Pain on Inside of Knee? Get To Know Your VMO

If you’ve ever had a nagging pain on the inside of your knee or a knee that seems to buckle or give way, there is a fair chance you’ve had some dysfunction in the VMO muscle.

VMO dysfunction is very common in runners, hikers, cyclists, athletes involved in jumping sports and after any knee injury.

In this short blog, we’ll find out more about how issues develop in the VMO and what you can do to help.


VMO stands for Vastus Medialis Oblique and this is part of the quads, running along the inside of the thigh, with the bulk of the muscle sitting directly above the inside of the knee.



The role of the VMO is to assist with extending your knee and arguably the most responsible muscle for knee stability, as it helps control the alignment of the knee-cap.

When the VMO isn’t functionally optimally, the knee cap tends to shift slightly out of place during movements such as squats and lunges, causing pain and inflammation behind the knee-cap.


When the quads get overloaded (suddenly or over time), tightness in the muscle fibres (called trigger points) can refer a toothache-like pain deep in the knee joint (see Figure 1 below).

This pain from the overloaded VMO muscle can often be confused with joint pain such osteo-arthritis or a meniscus tear, as the location and type of pain are often similar.

Figure 1

Figure 1

The initial knee pain then may disappear after a few weeks, only to be replaced by a sudden weakness in the knee (a condition called “buckling knee”) that causes a person to unexpectedly fall while walking.


The VMO can be activated as a protective response to knee injury such as to the ligaments, meniscus or post-surgery.

The VMO is also commonly overloaded with repeated use in the following situations:

  • suddenly increasing your volume of running or cycling (running places around 6 x body weight through the quads)

  • a new (or sudden increase) in an exercise program involving repetitive squats, lunges, leg extensions or wall sits

  • jumping sports e.g. basketball

  • cycling - poor bike fit

  • walking downhill or stairs

  • being over-zealous in rehabbing the VMO - too much strengthening too soon


Physiotherapy assessment will involve a comprehensive movement assessment to determine the cause of your VMO issue.

“Short term treatment such as soft tissue massage and dry needling is very helpful, while long term building capacity in the quads, glutes and core is critical to prevent a relapse.



Tightness and contraction of the VMO responds very well to dry needling, which can de-activate the trigger points (knots in the muscle).

The benefit of dry needling is that it can reach the deep fibers of the muscle and lead to a quicker resolution of symptoms. 

Treatment of the VMO is generally very responsive to treatment, provided the contributing factors are addressed.


  • apply heat to the VMO muscle 10 minutes each day to increase blood flow and reduce tension

  • if you’re a runner or hiker, avoid the hills (in the short-term)

  • ensure your shoes are not overly worn

  • when running - avoid over-striding, ensure proper warm up and cool down and take walking breaks frequently to avoid overloading the VMO

  • avoid prolonged kneeling on the floor e.g. gardening, washing floors - use a low bench or stool to sit on instead

  • foam roll the VMO daily for a few minutes (see below). It’s also a good idea to roll out the adductors which are also commonly tight

Foam Roller for the VMO:

Foam rolling the inner quad and adductor - fun times!

Foam rolling the inner quad and adductor - fun times!

Questions or concerns about your knee pain?

If you are curious about how we can help with our knee pain, I’d love to help you out.

Please leave a comment below or send an email direct to

If you’d like to get your knee on the fast track straight away, please use the button below to schedule an appointment online:

Building A Resilient Knee For Running

Building A Resilient Knee For Running

Important Note: This blog post is very general in nature. Some or all of the advice may not be appropriate for you. Please check with your Physiotherapist for specific advice on your condition.

If you’re fairly new to running - and tell your friends and family you’re planning or running a marathon or half-marathon, very often you get this well intentioned question:

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While we can easily shake off the comment at the time, it’s often not until a few months down the track, when your training volume starts to increase, you may in fact start getting some twinges in the knee, that the comment can come back to haunt you.

An element of doubt can sit in the back of your mind, making you question:

“Is running actually harming my knees”?

“Were they right after all”?

So what does the research say?

There’s a common view in the community that running isn’t good for your knees, and may cause early wear and tear and possibly lead to arthritis.

So what does the research actually show?

A very high quality study recently came out that followed over 100,000 people to see how their lifestyle and exercise habits related to their risk of developing knee arthritis.

The study showed that recreational runners had a risk of developing knee arthritis that was around 3.5%, compared with non-runners whose risk was 10.2%.

Knee arthritis risk: Runners vs Non-Runners

Knee arthritis risk: Runners vs Non-Runners

In other words the non-runners had a three times greater chance of developing knee arthritis that runners.


