Knee pain is the second most common musculoskeltal injury. When we have knee pain, everything is effected from walking, stairs, squatting, and lunging. Knee pain comes in several varieites. The most common diagnosis for those older than 45 years is knee osteoarthritis and for patients younger than 40 years the diagnosis is generally patellofemoral pain syndrome (1). Knee osteoarthritis generally is associated with activity-related knee joint pain and possibly morning stiffness for less than thirty minutes (1). Patellofemoral pain is described as anterior knee pain during a squat in those who are physically active (1). However, there are other causes of pain around the knee such as ligaments, tendons, and the meniscus. Ligaments, tendons, and the mensicus can be injured with repetitive motions, but generally occur with some type of trauma or twisting. The ACL (anterior cruciate ligament) and the MCL (medial collateral ligament) are generally the two most injured ligaments in the knee. Depending on the severity, a surgery may be warranted, but most often, degenerative and minor sprains and strains are best handled by physical therapy.
Some people have noisy knees. The knees can make a lot of sounds due to underlying conditions. Couch et al (2025) found in 103 studies with 36,000 participants, noisy knees occurred in 41% people and 36% were pain-free; but, the quality of evidence was very low. Additionally, they discovered low to very low certainty of a link between noisy knees and osteoarthritis on x-ray or MRI (2). This means that just because your knees may make noise does not mean your going to have arthritis in your knees overtime.
Much like other conditions in the body, most of us have injured structures that have no pain or are asymptomatic. Nowadays, everyone wants and MRI. According to Horga et al (2020) our of 115 uninjured sedentary adults (230 knees total), the majority of knees showed abnormalities at 97%! Sedentary adults are people who are not active. Not one person in this study had knee pain; yet, 97% showed injuries to meniscus, cartilage, bone marrow, tendons, and even ligaments (3). The take away from this study is that we all likely have some type of knee pathology, but the pathology does not always correlate or cause pain. Amazing.
Treatment of knee pain is focused on strengthening from the hip to the foot, restoration of motion, and aerobic exercise. The American Academy of Orthopedic Surgeons (2021) note several strong recommendations for those with knee arthritis: supervised exercise (physical therapy), education, topical NSAIDS, and Oral NSAIDS. Through the work of Dunning et al (2018 & 2025) dry needling has shown great reductions in pain and improvement in function for knee osteoarthritis.
At the SHOP, we develop plans and routines to help with all types of knee pain. We believe in these treatments and implement them throughout our practice to help you achieve decreased pain, improved mobility, and enhanced ability to do the things you love.
References
1. Duong V, Oo WM, Ding C, Culvenor AG, Hunter DJ. Evaluation and Treatment of Knee Pain: A Review. JAMA. 2023;330(16):1568-1580. doi:10.1001/jama.2023.19675
2. Couch JL, King MG, De Oliveira Silva D, et al. Noisy knees - knee crepitus prevalence and association with structural pathology: a systematic review and meta-analysis. Br J Sports Med. 2025;59(2):126-132. Published 2025 Jan 2. doi:10.1136/bjsports-2024-108866
3. Horga LM, Hirschmann AC, Henckel J, et al. Prevalence of abnormal findings in 230 knees of asymptomatic adults using 3.0 T MRI. Skeletal Radiol. 2020;49(7):1099-1107. doi:10.1007/s00256-020-03394-z
4. Srivastava AK; Surgical Management of Osteoarthritis of the Knee Work Group, Staff of the American Academy of Orthopaedic Surgeons. American Academy of Orthopaedic Surgeons Clinical Practice Guideline Summary of Surgical Management of Osteoarthritis of the Knee. J Am Acad Orthop Surg. 2023;31(24):1211-1220. doi:10.5435/JAAOS-D-23-00338
5. Dunning J, Butts R, Young I, et al. Periosteal Electrical Dry Needling as an Adjunct to Exercise and Manual Therapy for Knee Osteoarthritis. The Clinical Journal of Pain. 2018;34(12):1. doi:https://doi.org/10.1097/ajp.0000000000000634
6. Dunning J, Young I, Taylor N, et al. Effect of dose interval of periosteal and intraarticular electrical dry needling boosters on pain and disability in patients with knee osteoarthritis: a multi-center randomized clinical trial. Physiotherapy Theory and Practice. Published online October 17, 2025:1-14. doi:https://doi.org/10.1080/09593985.2025.2575837
