your 12-step guide to avoid knee pain from ealing physio experts

However, the clinical challenge extends beyond the geriatric demographic. The rise of amateur athletics, exemplified by the popularity of the Ealing Half Marathon and the Ealing Eagles Running Club, has introduced a wave of activity-related pathologies in younger demographics.³ Conditions such as Patellofemoral Pain Syndrome (PFPS) and Achilles tendinopathy are becoming ubiquitous in clinics, driven by training errors and biomechanical deficits rather than degeneration.²

This report advocates for a hybridised clinical model that integrates the manual therapy heritage of CK Physiotherapy—established by Bryan Kelly and Emma Cadwallader—with advanced technological interventions.⁷ By combining "high-touch" Chartered Physiotherapy with "high-tech" modalities like Extracorporeal Shockwave Therapy (ESWT) and neuromuscular electrostimulation ⁹, clinical outcomes can be significantly optimized. The analysis that follows details a rigorous 12-step management protocol, supported by National Institute for Health and Care Excellence (NICE) guidelines, ensuring that CK Physiotherapy remains the premier destination for knee health in West London.

The Epidemiology and Local Context of Knee Pain

The Ealing Demographic Profile

Understanding the specific needs of the local population is essential for targeted clinical intervention. Ealing’s demographic data reveals a dichotomy of patient profiles: the sedentary office worker and the active amateur athlete.

Musculoskeletal Burden in Ealing:

The sheer volume of MSK issues in Ealing necessitates a robust physiotherapy response. With 1,400 residents claiming Incapacity Benefit specifically for MSK conditions, the economic and social impact is tangible.¹ The data highlights a critical gap in community care: while 87% of people with chronic pain have comorbidities like cardiovascular disease or depression, there remains unexplained variation in GP referrals to MSK services.¹ This creates a vital role for private physiotherapy clinics to bridge the gap, offering direct access to specialized care without the delays associated with statutory services.

The "Weekend Warrior" Phenomenon:

Ealing boasts a vibrant active community, supported by infrastructure like the Ealing Half Marathon and local parkruns.³ However, this enthusiasm often outpaces physiological adaptation. The "weekend warrior"—typically a middle-aged professional who remains sedentary Monday through Friday but engages in high-intensity sport on weekends—is a prime candidate for acute knee injuries. The abrupt spike in acute workload against a backdrop of chronic inactivity leads to soft tissue failure, manifesting as ligament sprains or meniscal tears.¹¹

The Spectrum of Knee Pathology

Knee pain in the UK population is not a monolith; it presents in distinct clusters based on age and activity level.

The Role of the Chartered Physiotherapist

In a landscape crowded with unregulated practitioners, the "Chartered" designation is a primary signifier of safety and quality. Chartered Physiotherapists, such as those at CK Physio, are members of the Chartered Society of Physiotherapy (CSP) and registered with the Health and Care Professions Council (HCPC).⁸

This regulatory framework ensures that treatment is not merely palliative but diagnostic. Unlike osteopaths or chiropractors who may focus heavily on spinal alignment, Chartered Physiotherapists employ a broader scope of practice that includes exercise prescription, electrophysical agents, and rehabilitation science.¹³ For a patient in Ealing with knee pain, this distinction is critical: it guarantees that their treatment plan is evidence-based, safety-checked against contraindications, and integrated with the broader medical system (e.g., GP referrals for imaging).¹⁴

Anatomy, Biomechanics, and Pathophysiology

Functional Anatomy of the Knee

To effectively manage knee pain, one must appreciate the joint's inherent instability. The knee is not a simple hinge; it involves complex rolling and gliding mechanics between the femur and tibia, dependent entirely on soft tissue for stability.¹⁵

Key Structures:

• The Tibiofemoral Joint: The weight-bearing interface. It relies on the menisci—crescent-shaped fibrocartilage discs—to disperse compressive loads. Meniscal tears, common in both acute trauma and degeneration, disrupt this load distribution, accelerating osteoarthritis.¹⁶
• The Patellofemoral Joint (PFJ): The interface between the kneecap (patella) and the femoral groove. This joint withstands immense forces—up to seven times body weight during deep squats. Dysfunctional tracking of the patella is the primary cause of anterior knee pain in runners.²
• The Extensor Mechanism: Comprising the quadriceps muscles, quadriceps tendon, patella, and patellar tendon. Pathologies here, such as tendinopathy, are classic overuse injuries where the rate of tissue degradation exceeds the rate of repair.¹⁸

The Kinetic Chain Concept

Knee pain is rarely an isolated phenomenon; it is frequently the "victim" of a "criminal" located elsewhere in the body. The kinetic chain concept posits that the knee acts as a link between the foot and the hip.

