Introduction
Knee care · Knee pain
Knee pain by location and pattern: what it can mean, and when to seek care
Dr Sean LeoOrthopaedic Surgeon, Singapore
Clinic enquiries · Not an emergency service
Illustrative image
Where your knee hurts is a clue, not a diagnosis.
Where your knee hurts is a clue, not a diagnosis.
Where your knee hurts is a clue, not a diagnosis.
Knee pain can come from many different conditions, and treatment depends on the cause.[1] Where the pain sits and how it behaves are useful clues. They narrow the possibilities. They do not name a diagnosis.[1] This page maps the common patterns by location and shows the signs that should not wait.
Describing your pain well is a real contribution to an assessment. Seeing an orthopaedic surgeon about your knee does not mean surgery has already been decided.
OrthoKinetics is Dr Sean Leo’s professional brand. Clinical consultations and treatment are provided through OrthoSports Orthopaedic & Sports Surgery.
What’s covered on this webpage
Follow the route in order, or jump to the stop you need. Stops you have read are marked.
How to use this page
How to use this page
How to use this page
The knee packs many structures into a small space, so their symptoms overlap.[1] A location or a pattern can narrow the possibilities without naming the structure responsible, and more than one concern can contribute. Each zone below lists recognised possibilities, never a verdict.
The knee is several structures in a small space.
The knee is several structures in a small space.
The knee is several structures in a small space.
The kneecap (patella) sits in a groove at the front of the thigh bone. A C-shaped cushion of cartilage, the meniscus, lies between the bones on each side. Ligaments steady the joint: two along the inner and outer sides, two deep inside. Tendons attach the muscles above and below the kneecap. Small fluid-filled sacs, called bursae, help tissues glide. Behind the knee is a hollow called the popliteal space.
Where the pain sits
Where the pain sits
Where the pain sits: a location map
Find the part of your knee that hurts most. The table lists recognised possibilities, never a diagnosis.
| Where it hurts | Recognised possibilities |
|---|---|
| Front of the knee and around the kneecap | Patellofemoral pain, a tendon problem, bursitis[2][1] |
| Inner side | Medial collateral ligament (MCL) injury, medial meniscus problem[3][4] |
| Outer side | Iliotibial (IT) band syndrome[5] |
| Back of the knee | Baker’s (popliteal) cyst[7] |
| Both knees, or the whole knee | Osteoarthritis pattern[1] |
Signs that should not wait apply in every zone. Read When should knee pain be seen by a doctor? first.
Front of the knee and around the kneecap
Patellofemoral pain is a common pattern. It is an ill-defined ache around or behind the kneecap that builds gradually and is worse with squatting, stairs, long sitting, jumping or running.[2] A clinician reaches it by combining your story with an examination and by considering other causes of front-of-knee pain.[2] It names a pattern of symptoms, not wear and tear.[2]
Pain between the kneecap and the shin after repeated running or jumping fits a tendon problem. A warm, red knee that is worse with kneeling or bending fits bursitis.[1]
More about patellofemoral pain
The main guideline supports exercise that is progressed over time and focused on hip and knee strength. It also notes that symptoms can recur and persist for years.[2]
Inner side
The medial collateral ligament (MCL) resists force that pushes the knee inwards. Its injury typically follows a blow to the outer side, or a sideways or twisting force without contact, with pain and tenderness on the inner side.[3]
The medial meniscus is the second possibility. A twist on a bent, weight-bearing knee is the typical way it is injured. Wear-related tears develop slowly in middle-aged and older knees, often with no clear injury.[4] An examination is needed to tell these apart, and to grade a ligament injury.[3]
Outer side
Iliotibial (IT) band syndrome is a common cause of outer-knee pain in athletes.[5] In runners it is the most common injury on the outer side of the knee.[6] The pain sits between two bony landmarks on the outer knee. It is a clinical diagnosis and rarely needs scans or other tests.[5]
How common is it in runners?
Estimates range from 5% to 14% of runners. These figures describe runner populations, not everyone.[6]
Back of the knee
A Baker’s (popliteal) cyst is a fluid-filled swelling at the back of the knee. It can cause pain in the knee and calf, a build-up of fluid, and occasional locking or clicking.[7] A swelling behind the knee is worth having assessed.[7]
Safety note: If one calf is newly painful and swollen, arrange an urgent same-day assessment. Calf pain and swelling can overlap with the warning signs of a blood clot in the leg.
Both knees, or a hot, red knee
Pain and stiffness in both knees, with mild swelling, is the osteoarthritis pattern. It is more common in older people.[1] Stiffness that lasts more than 30 minutes after waking is worth a review.[8] Age alone does not make replacement inevitable.