Rather then their joints ‘wearing out’, runners had increased muscle bulk around the knee, providing a protective effect on the joint.

This study allows you to be confident that recreational running will not harm, and may actually improve, your hip or knee joint health.

Biggest Risk Factor

So if running doesn’t cause arthritis in the knee, then what is the biggest risk factor?

If we look at the research again - the biggest risk factor for knee arthritis was being over weight.

So in terms of knee arthritis, the risk of being inactive and becoming overweight is much greater than being active and running regularly.

Knee pain and running

So… we know running doesn’t cause arthritis - (it actually might prevent it).

However, the knee is still a very common area of pain and injury for runners (in fact 50% of all running injuries are in the knee).

Photo Credit: Rich Wily Running Symposium La Trobe 2018

Photo Credit: Rich Wily Running Symposium La Trobe 2018

Patello-femoral Syndrome

The most common running related injury is what we call Patello-femoral Syndrome (also known as Runner’s Knee).

Patellofemoral pain (PFP) is a condition where pain is felt on the front of the knee, either around or behind the patella.

It is caused by an increased load and force going through the knee-cap that, resulting in inflammation and swelling around the knee.


The main symptom of Patello-Femoral Syndrome is pain with loading and a general vague ache in the front of the knee.

The pain generally gets worse with:

  • running especially downhill

  • climbing stairs

  • kneeling and deep squatting

  • sitting with knee bent up for prolonged periods e.g. sitting on a plane or movie theatre

Key Point:

A key point here is that knee pain from running is most likely related to inflammation around the knee cap rather than any structural joint damage.

The confusing thing is that the aching pain from patello-femoral syndrome can mimic the pain you may feel in the early stages of knee arthritis.

No doubt this can be a little disconcerting.

But you definitely don’t need to freak out about developing knee arthritis.

2 choices:

When you develop knee pain as a runner - you have 2 options:

  1. Keep running and push through the pain barrier.

    Sometimes this can help and the pain goes away. But sometimes the pain doesn’t get better and things just get worse. Runners traditionally have very good pain thresholds - but the jury is still out if this is a good thing or not!

  2. Stop running altogether.

    As runners, we know when you stop running, you tend to lose your fitness really quickly. Your capacity decreases rapidly and your muscles become de-conditioned and so just resting doesn’t really solve anything. When you get back to running, the pain and inflammation is just as bad as before.

Thankfully there is a 3rd option - and the rest of this post will be talking about five very practical strategies you can use to help reduce your knee pain and get back to running.

5 Strategies to help with knee pain and get you back to running

Before we start, we need to get on the same page.

Unfortunately there are no quick fixes.

There are multiple factors (20-30!) that may all play a role in why you’ve developed knee pain.

Without doubt, the best results come with a personalised assessment with a Physio who has a special interest in running.

This will help identify the main issues and get you on the fast track to healing.

On average, it takes 8 - 12 weeks to reduce knee pain and get back to running properly again.

Getting healthy again will test your patience, and it is very often a case of 2 steps forward 1 step back.

1. Reduce Inflammation


If we go back to the original cause of the patello-femoral pain in the knee - it is inflammation that develops under the knee cap.

If you have knee pain, it means you have inflammation.

So the first and most important step is to reduce the inflammation in the knee.

The best way to do this is to use a good quality ice pack on your knee for 15 mins x 2 day (every day for 2 weeks).


The ice packs we sell in the clinic are the Sideline Ice and Wrap ($39)…they are a great option.

Using the velcro strap means you can get a solid compressive effect and still keep moving about, without having to stay seated the whole time.

Often the knee starts to feel better quite quickly when you decrease the inflammation, but it’s important to keep icing for 2 weeks so you completely break the inflammatory cycle.

If you start to feel better and then return to exercise too quickly, you will start the inflammatory process over again.

Another good option when you have knee pain is getting into a pool or standing in the cold water down at the beach. The buoyancy of the water can have a positive impact on decompressing the knee.

We don’t tend to use anti-inflammatory medication, unless the pain and inflammation is severe.

2. Reduce Load

Generally, activities with more knee bending increases stress to the Patella-femoral joint.

So to reduce irritating your knee further, you will need to:

  • reduce heavy weights especially lunges and squats

  • avoid stairs

  • avoid kneeling

  • avoid sitting with your knee bent up for prolonged periods

Sometimes you also need to avoid a quad stretch as this can also irritate the knee joint

Reducing Load When Running

If at all possible, we like to keep you running in the short-term, with a few alterations.