The "Bottom-Up" Driver:

Excessive subtalar pronation (rolling in of the foot) causes obligatory internal rotation of the tibia. If the femur does not rotate synchronously, torsional stress creates torque at the knee, straining the medial collateral ligament (MCL) and increasing lateral patellar compression.19 This is a frequent finding in Ealing Eagles runners who lack appropriate footwear or orthotic support.5

The "Top-Down" Driver:

Weakness in the hip abductors, specifically the Gluteus Medius, leads to contralateral pelvic drop and femoral internal rotation during the stance phase of gait. This manifests as dynamic knee valgus (knock-knees), a precarious position that places high stress on the ACL and patellofemoral joint.17 Clinical studies verify that addressing hip strength is often more effective for knee pain than treating the knee itself.20

Pathophysiology of Osteoarthritis (OA)

Osteoarthritis is the most prevalent cause of knee pain in the UK’s older population.¹² It is not simply "wear and tear" but a metabolically active disease of the whole joint.

• Mechanism: It involves the breakdown of articular cartilage, subchondral bone remodeling (sclerosis), and the formation of osteophytes (bone spurs).
• Inflammatory Component: Modern research highlights a low-grade inflammatory component (synovitis), which sensitizes nociceptors (pain nerves).¹⁵
• The Vicious Cycle: Pain leads to kinesiophobia (fear of movement), which causes muscle atrophy (sarcopenia). Weak muscles fail to absorb shock, increasing joint loading, which accelerates degeneration.²¹ Interventions like NMES and hydrotherapy aim to break this cycle.²²

The 12-Step Comprehensive Guide to Avoiding Knee Pain

This expanded protocol integrates clinical expertise with CK Physiotherapy’s specific service capabilities, offering a roadmap from acute pain to long-term resilience.

Step 1: Rapid Access and Differential Diagnosis

The "wait and see" approach is clinically inferior. Chronic pain pathways can become entrenched in the central nervous system (central sensitization) if pain persists beyond 3 months.²³

• The CK Advantage: Private physiotherapy bypasses the variability of NHS waiting times, offering assessment within 24-48 hours.³
• Differential Diagnosis: A Chartered Physiotherapist distinguishes between mechanical knee pain (which responds to physio) and systemic pathologies (e.g., Rheumatoid Arthritis, Gout) or referred pain from the lumbar spine (L3/L4 radiculopathy).¹³
• Imaging Referral: While clinical diagnosis is robust, physiotherapists can refer for MRI or Ultrasound scans if internal derangement (e.g., ACL rupture) is suspected.¹⁹

Step 2: Strategic Weight Management (Joint Offloading)

The relationship between adiposity and knee OA is linear and potent.

• Biomechanical Physics: The knee operates as a lever. For every 1lb of weight lost, 4lbs of compressive load is removed from the knee during walking. A 10lb weight loss equates to 40,000lbs less compressive force over a mile.²¹
• Metabolic Factors: Adipose tissue secretes adipokines, inflammatory cytokines that can accelerate cartilage destruction systemically. Therefore, weight loss has both mechanical and chemical benefits.
• NICE Guidelines: NG226 explicitly prioritizes weight management as a core treatment for OA.²⁵ The physiotherapy role involves facilitating this via non-impact cardiovascular exercise (swimming, cycling) that burns calories without traumatizing the joint.

Step 3: Biomechanical Correction (Footwear & Orthotics)

For the active population in Ealing, footwear is the primary interface with the environment.

• Shoe Prescription: Runners require assessment to determine if they need neutral cushioning, stability, or motion control shoes. The "EVA degradation" rule suggests replacing shoes every 300-500 miles, as the shock-absorbing foam compresses and hardens.²⁶
• Orthotic Intervention: CK Physio offers detailed analysis of foot mechanics. Custom or semi-custom insoles can correct leg length discrepancies or excessive pronation, realigning the tibial-femoral rotation axis.¹⁹

Step 4: Intelligent Load Management (Pacing)

Injury is fundamentally a mismatch between load capacity and load applied.

• The "Terrible Too's": Too much, too soon, too fast. This is the etiology of most tendinopathies treated at CK Physio.³
• Acute:Chronic Workload Ratio: A safe training progression involves increasing weekly volume by no more than 10%. Spikes above 1.5x the chronic workload are highly predictive of injury.
• Relative Rest: For conditions like Patellar Tendinopathy, complete rest is contraindicated as it reduces tendon stiffness. "Relative rest" involves continuing activity at a non-painful level to maintain tissue tolerance.¹⁸

Step 5: Posterior Chain & Quadriceps Strengthening

Muscle strength is the greatest protector of the knee joint.