Safety note: A knee that is suddenly very painful, hot and red, especially with a fever, may be infected. Go to an emergency department or call 995.[1]
Pain that comes from the hip
Hip problems can cause pain in the groin, down the front of the leg and in the knee. Sometimes knee pain is the only sign of a hip problem. This is called referred pain, and it is fairly common.[7] It is one reason an assessment may examine your hip as well as your knee.
How the pain behaves adds useful information.
How the pain behaves adds useful information.
How the pain behaves adds useful information.
No single pattern confirms a structure. Patterns add up, and a clinician weighs them together.[1]
Does swelling that starts later mean anything?
Swelling can start hours or days after a twist, and it is listed among the symptoms of a meniscus tear.[9] It does not confirm one.
What do locking, giving way and clicking suggest?
A knee that locks, gives way or painfully clicks is a warning pattern. Painless clicking is normal.[1] Giving way and clicking are also listed among meniscus tear symptoms,[9] and a Baker’s cyst can cause occasional locking or clicking.[7] Because they overlap, none of them names a cause.
When should knee pain be seen by a doctor
When should knee pain be seen by a doctor
When should knee pain be seen by a doctor?
Most mild knee pain without an injury or warning signs should start to feel better in a few days.[1] Four groups are kept apart below.
Routine. See a doctor if knee pain does not improve within a few weeks.[1]
Soon. Book an appointment for unexplained weight loss, pain at night or at rest, or previous treatment for cancer.[7]
Urgent, the same day. Arrange an urgent same-day assessment if your knee is very painful, you cannot move it or put weight on it, it is badly swollen or has changed shape, or it locks, gives way or painfully clicks.[1]
Emergency. Go to an emergency department or call 995 if your knee is out of place or pointing at an odd angle, you have numbness or tingling in the knee, leg or toes, or the knee is hot, red and very painful with a fever.[9][1]
- OrthoKinetics does not provide emergency or urgent care through this webpage or its WhatsApp contact.
The urgent-signs list at the end of the page applies in every case. For fuller guides, read Knee pain: when to see a doctor and Knee symptoms you shouldn’t ignore.
What happens at a knee assessment?
What happens at a knee assessment?
What happens at a knee assessment?
Assessment starts with your story: where the pain sits, when it began, what changes it and how it limits you. An examination follows. Scans are used selectively, when they can answer a useful question.[4] No single test or scan confirms a cause on its own.[4][11]
After an injury, a checklist called the Ottawa Knee Rule helps clinicians decide whether an X-ray is needed to look for a broken bone. It does not detect ligament or cartilage injuries.[10]
Tests you may meet
- Valgus stress test: gentle sideways pressure on the knee, slightly bent and then straight, to see whether the inner side opens more than it should. It is the key examination for the MCL.[3]
- McMurray test: the clinician bends and rotates the knee while feeling and listening for clicks or pain along the joint line that can suggest a meniscus tear. Its accuracy on its own is poor to moderate.[11]
- Joint-line tenderness: pressing along the line of the knee joint to find the tender spot.[11]
Tests gather information. They do not hand out verdicts.
What can you do while you wait?
What can you do while you wait?
What can you do while you wait?
Knee pain can often be treated at home.[1] Do not self-diagnose.[1] A doctor can suggest treatment based on what is causing your knee pain.[1] Read Knee pain: when to see a doctor for the full guide.
Structure / Patient / Goal
Structure / Patient / Goal
Deciding together
Structure / Patient / Goal
Choosing what to do about knee pain, including whether to be assessed, is organised around three questions: the structure, the patient and the goal.
S
Structure: what is affected?
Structure covers the diagnosis and the condition of the relevant joint or tissue. It includes what the assessment shows and what a test adds when testing is useful.
P
Patient: how does it affect you?
Patient means you as a whole person. Symptoms, health, function, preferences and practical circumstances can affect which options are reasonable.
G
Goal: what are you hoping to return to?
Goal describes what matters to you, such as daily independence, work, recreation or sport. For knee pain that has no name yet, the goal may be relief, a return to activity, or simply knowing what the pain is.
Your plan
Structure / Patient / Goal helps organise benefits, burdens, limitations and uncertainty. No single scan, symptom or motivation determines the outcome alone.
Where a description can take you
Where a description can take you
Where a description can take you
| If your description sounds like | Read next |
|---|---|
| Front of the knee or around the kneecap | Kneecap pathway on the knee hub; patellar tendonitis |
| Inner side | Meniscus; MCL |
| Outer side, in runners | Sports injury hub |
| Back of the knee | Baker’s cyst explained |
| Both knees, with stiffness | Knee replacement decisions |
| Pain that may come from the hip | Hip care |
| Causes listed by injury or no injury | Common causes of knee pain |
Choosing a route is navigation, not a diagnosis. If a sign that should not wait applies to you, use the urgent-signs list below instead.