Some common modifications include:

  • avoid downhill running and keeping to flat ground as much as possible

  • reduce speed and include some more walking breaks (especially when you feel knee pain)

  • do shorter, more frequent runs rather than longer runs

If running is still too sore you may need to take a complete break for 1-2 weeks.

In this time, you can generally keep walking and getting in the pool can be helpful too.

Some people like to get on the bike, which can be a good option to maintain your cardio-vascular fitness. However you need to be wary of developing muscles imbalances that cycling can often accelerate - most commonly increased hip flexor tightness and under-active gluteals.

3. Increase Tissue Capacity

If we look at which muscles are loaded when we run, the soleus muscle in your calf (takes up to x 8 body weight) and the quads (up to x 6 body weight).

Photo Credit: Rich Wily Running Symposium La Trobe 2018

Photo Credit: Rich Wily Running Symposium La Trobe 2018

They already work a lot so it probably doesn’t make a lot of sense to increase the strength of them, especially if you are running a lot and doing hills regularly.

But the accessory muscles such as the hamstrings, gastrocnemius, and the glutes have all got potential to improve their capacity and help off-load the knee.

Some common exercises you could include would be calf raises, bridges, clams, crab walks and hamstring curls on the ball.

Getting a Physio to develop a personalised program for you will provide many benefits in the long term and keep your knees from getting overloaded and inflamed.

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4. Create Neuro-muscular balance

Many people think of the knee as a simple hinge joint.

While the joint does act like a hinge, there are around 20+ muscles that attach and need to be balanced around the knee.

If you are a musician - anyone who plays the guitar - you know that every time you play, you spend a couple of minutes ‘tuning’ up, before you play.

If your strings aren’t fine tuned properly then obviously your going to sound terrible!

The muscles are like the strings of the guitar, and tend to get overloaded and tight with running, leading to increased loads on the knee-cap.


Keeping your muscles in tune could include things like:

  • foam rolling

  • stretching

  • deep tissue massage

If your muscles are having a bit of trouble releasing, then the next step would be to try dry needling.

Trigger point dry needling has the ability to reach deeper into the muscle, getting a more effective release.

You can find out more about dry needling here.

5. Modify Running Gait

There is some solid evidence showing that making some small modifications to your running gait can take pressure off your knee.

Returning to running after a knee injury can be a little scary.

We find sometimes people can be a bit over-cautious and defensive and this leads to a very upright posture, almost running within yourself.

Counter-intuitively, this upright posture tends to increase the force on the knee…so switching to a forwards lean is a simple solution.

Some studies have shown that incorporating a forwards lean can improve your running efficiency by up to 30%, as you tap into the power of gravity.

It’s important to lean forwards from your ankle, rather than bending from your waist, that could lead to pressure on your lower back.



A common thing with knee pain in running is over-striding.

This can lead to increase peak forces going through the knee.

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The solution is to modify your cadence (how many steps you take per minute).

Generally, increasing your cadence 5-10% can significantly decrease the peak load of force going through your leg.

For example, if you’re at 165 steps per minute - increasing to 175 - 180 may do the trick.

Many GPS watches track your cadence in real-time, or you could use a metronome app on your phone to help keep your rhythm.

Side note: Running with a faster cadence doesn’t mean you have to run at a faster speed. There is an art to learning to shorten your stride, but still run at a comfortable pace - it can take some practice.

Return to Running

Just a few final tips about returning to running from a knee injury:

  • for the first 3-4 weeks, choose a flat surface to run on and gradually layer in the hills as your pain allows

  • before you run - do a quick tune-up - foam rolling, gluteal engagement exercises

  • try taping the knee. About 50% of the time, using a rigid tape can make a huge difference in stabilising the knee cap. The other half of the time it doesn’t make much difference, so it is worth trying out - and your Physio can show you how

  • shoes - a new pair never goes astray after an injury and will help take the full shock absorption with less pressure on the knee

Pain as you return to running

As you return to running, your knee may still be twingy.

The following scale is useful to keep in mind and rates your pain level from 0 (no pain) and 10 (worst pain you could imagine).

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Of course, ideally the pain would be 0, and that’s great if that’s the case.

In reality, you may still have some twinges and soreness as you’re getting back into it.

This is really common and is often more related to the knee getting used to the loads again, rather than more damage.

We rate a 0-5 pain score as an acceptable level.

You can still run, but just be mindful, if your pain increases to a 6 or greater, then you need to stop and walk / rest.

Take note of your pain levels at the time of exercise, and also the 24 hour response.

Pain that lasts until the next day means you’ve probably done too much, so next time reduce the amount so your body can handle it and gradually build up from there.