• Quadriceps Dominance: The quadriceps absorb shock during heel strike. Weakness here correlates strongly with the progression of OA.¹²
• The VMO Myth vs. Reality: While isolating the Vastus Medialis Oblique (VMO) is debated, general quadriceps strengthening consistently improves patellar tracking.
• Gluteal Amnesia: Sedentary lifestyles lead to inhibited glutes. Reactivating the Gluteus Medius is essential to prevent dynamic valgus (knee collapse).¹⁷

Step 6: Flexibility and Tissue Quality

Restoring length-tension relationships in the muscles crossing the knee is vital.

• Hamstrings: Tight hamstrings keep the knee in flexion, increasing PFJ contact pressure.
• Rectus Femoris: Tightness in this bi-articular muscle compresses the patella into the femur.
• IT Band: While the ITB itself is a non-contractile fascia that cannot be "stretched," managing the tension in the Tensor Fascia Latae (TFL) muscle which inserts into it is effective.²⁷

Step 7: Ergonomic Optimisation

With hybrid working now standard, "commuter knee" and "desk knee" are prevalent.

• The 90-Degree Rule: Chairs must be adjusted so hips are slightly higher than knees. Sitting low forces the hip into deep flexion and creates posterior pelvic tilt.²⁸
• Popliteal Pressure: A gap of 2-3 fingers must exist between the seat edge and the back of the knee to prevent compression of the popliteal artery and vein, which can cause venous stasis and swelling.²⁹
• Movement Snacking: The "20-20-20" rule (every 20 mins, look 20 feet away, move for 20 seconds) combats the static loading that dehydrates articular cartilage.³⁰

Step 8: Manual Therapy Integration

Hands-on treatment provides the "window of opportunity" for rehabilitation.

• Maitland Mobilisation: Graded oscillatory movements of the tibiofemoral or patellofemoral joint reduce pain (neurophysiological effect) and improve stiffness (mechanical effect).²⁴
• Soft Tissue Release: Deep friction massage can break down scar tissue in chronic ligament sprains and reduce hypertonicity in muscles guarding an injury.³¹

Step 9: Electrotherapy Applications

CK Physio utilises electrotherapy not as a passive cure, but as a physiological modulator.¹⁰

• TENS: Blocks pain signals at the spinal cord level (Gate Control Theory) and stimulates endorphin release.
• NMES: Essential for post-operative inhibition, forcing the muscle to contract when the patient cannot voluntarily recruit it.²²
• Ultrasound: Accelerates the inflammatory phase of healing in acute ligament sprains.³²

Step 10: Shockwave Therapy (ESWT)

A distinct advantage of CK Physio is the provision of Focused Shockwave Therapy, a superior modality for deep-seated chronic pathologies.⁹

• Regeneration: It induces neovascularisation (new blood vessel formation) in degenerative tissue.²³
• Calcification: It physically breaks down calcific deposits in tendons via cavitation.³³
• NICE Compliance: Used in accordance with NICE guidance for refractory tendinopathies.³⁴

Step 11: Running Re-Education

Running form is a skill that must be coached.

• Cadence: Increasing cadence by 5-10% reduces vertical oscillation and ground reaction forces, protecting the knee.³
• Over-striding: Landing with the foot far ahead of the centre of mass acts as a brake, transmitting high impact forces through the tibia to the knee.

Step 12: Lifelong Maintenance

Knee health is a continuum.

• Periodic "MOTs": Regular check-ups to assess biomechanics before minor niggles become major injuries.¹³
• Diet & Hydration: Adequate hydration maintains synovial fluid volume. Anti-inflammatory diets may assist in managing OA symptoms.

Advanced Therapeutic Modalities: A Technical Deep Dive

Extracorporeal Shockwave Therapy (ESWT)

Shockwave therapy represents one of the most significant advancements in non-surgical musculoskeletal medicine. CK Physiotherapy’s investment in this technology places it at the forefront of conservative care in West London.

Physics and Mechanism:

ESWT devices generate high-energy acoustic waves, not electrical shocks. These waves travel through the skin and focus on a specific target tissue.

1. Direct Mechanical Effect: The positive pressure phase of the wave strikes the tissue, while the negative tensile phase creates cavitation bubbles. The collapse of these bubbles generates secondary shockwaves, creating micro-trauma.²³
2. Biological Response: This controlled micro-trauma triggers the release of growth factors (e.g., VEGF) and stimulates tenocytes (tendon cells) to produce collagen. It effectively converts a chronic, non-healing condition (tendinosis) back into an acute inflammatory state that the body can repair.⁹
3. Analgesic Effect: Shockwave therapy over-stimulates nerve endings (Hyperstimulation Analgesia), reducing the transmission of pain signals (Substance P depletion).¹⁸

Focused vs. Radial Shockwave:

CK Physiotherapy distinguishes itself by offering Focused Shockwave, which differs significantly from the more common Radial systems found in many clinics.9

Indications and Efficacy:

• Patellar Tendinopathy (Jumper's Knee): High-level evidence supports ESWT for chronic patellar tendinopathy, often showing superiority to eccentric exercise alone in the long term.³⁵
• Achilles Tendinopathy: NICE guidance (IPG571) supports ESWT for refractory cases. Studies indicate success rates of 60-80% in patients who have failed other conservative measures.³⁴
• Calcific Tendinopathy: ESWT is the gold standard non-surgical treatment for breaking down calcium deposits.³³

Contraindications (Safety First):

Adherence to safety protocols is paramount.

