Why Does My Knee Pain Come and Go?
- Dr. Patrick Thompson, DPT, OCS, Dip. Osteopractic, FAAOMPT
- 10 hours ago
- 6 min read
We’ve all been there, some days your knee feels completely fine…other days it hurts walking, squatting, getting up from a chair, even simply shifting weight. This leads to a never ending barrage of questions in your mind:
“What did I do to my knee?”
“Do I need an MRI?”
“Am I just getting older?”
“Why does it come and go?”
I am here to tell you, this is absolutely normal. Simply put, knee pain is much more complex than you may think, and not all knee pain is the same or even because of the knee. Lastly, despite knee pain feeling like it is random, when you take the time to address the root cause of the knee pain, then knee pain becomes much more predictable and treatable.
Why Does Knee Pain Feel Inconsistent?
To dive into this topic without getting too deep into the weeds with Physical Therapy/Biomechanics jargon, let's address the concept of Load versus Capacity. Think of your knee as having a certain tolerance level it can handle throughout the day. On any given day, your knee can only handle so much stress such as walking, squatting, stair climbing before it starts to hurt - that’s your capacity. The actual activities you perform throughout the day - the workouts, steps, time on your feet - that is your load. The idea is to make sure you keep your daily load within the capacity of the knee to avoid constant flare ups.
To explain the above with a cup of water analogy. If you have a cup of water, the cup is your capacity and the water is the load. If you add too much water, then the cup will overflow, causing a mess (aka causing pain at the knee). The idea, however, is to get a bigger cup (more capacity) to prevent the water from overflowing - as opposed to filling the same cup with less water.
Building on the concept is pattern recognition. Many times you THINK that your knee pain is random and there isn’t a rhyme or reason to your pain. Do any of these sound like you?
Your knee feels stiff when you wake up every morning, then it loosens up throughout the day.
It doesn’t hurt during your workout, but aches later in the day.
It bothers you only when you’re driving long distances or sitting down watching your favorite movie.
Your knee pain comes out of nowhere, quick and sharp stabs with “random” movements.
Your knee pain “jumps” from one knee to the other knee for no apparent reason - weekly, even daily.
If any of these sound like you, you are not alone, as each of these above examples highlights a slightly different presentation of knee pain. And many times, despite not being able to pinpoint a specific pattern or major movement to consistently recreate your knee pain, your story reveals an actual pattern that flares seemingly dormant knee pain. The goal, of course, is to recognize and understand the pattern.
To put a bow on this portion, knee pain isn’t random, it usually happens when the demands on your body temporarily exceed what your knee is prepared to handle - usually while repeatedly doing an unrecognized movement pattern.
The Unseen Drivers of Knee Pain
My favorite analogy for root cause treatment seems appropriate to open this section up. “A leaky pipe in the ceiling creates a puddle on the floor…if you only mop up the puddle, and never fix the leaky pipe, then it is only a matter of time before you have a puddle again.” The same can be said when you are dealing with chronic or recurrent knee pain. Many times in healthcare we become focused on the puddle (pain/symptoms) and inadvertently disregard the potential leaky pipe above or below.
Using this analogy directly to the example of knee pain, some common leaky pipes (causes) that manifest as knee pain include:
Hip Weakness - Including glutes and hip abductors.
Lower Back dysfunction which creates hip weakness and subsequent knee pain.
Movement patterns during functional activities such as squatting and lifting.
Ankle Joint stiffness creating unnecessary stress at the knee.
Arch/Foot considerations creating alignment issues and stress at the knee.
Peripheral nerve entrapments which manifest as knee pain
And honestly, so many more potential leaky pipes which require treatment away from the knee.
As you can imagine, if one of the above examples is the actual driver to the knee pain, then this is where the treatment needs to focus. I am not suggesting to ignore the knee pain - but rather, mop the puddle up at the knee AND fix the leaky pipe causing the puddle. This is by far the most overlooked portion in self treatment and why many aches and pains relentlessly return time after time.
And just to make sure I am not ignoring or discounting localized knee dysfunction…yes, many times the source or root cause of your current knee pain is from an injury sustained at the knee (traumatic ACL or Meniscus Injury, for example). However, if that injury has healed and been addressed with time, rehab, or surgery, and the pain seems to wax and wane months or years later, then there is a possibility that:
1. Compensatory patterns from the knee injury have occurred and the compensations are what is now driving the recurrent symptoms; or,
2. The ACL was already susceptible to an injury because of a muscular imbalance or biomechanical dysfunction - and the leaky pipe was there all along.
To wrap up this second section, biomechanical dysfunction or muscular imbalance above and below the knee can affect how stresses are distributed at the knee joint. The fluctuating amount of daily stress at the knee is a reason that your pain comes and goes without a discernable pattern.
Why It Keeps Coming Back & What Actually Helps
Let’s dive into the nuts and bolts of why your pain comes back and what actually helps. When you are in pain, there is something engrained in our minds that we need to implement the RICE method - boiling down to rest, ice, compression, and elevation. This method was commonly used years ago and likely what you were told to do as kids after an injury. Other common approaches to self treatment of pain are relentless stretching and generic knee strengthening exercises. While these approaches aren’t inherently “wrong,” they are too routinely used in isolation (not addressing the underlying pain driver) and oftentimes leave you wanting more and still in pain.
Treatment must target both the pain driver AND the symptoms. This is when a deeper dive into your symptoms must happen so the appropriate treatment program can be prescribed. This treatment program needs to include a recipe of approaches - never one approach in isolation. This means your program need to include more than just rest, or just stretches, or just massage, or just (insert technique here) . Your treatment program needs to include a targeted approach with a combination of manual therapy (hands on treatment including cupping/scraping, joint mobilizations, stretching/massage), corrective exercises at the driver and the knee, dry needling (if appropriate), and education on your pain pattern / activity modification.
This targeted treatment, focused on a differential diagnosis, biomechanical corrections, manual therapy inducing neuromuscular physiological changes, and strategic strengthening, is what leads to long term relief and breaks the cycle of pain → flare up → pain → flare up.
Let’s Wrap This Up
Revisiting the main topic of this post - Knee pain coming and going is common, but not random. While this is frustrating and can feel hopeless, recurrent knee pain (or any pain for that matter) can be appropriately addressed when you understand why and have a treatment plan that targets your hidden flare-up triggers.
With that being said, every case is different, which is why doing a checklist of generic exercises or treatments for “knee pain” rarely does the trick. Every situation requires individualized attention and treatment based on your story and based on your specific presentation. Remember, I always say, “A specific diagnosis requires a specific treatment.”
This is one of the foundational pillars at Flow Physical Therapy in Lafayette, Louisiana. Every session is at least 60 minutes of uninterrupted time with your Osteopractic Physical Therapist to take a thorough deep dive into your symptoms. We give you the space to tell your unique story, and follow up with a targeted treatment that provides real results, efficiently.
If you are growing tired and frustrated with your pain coming back, despite doing everything you are supposed to do, maybe even tried traditional Physical Therapy, Massage Therapy, or Chiropractics already, then it may be time for a different approach - an approach that looks beyond the puddle and focuses on the leaky pipe.
Dr. Patrick Thompson, PT, DPT, OCS, Dip. Osteopractic, FAAOMPT
Owner of Flow Physical Therapy and Wellness
337-366-1703