What about if you already injured your knee - is running still OK?

That is a great question, and it is very hard to say without a personalised assessment.

If you have previously torn a ligament or meniscus in your knee - some doctors would suggest you avoid running forever.

However, if we go back our research showing the biggest risk factor of knee arthritis is being over-weight, there is a case to be said for gradually re-introducing running (if it’s something you enjoy), as a means of maintaining effective weight control and creating a supportive muscular foundation for the joint.

Following the five strategies outlined above would most likely be a great help, but again please consult with a Physio to get a tailored plan set up for you.

Avoiding surgery

Some recent research has demonstrated that 65 per cent of people with knee arthritis and meniscus tears can avoid surgery by following a physiotherapy program (Katz et al. 2013).

The protocol involved an individualized physiotherapy treatment plan with a progressive home exercise program

The three-stage structured program was designed to:

  • decrease inflammation

  • improve range of motion

  • optimise muscle strength

  • improve aerobic conditioning (e.g., with the use of a bicycle, elliptical machine, or treadmill)

  • proprioception and balance re-training


Running is safe - it definitely doesn’t cause arthritis and may even protect your knees.

Knee pain is common however and the most common cause is knee cap pain.

Listen to your body - respect it - get in touch with Physio who can guide you back to running safely.

Rather than pushing through the pain or stopping alltogether, try the 5 Strategies:

  • decrease inflammation using an ice pack

  • temporarily decrease load

  • increase tissue capacity with some simple strengthening exercises

  • create muscle balance

  • modify your running gait

If you have any other questions about knee pain and running, I’d love to help you out.

You can send me email to

If you’d like to get started on your journey back to running pain-free again, simply click on the link below to schedule an appointment.

Dan O'Grady is an experienced Running Physio in Adelaide who has worked with runners from around the world including ultra-marathoners and weekend warriors.

  • Dan worked with Robert De Castella's Indigenous Marathon Project at the 2013 New York City Marathon.

  • A keen runner himself, Dan ran the New York City marathon in 2015 & 2017 and is currently preparing to break his 5k PB before he turns 40!

  • For running advice & inspiration, follow our Instagram


The Number 1 Risk Factor For Developing Knee Arthritis

A new study has shown there is likely to be a 276 per cent rise in knee replacement procedures from 2013 to 2030 (based on data from Australia's joint replacement registry).

Pretty staggering ! 😱

The biggest risk factor for knee arthritis leading to a total knee replacement is being overweight, which overtime stresses the knee joints (70% of Aussies are overweight).

This article talks about your options, especially if you want to avoid surgery.

Main points 💥

✅ Gradually increase your activity levels and incorporate targeted strengthening exercises to build the muscles around the knees.

✅ This can make them stronger, help to maintain appropriate co-ordination and reduce pain.

✅ Don't be fearful of exercise and movement, even if you do feel some pain. Pain doesn't equal damage.

✅ Running 💯% does not cause knee arthritis. On the contrary, runners have less chance of developing arthritis because they generally not overweight.

✅ Consult with your GP and Physiotherapist who can develop a customised plan to get you moving well again.

✅ Individual movement assessment can help you identify your weak links and help get you on the fast track.

✅ For more info about how Physio can help with your knee pain and get you moving well again 👇

Knee Osteoarthritis (OA) Part 2 - What Is The Best Type Of Exercise?

Exercise therapy: the treatment of choice

This months blog has a focus on exercise for knee osteo-arthritis (OA), an issue that I’ve had a passion for treating for many years.

It’s predicted that arthritis will soon impact over 3 million Australians.

Thankfully, there has been some very positive research showing the benefits of combining a tailored Physiotherapy program with an exercise program to build your bodies capacity, with significant benefits in the short term (six weeks) and long-term (one year).

I hope you will find some useful information and if you know anyone suffering with knee pain from OA, it would be great if you could please share it with them.

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Current guidelines recommend exercise for everyone with knee osteoarthritis, irrespective of radiographic disease severity.

Evidence shows a personalised exercise program, gives the best long term outcomes. 

These exercise programs consist of:

  • specific neuro-muscular exercises to help align the knee joint

  • cardiovascular aerobic fitness

  • strength training

Ideally this exercise program is set up by a Physiotherapist after a comprehensive assessment. 

Is exercise and movement safe for people with knee OA?

It is a common misconception that exercise causes arthritis.

Research shows that the main risk factors for knee OA are:

  • excess body weight

  • reduced muscle strength

  • knee mis-alignment

  • history of a prior traumatic knee injury

An important point to make here is that (except for traumatic injury) all of these factors are modifiable, meaning we have control over them.