• Absolute Contraindications: Pregnancy (due to unknown effects on fetus), presence of a cardiac pacemaker (potential interference), malignancies/tumors at the treatment site (risk of metastasis), and active infections.³⁷
• Relative Contraindications: Use of anticoagulants (blood thinners) due to risk of haematoma, and corticosteroid injection within the last 6 weeks (risk of tissue rupture).³⁷

Electrotherapy: TENS, NMES, and Ultrasound

While exercise is the cornerstone, electrotherapy provides the physiological environment for exercise to occur.

Transcutaneous Electrical Nerve Stimulation (TENS):

• Mechanism: TENS operates on the "Gate Control Theory" of pain. By stimulating large-diameter sensory fibres (A-beta), it inhibits the transmission of pain signals from small-diameter nociceptive fibres (C-fibres) at the dorsal horn of the spinal cord. Low-frequency TENS also stimulates the release of endogenous opioids (endorphins).³⁹
• Clinical Application: At CK Physio, TENS is used to manage OA pain, enabling patients to perform their rehabilitation exercises with reduced inhibition.⁴⁰ It is a safe, drug-free alternative to long-term analgesic use.
• Safety: TENS pads should never be placed over broken skin, the carotid sinus, or the uterus during pregnancy.⁴¹

Neuromuscular Electrical Stimulation (NMES):

• Mechanism: NMES bypasses the central nervous system to depolarize motor nerves directly, causing a muscle contraction.
• Clinical Application: Following knee surgery (e.g., ACL reconstruction) or severe OA flare-ups, the quadriceps muscle often shuts down due to arthrogenic muscle inhibition (AMI). The patient literally "forgets" how to contract the muscle. NMES forces the muscle to contract, preventing atrophy and re-establishing the neural connection.²² Evidence shows significant strength gains when NMES is added to standard care.⁴²

Therapeutic Ultrasound:

• Mechanism: Uses piezoelectric crystals to generate high-frequency sound waves (1MHz or 3MHz).
• Thermal Effects: Continuous waves generate heat deep within tissues, increasing extensibility of collagen (useful for scar tissue).⁴³
• Non-Thermal Effects: Pulsed waves create acoustic streaming and stable cavitation, which upregulates cell membrane permeability and protein synthesis. This accelerates the inflammatory phase of repair in acute ligament sprains (MCL/LCL).³²

Rehabilitation Protocols and Exercise Science

The following exercises are core components of the CK Physiotherapy knee protocols. They are selected based on electromyographic (EMG) evidence of muscle recruitment and joint safety.

Early Stage: Isometric & Closed Kinetic Chain

Straight Leg Raise (SLR):

• Technique: Patient lies supine, one leg bent, the other straight. The straight leg is lifted to 45 degrees while maintaining full knee extension.¹³
• Target: Rectus Femoris and Iliopsoas without PFJ compression.
• Indication: Acute knee pain, post-op, or when bending is painful.

Wall Squat (Isometric):

• Technique: Back against wall, feet hip-width apart. Slide down to a comfortable angle (30-60 degrees) and hold for 10-30 seconds.¹⁷
• Biomechanics: This is a closed kinetic chain exercise. Co-contraction of hamstrings and quads provides joint stability and minimizes anterior shear forces on the ACL.

Glute Bridge:

• Technique: Supine, knees bent. Lift hips until trunk and thighs are aligned.
• Target: Gluteus Maximus.
• Progression: Single-leg bridge to increase demand and identify asymmetries.¹³

Mid Stage: Strengthening & Stability

Clamshells:

• Technique: Side-lying, knees bent at 45 degrees. Open top knee like a clam while keeping heels touching and pelvis perpendicular to the floor.¹⁷
• Target: Gluteus Medius isolation. Essential for preventing dynamic valgus (knock-knees).

Sit-to-Stand:

• Technique: Controlled descent onto a chair and explosive concentric drive upwards.
• Functional Relevance: Vital for maintaining independence in older adults. It mimics daily demands.⁴⁵

Step-Ups:

• Technique: Step onto a box, driving through the heel of the leading leg. Ensure the knee does not collapse inward.
• Target: Concentric quadriceps and glute stability.

