Medial Knee Pain: Understanding the Inner Knee and How to Treat It

Medial knee pain — pain on the inner side of the knee joint — is one of the most common musculoskeletal complaints in both active and sedentary individuals. It can arise from injury, overuse, or degenerative changes affecting the soft tissues, cartilage, or bone structures that stabilise the inner knee. Understanding the underlying cause is key to ensuring effective treatment and preventing long-term joint damage.

Understanding Medial Knee Pain

The medial side of the knee involves several key structures: the medial collateral ligament (MCL), medial meniscus, pes anserine tendons, and articular cartilage. Pain in this region often stems from injury, inflammation, or gradual wear.

Common causes include:

• Medial meniscus tear: A common cause of deep, catching pain, often following a twisting injury.

• MCL sprain: Typically due to a blow to the outer knee or sudden change in direction.

• Osteoarthritis: Degenerative cartilage wear, often accompanied by stiffness and swelling.

• Pes anserine bursitis: Inflammation where the hamstring tendons attach to the inner shin.

• Overuse injuries: Common in runners or athletes with poor lower limb alignment or weak hip stabilisers.

Pain may develop gradually or suddenly, depending on the cause, and can feel sharp, aching, or tender when pressure is applied to the inner joint line.

Recognising the Symptoms

Symptoms of medial knee pain can vary depending on the underlying pathology, but common signs include:

• Tenderness along the inner joint line or just below the knee

• Swelling or stiffness, particularly after activity

• Clicking, catching, or locking sensations (suggesting meniscus involvement)

• A feeling of instability or weakness

• Pain when climbing stairs, squatting, or getting up from sitting

Some patients may also notice that pain worsens with weather changes or prolonged inactivity — typical of arthritic causes.

Broader Impacts of Inner Knee Pain

Medial knee pain can have a ripple effect beyond the joint itself. When discomfort persists, people often unconsciously alter their walking pattern to avoid pain, leading to hip, lower back, or opposite knee strain. Over time, this compensation can cause secondary problems and accelerate joint degeneration.

In athletes, medial knee pain can limit performance and increase the risk of additional injuries, particularly to the ACL or patellofemoral joint, due to altered movement mechanics.

Consequences of Ignoring Medial Knee Pain

Ignoring inner knee pain or continuing to exercise through it can worsen the underlying damage.
Potential complications include:

• Meniscus tear progression, leading to joint instability and swelling

• Cartilage degeneration, contributing to early osteoarthritis

• Chronic inflammation or bursitis, causing persistent tenderness

• Muscle imbalance, especially in the quadriceps and hip stabilisers

Early diagnosis and treatment can prevent these issues and help restore normal biomechanics before long-term damage occurs.

Diagnosis and Assessment

Accurate diagnosis often involves a detailed physical examination, imaging, and movement analysis.
Key diagnostic tools include:

• MRI scan: To visualise soft tissues such as meniscus, ligaments, and cartilage.

• Ultrasound: Useful for assessing tendon and bursa inflammation.

• X-ray: To evaluate bone alignment and arthritic changes.

• Motion analysis: (such as MAI Motion™) to assess gait and joint loading patterns.

A comprehensive assessment helps identify not just where the pain is, but why it developed, enabling tailored treatment.

Treatment and Rehabilitation Options

Treatment depends on the cause but generally focuses on reducing pain, restoring movement, and improving joint stability.

Conservative treatments include:

• Rest and load management: Avoid high-impact activity initially.

• Ice and anti-inflammatory therapy: To reduce pain and swelling.

• Physiotherapy: Strengthening the quadriceps, hamstrings, and glutes for balanced support.

• Orthobiologic injections: Such as platelet-rich plasma (PRP) or hyaluronic acid for tissue regeneration and pain relief.

• Regenerative approaches: Stem cell or cartilage regeneration techniques can help restore damaged joint surfaces in early degeneration.

Surgical options may be considered for severe meniscal tears, ligament ruptures, or advanced cartilage damage, particularly if conservative treatment fails.

Recovery and Prevention

Recovery typically takes 6 to 12 weeks depending on the severity and treatment method. Adhering to a structured rehabilitation plan is vital to prevent recurrence.

Preventive measures include:

• Maintaining a healthy weight to reduce knee loading

• Regular strength and flexibility training

• Correct footwear and alignment correction for athletes

• Adequate warm-up and cool-down before and after exercise

• Addressing early warning signs of pain or stiffness promptly

Frequently Asked Questions

What does medial knee pain feel like?
It often presents as a dull ache or sharp pain along the inner knee joint, especially when bending, twisting, or bearing weight.

Can medial knee pain heal on its own?
Mild strains may improve with rest and physiotherapy, but persistent pain lasting over two weeks should be evaluated professionally.

Is exercise safe with medial knee pain?
Low-impact activities such as swimming, cycling, or controlled strength exercises are beneficial, but avoid running or deep squats until pain-free.

When should I consider surgery?
If pain persists despite conservative treatment or there is mechanical locking, significant meniscal damage, or instability, surgical evaluation may be required.

Can medial knee pain be prevented?
Yes — maintaining joint strength, flexibility, and proper biomechanics greatly reduces the risk of medial knee injury and degeneration.

In summary, medial knee pain is a common but often complex issue involving multiple structures of the inner joint. Whether caused by injury, degeneration, or overuse, early diagnosis and regenerative rehabilitation can restore balance, protect cartilage, and preserve natural joint function for years to come.