Seek urgent medical assessment if the pain is very severe, if you cannot move the knee or put weight on it, if the knee is very swollen or has clearly changed shape, or if it is clearly hot and swollen, especially if there is redness, fever, chills or you feel generally unwell. A locked knee, instability or giving way, or painful clicking also warrants medical assessment without delay. After an injury, seek urgent assessment if you cannot walk or bear weight, if the knee is deformed or very swollen, or if you develop tingling, numbness or a clear loss of sensation in the leg or foot.
Symptom — knee
Knee pain: where should you start?
Knee pain can have many causes. The location or intensity of the pain alone is not enough to determine its cause. Assessment starts with symptoms, context and functional ability, with priority given to checking for warning signs.
When should you seek urgent assessment?
What information helps assess knee pain?
Useful details include when the pain started, whether it was sudden or gradual, whether there was trauma or twisting, where the pain is felt, whether there is swelling, redness or warmth, whether walking and weight-bearing are possible, and whether there is morning stiffness, locking, instability or a feeling that the knee gives way while standing or walking. Previous injury or surgery and general health also matter. No single symptom or sign is enough to establish the diagnosis.
Do I need imaging?
Not every episode of knee pain needs imaging. For suspected osteoarthritis specifically, osteoarthritis can be diagnosed clinically without routine imaging in people aged 45 or over when pain is activity-related and there is either no morning joint-related stiffness or stiffness lasting no more than 30 minutes. Imaging should not routinely be used to diagnose osteoarthritis unless there are atypical features or features suggesting an alternative or additional diagnosis.
How can physiotherapy help?
After checking for signs that require referral or urgent medical assessment, physiotherapy assessment can characterise the pain and assess functional ability, range of motion, strength, walking and the activities that aggravate symptoms or limit function. Depending on the diagnosis and context, care may include education, adjustment of activity level or mechanical load, progressive therapeutic exercise and reassessment. There is no single protocol that is appropriate for every presentation of knee pain.
When should you move to information about a specific diagnosis?
If knee osteoarthritis is already known, or becomes likely after appropriate clinical assessment, you can continue to the information about knee osteoarthritis. Knee pain alone does not mean that there is a meniscal or ligament injury and does not automatically mean that an X-ray or MRI is required.
Centre NASSER
Continue in the appropriate pathway
This page starts from the symptom and does not make a diagnosis. If warning signs are present, appropriate medical assessment comes first.
Centre NASSER
Knee pain: where should you start?
Knee pain can have many causes. Assessment starts with symptoms, context and functional ability, with priority given to checking for warning signs that need prompt medical care.