Late Stage: Dynamic & Plyometric

Single-Leg Romanian Deadlift (RDL):

• Technique: Standing on one leg, hinge at the hips keeping the back straight, extending the free leg behind.¹⁷
• Target: Hamstring eccentricity and proprioceptive balance.

Decline Squats:

• Indication: Specifically for Patellar Tendinopathy. The decline board isolates the load onto the patellar tendon, stimulating remodeling.¹⁸

Ergonomics, Lifestyle, and the Ealing Environment

Workplace Ergonomics: The "Office Athlete"

With Ealing’s high commuter population, workplace setup is a primary driver of knee morbidity.

• Chair Configuration: The seat height must allow feet to be planted firmly. If feet dangle, the posterior thigh compresses against the seat edge, reducing venous return. A footrest is mandatory for shorter individuals.⁴⁶
• Knee Angle: A 90-degree flexion angle is standard, but prolonged static flexion increases patellofemoral pressure. Users should utilize the chair’s tilt mechanism to vary the hip angle and frequently extend the legs under the desk.⁴⁶
• Standing Desks: While beneficial, standing for too long causes venous pooling. The ideal ratio is sitting for 60% and standing for 40% of the day, changing position every 30-45 minutes.⁴⁶

Active Recovery Environments in West London

Ealing offers exceptional green spaces for active rehabilitation, which CK Physio encourages as part of a biopsychosocial approach.

• Walpole Park: Offers flat, even grass surfaces ideal for early-stage return-to-run programs. Grass reduces impact forces compared to pavement.⁴⁷
• Brent Meadow to Top Locks: A 2.5-mile canal-side walk. The flat towpath is perfect for measuring walking tolerance in OA patients without the challenge of hills.⁴⁸
• Horsenden Hill: A more challenging route with gradients. Suitable for late-stage rehab to test knee stability and quadriceps endurance on inclines.⁴⁸
• Social Prescribing: For older adults, combating isolation is key to pain management. Groups like the Ealing Walking Club (slow mid-week walks) and U3A Ealing offer structured, supportive environments for keeping active.⁴⁹

Case Studies and Clinical Narratives

Case Study A: The Ultra-Marathoner (Patellofemoral Pain)

• Patient Profile: Jonny, 34, Ealing Eagles runner.
• History: Developed sharp anterior knee pain during a 42-mile ultra-marathon. Pain worsened with stairs and sitting.
• Assessment: Diagnosis of acute PFPS driven by overload and VMO delay.
• Treatment Pathway:

1. Acute Phase: Ice and taping (McConnell tape) to offload the patella. Relative rest from running.
2. Rehab Phase: Gluteus medius strengthening (Clamshells) and VMO activation (Isometric contractions).
3. Return to Sport: Gait re-education to increase cadence. Gradual re-introduction of mileage on soft surfaces (Walpole Park).
   Outcome: Full return to running within 6 weeks without pain.6

Case Study B: The Construction Worker (Complex Trauma)

• Patient Profile: John, 50, physical labourer.
• History: History of spinal injury, presenting with severe knee instability and pain. Knee hyperextended by 40 degrees during gait.
• Assessment: Posterior capsule laxity and severe quadriceps weakness leading to "recurvatum" (hyperextension).
• Treatment Pathway:

1. Mechanical Support: Prescription of a hinged knee brace to prevent hyperextension.
2. Neuromuscular: Intense NMES program to recruit quadriceps motor units.
3. Functional: Closed chain strengthening to build stability.
   Outcome: Regained stability and reduced pain, allowing continued employment.51

Case Study C: The Office Administrator (Chronic Tendinopathy)

• Patient Profile: Jayne, 42, sedentary job.
• History: 12-week absence from work due to knee pain. GP advised rest, which led to deconditioning.
• Assessment: Chronic Patellar Tendinopathy (Tendinosis) and severe deconditioning.
• Treatment Pathway:

1. Intervention: Fast-tracked via private physio to avoid NHS waitlist.
2. Modality: Focused Shockwave Therapy (4 sessions) to restart healing.
3. Ergonomics: Adjustment of office chair to relieve popliteal pressure.
4. Exercise: Eccentric squat program.
   
   Outcome: Return to work within 4 weeks of starting physio. Pain eliminated.52

Conclusion

The management of knee pain is a complex, multifactorial challenge that demands a sophisticated clinical response. For the residents of Ealing—from the dedicated runner at Lammas Park to the retiree navigating the high street—generic advice is insufficient.

This updated 12-Step Guide represents a synthesis of local knowledge, clinical expertise, and cutting-edge technology. By combining the diagnostic precision of Chartered Physiotherapy with the regenerative power of Focused Shockwave Therapy and the neuromuscular benefits of Electrotherapy, CK Physiotherapy offers a pathway not just to pain relief, but to genuine structural recovery.

