Knee pain is one of the most common reasons patients come to see me — and one of the most mismanaged in primary care. The problem is that "knee pain" is not a diagnosis. It's a symptom with dozens of possible causes, and treating the wrong thing is at best useless and at worst harmful.
Here's how I approach a new patient with knee pain.
Step 1: The History
Before I touch your knee, I ask a lot of questions. When did it start? How did it start — gradually, or from a specific incident? Where exactly does it hurt — inside, outside, front, behind? Does it hurt going up or down stairs? Do you have swelling? Does it lock, give way, or click?
The history alone narrows the diagnosis significantly. A young soccer player with acute onset swelling after a pivot is almost certainly an ACL tear. A 55-year-old with medial knee pain that came on gradually is probably osteoarthritis or a meniscal tear.
Step 2: Physical Examination
I examine both knees — the uninjured one first, so I know your baseline. The exam includes:
- Range of motion — how far does it flex and extend?
- Patellar tracking — does the kneecap move normally?
- Ligament stress tests — Lachman, anterior drawer, valgus/varus stress tests to evaluate the ACL, PCL, MCL, and LCL
- McMurray test — for meniscal tears
- Joint line palpation — where exactly is the tenderness?
- Effusion — is there fluid in the joint?
The Most Common Causes We See
ACL Tear
The classic: noncontact pivot injury with a "pop," immediate swelling, and instability. MRI confirms it. Treatment depends on age, activity level, and goals — surgery isn't always necessary, but athletes who want to return to pivoting sports usually need it.
Meniscal Tear
Can be acute (twist injury) or degenerative (gradual onset, older patients). Medial joint line pain, pain with squatting, occasional locking or giving way. MRI is the gold standard. Conservative treatment works well for many — PT, activity modification, occasional injection. Surgery for cases that don't respond.
Patellofemoral Pain Syndrome
Pain around or under the kneecap, worse going downstairs or sitting for long periods. Very common in runners and young women. Almost always responds to physical therapy focused on hip strengthening and patellar tracking.
IT Band Syndrome
Lateral knee pain in runners, cyclists, and hikers. Pain that comes on predictably at a certain mileage and resolves with rest. Responds to stretching, foam rolling, and addressing training errors. Our PT team is excellent at identifying the underlying biomechanical cause.
Osteoarthritis
The most common knee condition in adults over 50. Gradual onset, morning stiffness, worse with activity. X-ray confirms. Treatment: exercise, weight management, physical therapy, anti-inflammatory medications, and injections (cortisone or PRP). Surgery (knee replacement) is a last resort and works well when appropriately indicated.
Patellar Tendinopathy ("Jumper's Knee")
Pain at the bottom of the kneecap, common in jumping sports (basketball, volleyball). Responds well to eccentric strengthening and load management — a good PT can make a dramatic difference.
When to Get Imaging
I don't reflexively order an MRI for every knee complaint. I use imaging selectively:
- X-ray first if I'm concerned about fracture, arthritis, or structural bony issues
- MRI when I suspect ligament, meniscal, or cartilage injury that will change management
Our Approach at ParikhHealth
The advantage of being seen at ParikhHealth for knee pain is the integrated team approach. Dr. Parikh evaluates the knee and diagnoses the problem. If physical therapy is indicated — and it usually is — Miral, Sonia, or Harshit start the program in-house. There's no referral chase, no communication gap between your doctor and your PT.
If you need an orthopedic surgery consult, I have relationships with excellent surgeons in the Bay Area and will help coordinate that referral.
Don't ignore knee pain. Early evaluation and appropriate treatment lead to faster recovery, fewer complications, and often surgery avoidance. Call 408-266-3100 or book online.