Medial Knee Pain: Common Causes and Effective Management

Have you ever felt a nagging pain on the inside (medial) of your knee that just won’t go away? Medial knee pain can be disruptive, impacting your daily activities and overall quality of life. In this blog, we explore the most common causes of medial knee pain, how physiotherapy can help, and what steps you can take to manage it effectively. 

Anatomy of the Medial Knee 

Understanding the anatomy of the medial knee is key to identifying the source of pain. Here are the main structures involved: 

  

Tibiofemoral Joint: The knee joint comprises three bones—the femur (thigh bone), tibia (shin bone), and patella (kneecap). The medial compartment of the tibiofemoral joint is often a primary site of pain due to its load-bearing role. 

Meniscus: The medial meniscus is a fibrocartilaginous structure that acts as a shock absorber and stabiliser for the knee. Tears in the meniscus are a common cause of medial knee pain. 

Medial Collateral Ligament (MCL): The MCL provides stability by preventing inward (valgus) movement of the knee. Injuries to this ligament can lead to pain and instability. 

Common Causes of Medial Knee Pain 

1. Meniscal Tears

Meniscal tears can result from acute injuries or age-related degeneration. 

Acute Tears: Often caused by twisting movements while the knee is flexed. Symptoms include swelling, stiffness, tenderness along the joint line, and mechanical issues such as clicking or locking. 

Degenerative Tears: These develop gradually, commonly in individuals over 30, and may occur without a specific injury. Symptoms include persistent, dull pain and occasional swelling. 

2. MCL Sprains 

MCL injuries typically occur due to a force pushing the knee inward, such as during sports or falls. 

Grades of Sprains: 

Grade 1: Mild tenderness and minimal joint laxity. 

Grade 2: Partial disruption of the ligament, with some laxity. 

Grade 3: Complete disruption, often associated with injuries to other structures like the ACL. 

3. Osteoarthritis (OA) 

Knee osteoarthritis is a degenerative condition that affects the cartilage within the joint. It is most common in the medial compartment of the tibiofemoral joint and can lead to symptoms such as: 

• Pain that worsens with activity.
• Stiffness and swelling. 
• Crepitus (cracking sounds) during movement. 
• Bow-legged deformities (varus alignment) in severe cases. 

Managing Medial Knee Pain 

  

Meniscal Tears 

Conservative Management: Includes physiotherapy, activity modification, and strengthening exercises. Tears in the outer (vascular) zone of the meniscus often respond well to non-surgical treatments. 

Surgical Options: For tears that do not improve with conservative care, procedures such as partial meniscectomy or meniscal repair may be considered. Meniscal repairs typically yield better long-term outcomes but require longer rehabilitation. 

MCL Sprains

Grades 1 & 2: Most cases can be treated conservatively with physiotherapy focusing on strengthening and restoring mobility. 

Grade 3: While surgery is rarely necessary, it may be indicated for severe injuries involving other knee structures. 

  

Osteoarthritis 

Conservative Treatment: Includes exercise therapy, weight management, and activity modification. Knee bracing and pharmacological interventions may also help manage symptoms. 

• Surgical Interventions: For advanced OA, options include: 
• High tibial osteotomy (realigning the knee to reduce medial compartment loading). 
• Unicompartmental knee arthroplasty (partial knee replacement). 
• Total knee arthroplasty (full knee replacement) for severe cases.

Prevention and Self-Management Tips 

Strength Training: Incorporate exercises that target the hips, glutes, and quadriceps to support knee stability. 

Proper Footwear: Use shoes with good cushioning and consider orthotics for biomechanical alignment. 

Warm-Up and Stretch: Prepare your muscles and joints before engaging in physical activity. 

Load Management: Avoid overloading the knee with repetitive high-impact activities. Gradually increase the intensity of exercises. 

Listen to Your Body: Use a pain scale to guide activity levels. Pain below 3/10 is generally acceptable, but pain above 3/10 indicates the need for regression. 

When to Seek Professional Help 

If your medial knee pain persists, worsens, or significantly impacts your daily life, consult a physiotherapist. They can provide a personalised treatment plan, including targeted exercises, manual therapy, and activity modifications to address your specific condition.