The evidence is clear: early intervention, biomechanical correction, and active rehabilitation are the pillars of knee health. Through this comprehensive framework, CK Physiotherapy reaffirms its position as the trusted authority for musculoskeletal care in West London, empowering patients to move better, feel better, and live active, pain-free lives.

Frequently Asked Questions About Knee Pain

How long does it typically take to recover from knee pain?

Recovery time varies significantly depending on the condition—acute injuries like ligament sprains may resolve in 4-8 weeks with proper treatment, while chronic conditions like osteoarthritis require ongoing management and can show improvement within 6-12 weeks of consistent physiotherapy.

Can I continue exercising if I have knee pain?

Exercise should continue using the principle of "relative rest," where you modify activities to stay within non-painful ranges rather than stopping completely, as complete rest can lead to muscle atrophy and joint stiffness that worsen knee problems.

Is surgery always necessary for knee injuries?

The majority of knee conditions, including meniscal tears in older adults and many ligament injuries, respond well to conservative treatment with physiotherapy, and surgery should only be considered after exhausting non-surgical options or in cases of complete ruptures requiring structural repair.

Should I use ice or heat for knee pain?

Ice is most effective in the first 48-72 hours after acute injury or during inflammatory flare-ups to reduce swelling, while heat is better for chronic stiffness and muscle tension before exercise to improve tissue extensibility.

Can weather changes actually affect knee pain?

Barometric pressure changes can influence joint pain sensitivity, particularly in people with osteoarthritis, as pressure drops may cause tissues to expand slightly and increase pain perception in already sensitised joints.

Will losing weight really make a difference to my knee pain?

Weight loss has a profound mechanical effect—every pound lost removes four pounds of compressive force from the knee during walking, and a 10-pound reduction equals 40,000 pounds less force per mile walked.

Are there warning signs that knee pain is serious?

Seek immediate medical attention if you experience sudden severe pain with inability to bear weight, visible deformity, significant swelling within hours of injury, locking or giving way of the joint, or if pain is accompanied by fever or systemic symptoms.

Can knee problems cause pain in other areas of my body?

Knee dysfunction frequently causes compensatory pain in the hip, lower back, or opposite knee due to altered gait mechanics and kinetic chain dysfunction, which is why addressing knee problems early prevents secondary issues developing elsewhere.

Is running bad for my knees?

Running itself does not cause osteoarthritis when performed with proper technique, appropriate footwear, and progressive training loads—in fact, regular moderate running can strengthen supporting muscles and improve cartilage nutrition through joint movement.

How quickly should I seek treatment for new knee pain?

Early intervention within the first 2-4 weeks of symptoms prevents chronic pain pathways from becoming established in the central nervous system and significantly improves treatment outcomes compared to waiting months before seeking care.

Can diet and supplements help with knee osteoarthritis?

While no supplement can reverse cartilage damage, maintaining adequate hydration supports synovial fluid production, and anti-inflammatory dietary patterns rich in omega-3 fatty acids may help manage OA symptoms alongside conventional treatment.

Do I need an MRI scan before starting physiotherapy?

Most knee conditions can be accurately diagnosed through clinical examination by a Chartered Physiotherapist, and imaging is only necessary when internal derangement (such as ACL rupture or complex meniscal tears) is suspected or if symptoms don't respond to initial treatment.