This can be quite an empowering feeling, when you contrast this with someone who is told by a specialist, after viewing their scans, that nothing can be done, apart from surgery.

The risk of pain and injury are greatest when your physical capacity is low, as it sets you up for constant overload and damage.    It's important to note that    regular moderate       exercise       strengthens joints    and can decrease the risk of osteoarthritis.    Moderate activity levels provide the ‘sweet spot’ for physical health and acts like a vaccine against injury.

The risk of pain and injury are greatest when your physical capacity is low, as it sets you up for constant overload and damage.

It's important to note that regular moderate exercise strengthens joints and can decrease the risk of osteoarthritis.

Moderate activity levels provide the ‘sweet spot’ for physical health and acts like a vaccine against injury.

Getting past the fear of movement in OA

APA physiotherapist Dr Christian Barton, an OA researcher at LaTrobe University, says:

“One of the biggest problems we have to address is that many people are told to rest when they have pain, rather than stay active. As a result they often become quite sedentary, which can lead to depression, weight gain and an increased risk of other chronic diseases.

Proper exercises, regular physical activity and good health education are essential for OA management, all of which can be delivered by exercise specialists like physios. The missing link is the funding to provide patients the opportunity to do this.”

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You Have Two Options:

  1. OA Diagnosis —> Fear of doing more damage —> rest/avoid activity —> deconditioning —> depression —> weight gain —> increase load on knee —> downward spiral —> general health declines

  2. OA Diagnosis —> Consult with Physiotherapist (with a special interest in knee OA) —> personal assessment —> address fear of movement —> set up with graduated exercise program —> Physiotherapy manual techniques to decrease pain, improve joint alignment —> re-build capacity —> maintain happy and healthy life

What is the point in doing exercise and rehab if I’m eventually going to need surgery?

The first thing to keep in mind is that not everyone with OA will progress to a point where they need a joint replacement.

In fact only about 30% in those are diagnosed with OA subsequently go onto require a total knee replacement.

We know that ‘prehab’ gives significantly better outcomes if you do eventually need to go for surgery, so by getting your knee stronger and more robust will have direct benefits. You

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A Few Notes On Pain

As you start to move more, you most likely feel some knee pain.

It's critical though you understand one key fact: "Pain does not equal tissue damage".

The truth is pain is related to the threat of tissue damage, not actual tissue damage.

There is a whole field of pain neuroscience research now showing that the pain you feel is not correlated with how much tissue damage there is.

This is relevant to know for people with knee OA, as many people have severe joint degeneration on x-rays, yet have absolutely no pain.

Rather pain is a 'request for change' and in chronic knee pain may be more related to ongoing weakness and stiffness in the knee.

A sure sign that movement is needed to get the muscles stronger and protect the knee joint.

It’s OK for exercise to be painful (especially as you warm-up at the beginning), but try and keep it to an acceptable level (e.g. < 5/10). Also, monitor the response in the following 24 hours after you exercise.

Patience is key.

As you build your capacity over time, you will get less intense and frequent pain flare-ups.

Credit: Christian Barton Presentation

Credit: Christian Barton Presentation

Three Components To An Effective Exercise Program:

  1. Neuro-muscular control

One important risk factor that can lead to progression of knee OA is the mis-alignment of your knee (in particular the kneecap).

Many people with knee pain who get motivated to exercise may end of causing a flare-up if there knee is out of alignment.

Some signs you may have a knee alignment issue:

  • general ache/pain in the front of the knee

  • pain aggravated activity involving a bent knee and body weight on the leg (e.g. walking up and down stairs, squatting, kneeling, jumping or hopping)

  • pain aggravated by sitting for prolonged periods e.g. driving or sitting in a movie theatre (eg, jumping, hopping, running, going up or down stairs, or squatting).

  • some people also hear and feel a grinding / clicking around the knee with mild swelling


A number of factors can alter the mechanics of the patellofemoral joint and increase joint stress, leading to OA.

This is where an detailed Movement Assessment with an experienced Physiotherapist can really pay dividends.

We can quickly see which parts of your body are moving efficiently and which are not and then take the time to out together a customised plan of attack for you and this can have the capacity to not only reduce symptoms but have the potential to slow disease progression.

Manual therapy, dry needling, exercise and taping can all greatly assist with re-aligning your knee joint.

Pilates can also very beneficial it helping to build the neural pathways for efficient movement.

