treated directly. A lumbar restriction at L3–L4 affecting the femoral nerve distribution can produce anterior thigh and knee pain that responds to cervical-lumbar treatment rather than anything at the knee.

Kinesiology Taping for the Knee

Applied correctly for the specific diagnosis, kinesiology tape can:

Improve patellar tracking mechanics in the femoral groove (McConnell-style taping for PFPS)
Reduce dynamic valgus collapse by cueing the knee into a more neutral position
Improve joint proprioception — the knee's awareness of its own position, which is consistently impaired in knee pain of all causes
Allow patients to continue work and sport at a manageable pain level while rehabilitation produces structural change

Taping is a bridge. It is included in our treatment where appropriate and taught to patients who benefit from self-application.

IASTM — Instrument-Assisted Soft Tissue Mobilisation

IASTM — often called "scraping" — uses precision-shaped stainless steel instruments applied to the skin to detect and treat altered fascial tissue, scar adhesions, and chronic soft tissue restrictions. At the knee, IASTM is particularly valuable for:

Thickened or restricted IT band tissue in runners with lateral knee pain
Post-surgical adhesions following meniscectomy, ACL reconstruction, or knee replacement that restrict flexion or extension
Patellar retinaculum restrictions contributing to abnormal patellar tracking
Pes anserine bursitis and chronic medial knee tendon restrictions
Patellar tendinopathy with localised degenerative tendon tissue

The evidence supports its use. A 2025 systematic review and meta-analysis published in BMC Musculoskeletal Disorders found that IASTM significantly reduces patient-reported pain in musculoskeletal disorders based on moderate-certainty evidence. A 2023 randomised trial published in Frontiers in Medicine specifically for patellofemoral pain syndrome found IASTM superior to conventional massage therapy for pain reduction and functional improvement at both short- and medium-term follow-up.

Progressive Hip, Quadriceps, and Gluteal Strengthening

Once acute symptoms are under control, strengthening is the most important component of sustained knee pain management. Weak hip abductors, an under-active gluteus maximus, and an inhibited quadriceps are consistently found in knee pain patients of all diagnoses. The programme progresses individually: from clamshells and glute bridges to single-leg Romanian deadlifts and sport-specific movement patterns. No gym equipment, no fitness background required. The exercises are introduced in the clinic and adapted for home.

Chiropractic care: safe before, during, and after knee surgery

One of the most important messages for patients considering surgery or already post-operatively: chiropractic care is appropriate and beneficial at every stage.

Before surgery: Maintaining hip and lumbar mobility, building the surrounding musculature, and normalising gait patterns before a planned knee operation improves surgical outcomes and shortens post-operative rehabilitation timelines — even when the operation itself is unavoidable.

After surgery: Knee surgery addresses the knee — it does not address the compensation patterns that accumulated in the months or years before it. Patients after meniscectomy, ACL reconstruction, or total knee arthroplasty typically walk asymmetrically, unconsciously offload the operated side, and frequently develop low back pain, hip pain, or contralateral knee pain as a result. The pelvis tilts, the lumbar spine loads unevenly, and the adapted movement patterns become habitual. Chiropractic treatment after knee surgery restores mobility in the hip, SIJ, and lumbar spine, normalises the gait pattern, and progressively rebuilds the kinematic chain as a functional unit — without directly manipulating the operated knee.

The chiropractor never operates on the knee. The chiropractor optimises everything that influences it.

When to see a chiropractor for knee pain in Munich

As soon as knee pain is affecting your movement — and once it's clear there is no acute emergency requiring orthopaedic assessment. The earlier a kinematic chain dysfunction is identified and treated, the fewer compensatory patterns develop, and the less cumulative load the joint bears during recovery.

You do not need a referral to see us. No GP visit, no orthopaedic waiting list. We offer short-notice appointments because knee pain affects walking, stairs, sport, and work immediately.

Also see a doctor if:

Significant swelling occurred suddenly following trauma
The knee locks and cannot be fully extended or flexed
Redness, warmth, and fever accompany the knee pain
Progressive numbness or tingling extends into the lower leg
Symptoms haven't improved after 6–8 weeks of targeted treatment — MRI is then appropriate

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Knee pain FAQ

Anterior knee pain — what is it?

Pain in the front of the knee, particularly on stairs or after sitting, is typically patellofemoral pain syndrome. The most common cause is not at the knee — it's weak hip abductors allowing the knee to collapse inward during loading. Treatment that addresses only the knee without strengthening the hip consistently produces temporary results and recurring symptoms.

Runner's knee / outer knee pain — what helps?

The lateral knee pain that appears after a specific running distance is IT band syndrome. The IT band cannot be stretched. The effective approach is hip abductor strengthening, cadence correction (aim for 170–180 steps per minute), and IASTM to the lateral thigh and knee to address accumulated tissue restrictions. Treating only the knee symptom without addressing the hip is why this condition keeps coming back.

Can a chiropractor help with knee arthritis?

Yes. Cartilage loss is irreversible, but pain and function are highly modifiable. Building quadriceps and hip strength, maintaining joint mobility in the hip and lumbar spine, and normalising loading mechanics through gait correction are the primary tools. Chiropractic care for knee OA can reduce pain, improve function, and delay surgical intervention — or optimise recovery after it.

What is IASTM / scraping?

IASTM (Instrument-Assisted Soft Tissue Mobilisation) uses precision metal instruments on the skin to identify and treat fascial restrictions, scar adhesions, and degenerative tissue. At the knee, it's particularly effective after surgery, in chronic tendinopathy, and for IT band restrictions. It creates controlled micro-trauma that triggers a healing response — similar in mechanism to eccentric loading for tendinopathy.

Can I see a chiropractor if I need knee surgery or have already had it?

Absolutely, and we'd strongly encourage it at both stages. Before surgery: maintaining hip and lumbar mobility improves your surgical starting point and shortens rehabilitation. After surgery: addressing the compensation patterns in the hip, pelvis, and lumbar spine that developed before the operation is essential for full functional recovery and for preventing secondary problems in the back, hip, or opposite knee.

How long does knee pain treatment take?

For PFPS and IT band syndrome with early treatment: typically 4–8 weeks of significant improvement. For knee OA or post-surgical rehabilitation: 2–4 months of progressive improvement. What consistently holds true: earlier treatment produces shorter timelines and better long-term outcomes.

Do I need a referral or an MRI to see you in Munich?

No. Book directly — no GP letter, no waiting list, no referral required. Same-week appointments are available for patients in acute pain.