Works cited

1. Ealing Joint Strategic Needs Assessment- Musculoskeletal Health in Ealing 2017 - Ealing Council, accessed on November 26, 2025, https://www.ealing.gov.uk/download/downloads/id/13880/musculoskeletal_health_-_jsna_2018.pdf
2. DEMOGRAPHIC AND EPIDEMIOLOGICAL TRENDS IN PATELLOFEMORAL PAIN - NIH, accessed on November 26, 2025, https://pmc.ncbi.nlm.nih.gov/articles/PMC4458915/
3. How We Help Injured Runners | CK Physiotherapy Ealing, accessed on November 26, 2025, https://ckphysio.co.uk/blog/injured-while-running-visit-reliable-ealing-physiotherapy-clinic
4. Alessio Achieves 5th Place In Ealing Half Marathon - The Waldegrave Clinic, accessed on November 26, 2025, https://waldegraveclinic.co.uk/alessio-achieves-5th-place-in-ealing-half-marathon/
5. Lisa Snell - Ealing Eagles Running Club, accessed on November 26, 2025, https://www.ealingeagles.com/lisa-snell
6. Case Study: Frontal Knee Pain (Part 1) - Physio Effect, accessed on November 26, 2025, https://www.physioeffect.co.uk/resources/case-study-frontal-knee-pain-part-1
7. C K Physiotherapy Ealing | PhysiotherapistsUp - Best Physiotherapists Near You, accessed on November 26, 2025, https://www.physiotherapistsup.co.uk/345/c-k-physiotherapy
8. CK Physiotherapy Extend Their Range Of Physio Treatments To Clients In Ealing And Hanwell - EIN Presswire, accessed on November 26, 2025, https://www.einpresswire.com/article/510948415/ck-physiotherapy-extend-their-range-of-physio-treatments-to-clients-in-ealing-and-hanwell
9. Shockwave Therapy Treatment | CK Physiotherapy, accessed on November 26, 2025, https://ckphysio.co.uk/treatments/shockwave-therapy
10. Tailored Electrotherapy Sessions | CK Physiotherapy London, accessed on November 26, 2025, https://ckphysio.co.uk/treatments/electrotherapy
11. 4 Most Common Knee Injuries by Age | MidState Medical Center, accessed on November 26, 2025, https://midstatemedical.org/about/news-press/news-detail?articleid=66078
12. Increasing Prevalence of Knee Pain and Symptomatic Knee Osteoarthritis - PMC - NIH, accessed on November 26, 2025, https://pmc.ncbi.nlm.nih.gov/articles/PMC3408027/
13. 3 Things to Expect During Knee Physical Therapy Near Ealing - CK Physiotherapy, accessed on November 26, 2025, https://ckphysio.co.uk/blog/3-things-expect-during-knee-physical-therapy-near-ealing
14. CK Physiotherapy: Expert Physiotherapy Care in London, accessed on November 26, 2025, https://ckphysio.co.uk/
15. Knee pain - Musculoskeletal Matters, accessed on November 26, 2025, https://www.mskdorset.nhs.uk/knee-pain/
16. Knee Pain Statistics: 2025 Facts and Treatment Trends - QC Kinetix, accessed on November 26, 2025, https://qckinetix.com/blog/knee-pain-statistics-facts/
17. 5 Best Exercises for Runner's Knee (Patellofemoral Pain) - Health Cleveland Clinic, accessed on November 26, 2025, https://health.clevelandclinic.org/exercises-for-patellofemoral-pain-syndrome-pfps
18. Shockwave Therapy - WWL NHS Foundation Trust, accessed on November 26, 2025, https://www.wwl.nhs.uk/media/.leaflets/6110de0259d2a0.36360639.pdf
19. Sports Injuries - Physio in Ealing, accessed on November 26, 2025, https://www.ealingphysio.co.uk/sports-injuries/
20. Exercise for treating patellofemoral pain syndrome - PMC - PubMed Central, accessed on November 26, 2025, https://pmc.ncbi.nlm.nih.gov/articles/PMC10898323/
21. Knee Pain - Physiotherapy - NHS Borders, accessed on November 26, 2025, https://www.nhsborders.scot.nhs.uk/patients-and-visitors/our-services/allied-health-professionals/physiotherapy/physiotherapy-msk-services/knee-pain/
22. Effectiveness of electrical stimulation on rehabilitation after ligament and meniscal injuries: a systematic review - PubMed Central, accessed on November 26, 2025, https://pmc.ncbi.nlm.nih.gov/articles/PMC10868930/
23. An Evidence-Based Guide to Shockwave Therapy in Modern Physiotherapy, accessed on November 26, 2025, https://ckphysio.co.uk/blog/benefits-shockwave-therapy-physiotherapy-treatment
24. CK Physiotherapy in London • Read 5 Reviews - WhatClinic, accessed on November 26, 2025, https://www.whatclinic.com/physiotherapy/uk/london/ck-physiotherapy
25. Osteoarthritis in over 16s: diagnosis and management | Guidance - NICE, accessed on November 26, 2025, https://www.nice.org.uk/guidance/ng226/chapter/Recommendations
26. Up & Running - Ealing Half Marathon, accessed on November 26, 2025, https://www.ealinghalfmarathon.com/partners/up-running/
27. A long-distance runner with lateral knee pain | British Journal of Sports Medicine, accessed on November 26, 2025, https://bjsm.bmj.com/content/44/16/1209.1.long
28. Seating and ergonomics | CUH - Cambridge University Hospitals, accessed on November 26, 2025, https://www.cuh.nhs.uk/patient-information/seating-and-ergonomics/
