Health – Let’s talk knee injuries!

Knee pain ranks among the most debilitating conditions, disrupting everyday activities like walking, climbing stairs, or participating in sports and exercise. In New Zealand, knee injuries account for a significant portion of accident-related claims to ACC and represent one of the most common issues seen in physiotherapy clinics,often comprising a substantial share of musculoskeletal cases treated.

To better understand knee problems and know when to seek help, it’s useful to divide them into two main categories: acute (sudden onset, typically from a specific injury) and chronic (gradual, developing over time). Below, I outline the most common conditions in each group, along with warning signs that signal the need for prompt assessment.

Acute knee injuries: These result from a single traumatic event, such as a direct blow or the knee twisting beyond its normal range.

Ligament tears – A sudden pivot, twist, or collapse (with or without impact) can damage one or more of the knee’s four major ligaments: the ACL (anterior cruciate ligament, often called the “infamous” one in sports), PCL (posterior cruciate), MCL (medial collateral), or LCL (lateral collateral). Many cases respond well to conservative rehabilitation, but others require surgical reconstruction for full stability and function.

Meniscus tears – The menisci act as shock absorbers, cushioning the joint surfaces. They’re commonly injured during pivoting movements, leading to pain, swelling, and mechanical symptoms.

Kneecap (patella) dislocation – Usually straightforward to spot, the kneecap most often dislocates laterally (outward). It may stay out of place until manually relocated, often with dramatic swelling and instability afterward.

Chronic knee injuries: These develop gradually, sometimes over months or years, and worsen without intervention. Proactive management is key to preventing progression.

Patellofemoral pain/poor kneecap tracking – The patella floats between strong tendons and must glide smoothly in the femoral groove. Muscle weakness or imbalance can cause it to track unevenly, resulting in front-of-knee pain, especially during squatting, stairs, or prolonged sitting.

Patellar tendinopathy (jumper’s knee) – Repetitive loading from jumping, running, or kneeling irritates the tendon below the kneecap. Contrary to common belief, stretching alone rarely helps; targeted strengthening exercises are the cornerstone of recovery, gradually rebuilding tendon capacity for pain-free activity.

Osteoarthritis – Over time, the knee’s protective cartilage thins and develops cracks–like potholes forming in a road. While not always injury-related, prior damage accelerates it. Strength training, weight management, and activity modification often control symptoms effectively, though advanced cases may eventually require joint replacement.

Key warning signs

• Swelling – Especially rapid onset after injury, indicating internal damage (e.g., ligament tear or meniscus issue).
• Locking – The knee catches or sticks in position, suggesting a displaced fragment (often meniscus).
• Giving way / instability – The knee buckles or feels unreliable, commonly linked to ligament damage.
• Night pain – Pain severe enough to wake you may point to a fracture or serious structural injury.

The good news? You don’t always need a GP referral or an A&E visit for a knee injury. A qualified physiotherapist can assess you thoroughly, lodge an ACC claim if eligible, create a tailored rehab plan, order X-rays when appropriate, or refer to a specialist. Early intervention often leads to better outcomes and faster return to activity.

Look after your knees, they carry you through life. Stay strong, stay active, and seek help when needed.