2. Aerobic fitness

Aerobic exercise has many benefits for people with arthritis that include:

  • stimulating natural endorphins that can help decrease pain as much as taking medications (without the side effects)

  • builds your physical capacity and increases muscle strength to help protect the joint

  • helps in managing your weight (there is a large body of evidence that identifies obesity as a risk factor for developing OA of the knee, particularly in women)

  • improves mental health and lowers the risk of depression and anxiety

  • getting you out of the house and away from sedentary behaviours

  • strengthens social connections

What exactly is aerobic exercise?

Aerobic exercise can be defined by light to moderate intensity, and is characterised by our ability to maintain it for a prolonged duration (many minutes to several hours). You should be able to maintain a conversation as you move.

Capacity vs Demand

We know that your symptoms are likely to flare-up when you get fatigued. It is important to build your cardio-vascular capacity so you can comfortably perform your everyday activities with ease and comfort.


When you’re had a flare-up and are in pain, your activity levels tend to drop off. This has in impact on your bodies capacity, and your ability to deal with demand and loads will be temporarily reduced, until you can build it back up again.

Pacing yourself with a graded exercise program is the best way to re-build capacity. Monitoring your time, distance and pace can be extremely beneficial with a GPS watch or app in your phone.

How much aerobic exercise should I aim for?

Current guidelines recommend aerobic exercise be performed ideally on most, and preferably all, days of the week, for a minimum of 30-60 minutes a day.

This 30-minute total can be performed in one go, or be made up of 3 x 10-minute sessions, if that’s more convenient for your lifestyle.

How do you choose what sort of cardiovascular exercise to do?

“The best exercise is the one you’ll commit to doing”

Factors to consider:

  • What do you enjoy doing and what you will commit to?

  • How much time do you have to fit into the day?

  • Do you have any social support that would increase adherence?


Before you begin

As you begin an exercise program, you may need to allow a period of 'body tuning' i.e. using manual therapy, massage, dry needling and specific exercises to improve tissue quality and joint alignment.

Similar to playing an instrument, tuning up before hand makes things perform much better and reduces the wear and tear.


Gradually increasing the amount you walk would be an excellent way to start building your aerobic fitness.

Don’t forget to invest in some good quality shoes that are replaced every 3-6 months, depending on how active you are.


While cycling can be good for the health of the knee joint, unfortunately it can contribute to muscle imbalances.

Specifically cycling inhibits the glutes and makes the hip flexors and hamstrings tighten up. This can have consequences when walking and standing for long periods, as the knee joint is likely to experience increased load and strain.

If you really enjoy cycling, that’s cool, but you may need to spend some extra time working on correcting your muscle imbalances.

For many years it was thought running ‘caused bad knees’ and it was best to avoid if you have knee pain.

However, much research has come out recently with some surprising findings - runners are at a reduced risk of developing knee arthritis.

The exact mechanisms for this are still unclear, but may be related to runners maintaining a healthier weight level, with stronger muscles and more resilient joints.

BENEFITS OF RECREATIONAL RUNNING - Recreational running is not only good for your overall health, but also benefits your knees and hips—just 3.5% of these runners develop hip or knee arthritis. A sedentary lifestyle—not running—or competing as an elite runner increases the risk of hip or knee arthritis by 10.2% and 13.3%, respectively.   Source: Journal of Orthopeadic Sports Physical Therapy

BENEFITS OF RECREATIONAL RUNNING - Recreational running is not only good for your overall health, but also benefits your knees and hips—just 3.5% of these runners develop hip or knee arthritis. A sedentary lifestyle—not running—or competing as an elite runner increases the risk of hip or knee arthritis by 10.2% and 13.3%, respectively.

Source: Journal of Orthopeadic Sports Physical Therapy

Bottom line: there are certain strategies for helping offload the knee when running (such as increasing your cadence 5-10%) to keep you from aggravating your knee pain. Please contact us to find out more.


Getting in the water regularly would be one of the best things you could do for knee OA. The buoyancy of the water helps decompress the joints and allows you to move freely with minimal pain. Swimming, water aerobics or even just walking in the water can be very healing for the knee joints.

Just ensure you are still getting enough weight bearing exercise to stimulate your muscle and bone growth.

3. Strengthening

National guidelines recommend x 2 strengthening sessions per week.

This doesn’t mean you you need to necessarily go to the gym, (but it may be helpful if you have a small weights at home) to gradually progress your strength capacity.

Your Physio will be able to guide and progress your strength program.

Major muscle groups that should be targeted include the quads, glutes, hamstrings and calves.