29. Are you sitting comfortably? - UNISON, accessed on November 26, 2025, https://www.unison.org.uk/content/uploads/2013/06/On-line-Catalogue172943.pdf
30. Desk health ergonomics - Chelsea and Westminster Hospital, accessed on November 26, 2025, https://www.chelwest.nhs.uk/your-visit/patient-leaflets/hand-therapy/desk-health-ergonomics
31. Low-tech rehabilitation of bilateral patellofemoral knee pain in a runner: a case study - PMC, accessed on November 26, 2025, https://pmc.ncbi.nlm.nih.gov/articles/PMC1769305/
32. Low Intensity Ultrasound for Promoting Soft Tissue Healing: A Systematic Review of the Literature and Medical Technology - NIH, accessed on November 26, 2025, https://pmc.ncbi.nlm.nih.gov/articles/PMC6128661/
33. Interventional procedure overview of extracorporeal shockwave therapy for calcific tendinopathy in the shoulder - NICE, accessed on November 26, 2025, https://www.nice.org.uk/consultations/1704/2/description-of-the-procedure
34. NATIONAL INSTITUTE FOR HEALTH AND CARE EXCELLENCE - INTERVENTIONAL PROCEDURES PROGRAMME Interventional procedure overview of extracorporeal shockwave therapy for Achilles tendinopathy - NICE, accessed on November 26, 2025, https://www.nice.org.uk/guidance/ipg571/documents/overview-2
35. The effectiveness of shockwave therapy on patellar tendinopathy, Achilles tendinopathy, and plantar fasciitis: a systematic review and meta-analysis - PMC - NIH, accessed on November 26, 2025, https://pmc.ncbi.nlm.nih.gov/articles/PMC10468604/
36. Case Study: Shockwave for Achilles Tendonitis - Activ Physiotherapy, accessed on November 26, 2025, https://www.activphysiotherapy.co.uk/activ-blog/case-study-shockwave-achilles-tendonitis
37. Contraindications — Shockwave Therapy, accessed on November 26, 2025, https://shockwave-therapy.co.uk/contraindications
38. Best practices for extracorporeal shockwave therapy in musculoskeletal medicine: Clinical application and training consideration - NIH, accessed on November 26, 2025, https://pmc.ncbi.nlm.nih.gov/articles/PMC9321712/
39. A Guide to Understanding TENS (Transcutaneous Electrical Nerve Stimulation) - York Hospital, accessed on November 26, 2025, https://www.yorkhospitals.nhs.uk/seecmsfile/?id=5107
40. Electrotherapy - Ealing Physio, accessed on November 26, 2025, https://www.ealingphysio.co.uk/services/electrotherapy.php
41. TENS (transcutaneous electrical nerve stimulation) - NHS, accessed on November 26, 2025, https://www.nhs.uk/tests-and-treatments/transcutaneous-electrical-nerve-stimulation-tens/
42. (PDF) Effectiveness of electrical stimulation on rehabilitation after ligament and meniscal injuries: A systematic review - ResearchGate, accessed on November 26, 2025, https://www.researchgate.net/publication/221751900_Effectiveness_of_electrical_stimulation_on_rehabilitation_after_ligament_and_meniscal_injuries_A_systematic_review
43. Ultrasound Therapy: A Non-Invasive Solution for Sports Injuries, accessed on November 26, 2025, https://backinline-therapycentre.co.uk/ultrasound-therapy-a-non-invasive-solution-for-sports-injuries/
44. Knee exercises for runners - NHS, accessed on November 26, 2025, https://www.nhs.uk/live-well/exercise/knee-exercises-for-runners/
45. Video exercises for knee pain | The Chartered Society of Physiotherapy, accessed on November 26, 2025, https://www.csp.org.uk/conditions/knee-pain/video-exercises-knee-pain
46. Can Your Office Chair Cause Knee Pain? Here's What to Know - Sihoo UK, accessed on November 26, 2025, https://uk.sihoooffice.com/blogs/ergonomics/office-chair-knee-pain
47. Health walks in Acton and Ealing, accessed on November 26, 2025, https://www.ealing.gov.uk/info/201145/walking/962/health_walks_in_acton_and_ealing
48. Which of these walking routes gets your vote? - Around Ealing, accessed on November 26, 2025, https://www.aroundealing.com/news/which-of-these-walking-routes-gets-your-vote/
49. Ealing Walking Club - Do Something Good, accessed on November 26, 2025, https://dosomethinggood.ealing.gov.uk/project/ealing-walking-club/
50. Activities for older adults in Ealing: Staying active and connected - Home Instead, accessed on November 26, 2025, https://www.homeinstead.co.uk/ealing/blog/activities-for-older-adults-in-ealing-staying-active-and-connected/
51. Knee Pain - Case Studies - Nell Mead, accessed on November 26, 2025, https://nellmead.com/knee-pain-case-studies/
52. Case Studies | Injury Rehabilitation | Zurich Business, accessed on November 26, 2025, https://www.zurich.co.uk/business/our-expertise/injury-rehabilitation/your-rehabilitation/case-studies
53. Extracorporeal shockwave therapy for refractory plantar fasciitis | Guidance - NICE, accessed on November 26, 2025, https://www.nice.org.uk/guidance/ipg311