Dealing with flare-ups

  • flare-ups are a natural part of the OA presentation and should be expected

  • the main thing is to listen to your body and temporarily reduce any load and strain for a few days

  • focus on non-weight bearing exercise such as pool and pilates exercises to help keep strength in glutes and core

  • take panadol as needed

  • use ice or heat packs

  • keeping an activity log to monitor how your body responds to your exercise can help identify triggers

  • If your symptoms persist for more than a few days, make an appointment to see your Physio.

How can a Physiotherapist assist someone with knee OA?

1.  Assessment and Diagnosis

A modest investment in a Physio Assessment early on  in your journey pays big dividends in terms of identifying relevant contributing factors and helping you get on the fast track to healing. 

We spend a lot of time in the beginning educating you so you know what to expect in terms of recovery and what you need to do, to manage your recovery successfully.

"Give me six hours to chop down a tree and I will spend the first four sharpening the axe." - Abraham Lincoln

2.  Dry Needling / Massage and Taping

Often 4-6 sessions of manual therapy will help minimize pain, re-set your tissues and get you into a position where you can confidently self-manage. 

Muscles that are commonly tight and affecting your knee include the

  • ITB

  • TFL

  • hamstrings,

  • quads and calves

Foam rolling and spiky ball massage are effective at maintaining flexibility, but dry needling has the ability to get to the deeper part of the muscle and get a more effective release. 

Find out more about dry needling here.

We can also show you how to tape your knee to provide relief in the short-term.


3.  Guidance on load management

We will give you advice on how to gradually re-load your tissues to safely protect your knee from future flare-ups.  We work with your coach or trainer to manage your return to doing what you love. 

4.  Building a personalised home exercise program

You are the most important part of the healing process and what you do is the most important part getting you better. 

We use the convenient Physitrack App to build your personalised home program with videos delivered to your smart phone.

5.  Movement Re-Training

Once your pain is under control we then watch how you move and optimise your movement patterning to decrease the chances of the knee pain returning.

Pilates can be a very effective way to maintain efficient movement patterns.

Is Knee Pain or Injury keeping you from being as active and healthy as you want?


I hope this post has given you some valuable guidance in planning your exercise to help your knee. It is very general information, so please consult your Physiotherapist for advice specific for you.

There is a lot of positive research now that shows taking a proactive approach to your health can have a very successful outcome for your knee pain.

If you have knee issues and like some more personalised guidance, it would be a pleasure to help you (we can help in person or via our online tele-health portal).

Please take a moment to fill out the form below and we’ll get back to you as soon as possible.

Name *

Knee OA - Part 2 - Exercise

1. Do you think exercise is a beneficial intervention for knee OA patients. If so why?

Yes exercise is very beneficial for knee OA.

2. How often do you prescribe exercises for knee OA patients?

Doing some form o

3. What are the most effective exercises for your pt groups.

For knee pa

4. Do you often see changes in patient function and pain after an exercises prescription? If so what sort of changes do you often observe?

5. How many days a week should OA patients exercise?

6. How many repetitions and sets do you often prescribe patients with mild, mod and severe knee OA

7. How many times a week do you often prescribe such exercises?

8. What sorts of lower limb exercises do you prescribe patients with knee OA and why?


Knee Osteoarthritis - Part 1 Your Options

Osteoarthritis (OA) is the most prevalent joint disease and a leading source of chronic pain and disability worldwide.

There is a common perception among people with knee arthritis that nothing can really be done, (outside of taking medications or having knee replacement surgery).

This study by Mitchell and Hurley (2008) showed that many people were unaware of the options available to them, despite consulting with their general practitioner.

Research indicates less than 4% of people attending a GP clinic with knee osteoarhritis are referred to a Physiotherapist.

The intention behind this blog post is to inform you of some of your options, so you can make an educated decision about what is best for your situation.

Knee OA…what options do you have?

1. Ignore the pain

This can be an effective strategy in the beginning. Ignoring the pain and getting on with things can be actually be quite helpful.

This usually works particularly well when you are young and resilient.

Our bodies are masters at compensating and this means you can still do what you want in the short-term as your body may be able to transfer load from the knee into the hip or lower back.

As you get older though (around the age of 30+), this strategy has less effect as the compensatory patterns have a limited capacity.

As your body runs out of options and strategies, you will eventually find yourself not recovering like you did before and the stiffness and pain starts to get stronger.

2. Rest the knee and avoid using it

Advice to rest and avoid pain is commonly provided to people with knee and other joint pains - advice that is often wrong, and harmful.

Unfortunately the majority of people with knee OA reduce moving due to fear they will wear the knees out and make things worse.

This leads to a downward spiral of pain, weakness and a loss of confidence.

Interestingly, we know that weak thigh muscles are one of the biggest risk factors for ongoing knee pain. When you stop moving and become inactive, muscle loss accelerates significantly.



At some point in your 30's you naturally start to lose muscle mass and function.

Physically inactive people lose an average 3-5% of their muscle loss per decade after the age 30. The technical name for this is sarcopenia.

The picture above demonstrates the dramatic consequences of an inactive lifestyle and severe muscle wasting.

Adipose tissue refers to the fat layer around the muscles.

Clearly, avoiding movement is not going to be your best solution.

What about running, won’t that lead to increased OA?

Interestingly, recreational runners (3.5% risk) had a lower occurrence of developing knee OA compared with non-runners (10.2%).

One of the main ways running protects you from arthritis is by maintaining you at a healthy weight. This leads us to our next point.

3. Weight Loss

Obesity is a strong risk factor for knee pain and increases the risk of symptomatic knee osteoarthritis.

Women who are overweight are four times more likely to develop knee OA than women who are a healthy weight. And men who are overweight are five times more likely to develop OA than men who are a healthy weight.


But losing even a small amount of weight can be beneficial. For people who are overweight, every 5 kg of weight loss can reduce the risk of knee OA by more than 50 percent.

4. Medication

Medications such as panadol and anti-inflammatories have their place when you have an acute flare-up of knee pain.

But they are not designed for long-term use, due to their side effects on the liver and gastro-intestinal system.

5. Arthroscopic Surgery

Traditionally, arthroscopic surgery has been performed for chronic knee pain. Over the past few years however the research has indicated that for people with degenerative knee pain (including meniscal lesions), performing arthroscopic surgery does not improve outcomes.

The evidence refuting arthroscopy to treat meniscal degeneration and knee osteoarthritis (OA) is now clear and compelling. In Australia, the number of arthroscopies for degenerative knee pain has halved since 2011.

If the knee pain and degeneration is severe, conservative measures have been tried and you are having difficulty functioning day to day, then a Total Knee Replacement would be a logical thing to consider in consultation with your doctor.

However, the point being made here is that arthroscopic surgery is not required for degenerative knees.

Of course with any surgery there is the risk of infection and blood clots forming in the leg, as well as post-op recovery and rehabilitation for a few months afterwards.

6. Exercise therapy: the treatment of choice for Knee OA

Exercise therapy has the best evidence providing both short and long term benefits to people with knee OA.

High-quality evidence suggest that land-based therapeutic exercise provides benefits in terms of reduced knee pain and improved quality of life (Bennell et al 2015). This benefit can be sustained for 2-6 months after cessation of formal treatment.

Exercise therapy involves a combination of supervised sessions with a health professional to target:

  • strength

  • cardiovascular fitness

  • flexibility

  • neuro-muscular retraining

Getting all the pieces of the puzzle to get you back to doing what you love.

Getting all the pieces of the puzzle to get you back to doing what you love.

As you begin an exercise program, you may need to allow a period of 'body tuning' i.e. using manual therapy, taping, massage and dry needling to improve tissue quality and joint alignment.

Similar to playing an instrument, tuning up before hand makes things perform much better and reduces pain and tightness.

This is where are a good Physio comes in, who has a deep understanding of knee pain and a passion for helping people overcome it.

We do that everyday of the week and you can find out more about us here.


We know that movement and exercise can be what truly helps knee pain.

The evidence is compelling.

It addresses all of the modifiable factors that can get you out of reactive mode, and into building your foundation.

But what type of exercise specifically helps?


If you have any questions in the meantime, please feel free to contact us.

If you'd like to see how we can help set you up with a plan of attack to overcome your knee pain, please use our easy online booking system to schedule an initial appointment.


Mitchell HL, Hurley MV. Management of chronic knee pain: a survey of patient preferences and treatment received. BMC Musculoskelet Disord. 2008 Sep 18;9:123

Exercise for osteoarthritis of the knee: a Cochrane systematic review.

Fransen M, McConnell S, Harmer AR, Van der Esch M, Simic M, Bennell KL.

Br J Sports Med. 2015 Dec;49(24):1554-7

The Association of Recreational and Competitive Running With Hip and Knee Osteoarthritis: A Systematic Review and Meta-analysis.

Alentorn-Geli E, Samuelsson K, Musahl V, Green CL, Bhandari M, Karlsson J.

J Orthop Sports Phys Ther. 2017 Jun;47(6):373-390.

"Surgery versus Physical Therapy for a Meniscal Tear and Osteoarthritis, The New England Journal of Medicine, 2013"