OrthoKinetics Recovery Reflection
Recovery reflection
What do you do with the first story you tell yourself about a pain?
A sore knee invites a quick story. It is arthritis, or a tear, or an operation waiting for you. The story arrives long before the information does. Hold it loosely. Notice what the knee does, write it down in plain words, and let the assessment fill in what a guess cannot. The first story is rarely the last one.
Illustrative image
With you through the seasonsMeet Dr Sean Leo
Meet Dr Sean Leo
A consultant orthopaedic surgeon whose clinical focus is the knee, sports injuries and the lower limb.
- Dr Sean Leo is a consultant orthopaedic surgeon. OrthoKinetics is his professional brand; clinical services are provided through OrthoSports Orthopaedic & Sports Surgery at Mount Elizabeth Novena Specialist Centre and Connexion, Farrer Park Hospital.
- His clinical interests include sports injuries, including those in adolescent athletes; ligament reconstruction; realignment surgery; cartilage repair and joint-preservation approaches; knee replacement; and technology-assisted hip and knee surgery.
- The consistent aim is to return people to meaningful function and activity while avoiding unnecessary downtime.
- Qualifications: MBBS, MRCS (Ed), MMed (Ortho), FRCSEd (Ortho).
More detail: Meet Dr Sean Leo
- Training and career: Dr Leo trained in medicine at the National University of Singapore and served in the Singapore Armed Forces Medical Corps from 2000 to 2012, where his work included the care of soldiers in physically demanding roles. He completed postgraduate orthopaedic training in 2009 and a one-year clinical fellowship at Royal North Shore Hospital in Sydney, Australia, before joining Changi General Hospital as an orthopaedic consultant in 2012, where he later held the positions of Senior Consultant and Director of the Hip and Knee Service. With seniority, his educational contribution has evolved towards mentorship and support for junior doctors.
Questions people often ask
Common knee pain questions
Common knee pain questions
Why does my knee hurt when I bend it?
Pain on bending does not point to one structure. It is listed with the bursitis pattern, where a warm, red knee is worse with kneeling or bending,[1] and front-of-knee pain is worse with squats and stairs.[2] Where the pain sits and what else is happening help narrow it.
What does pain behind the knee mean?
A Baker’s cyst is one recognised possibility.[7] Calf pain and swelling can overlap with the warning signs of a blood clot, so a newly painful, swollen calf needs a same-day assessment. See the urgent signs below.
Costs and insurance
Costs and insurance
Practicalities
Cost, MediSave and insurance
A cost estimate for surgery can be given only after a consultation and assessment, once a surgical plan has been developed. A surgical estimate separates surgeon, anaesthetist, hospital or facility, implant and consumable costs, and the MOH publishes national fee benchmarks for common procedures. For how costs, MediSave and insurance work in Singapore, see Costs, insurance and MediSave, explained.
Insurance panels. Dr Sean Leo, Orthopaedic Surgeon, is on the specialist panels of Great Eastern (GE Panel), HSBC Life (HSBC Life Shield) and Singlife (Singlife Shield), and on the Prudential Panel. AXA Insurance Singapore became part of HSBC Life in 2023, and former AXA Shield plans are now HSBC Life Shield plans.
Corporate health plans. Dr Leo is on the panels of both Alliance Medinet and iXchange, which administer medical benefits for many company health plans. If your company plan uses either panel, you can see Dr Leo as a panel doctor.
If your company uses a different panel. Some company plans still let you see a doctor of your choice outside their panel, then claim reimbursement. This varies from plan to plan, as may the co-payment, so please check your benefits with your company’s HR department.
Panel arrangements change from time to time, so please confirm with your insurer or your company’s plan administrator before your appointment.
Dr Leo is on the panels shown. If your insurer is not listed, you may ask whether co-management with an Orthosports surgeon partner on that panel is clinically and administratively appropriate. Orthosports surgeon partners are collectively on the panels of all Shield plans.
Specific benefits, pre-authorisation, reimbursement and cashless treatment depend on the individual policy and insurer approval and are not guaranteed.
To book, use the appointment section at the end of this page.
Arrange a consultation: the appointment section is further down this page.
Sources
References
References
- NHS. Knee pain. https://www.nhs.uk/symptoms/knee-pain/
- Willy RW, Hoglund LT, Barton CJ, et al. Patellofemoral Pain: Clinical Practice Guidelines Linked to the International Classification of Functioning, Disability and Health. J Orthop Sports Phys Ther. 2019;49(9):CPG1-CPG95. PMID 31475628. DOI 10.2519/jospt.2019.0302
- Phisitkul P, et al. MCL injuries of the knee: current concepts review. Iowa Orthop J. 2006;26:77-90. PMID 16789454. PMC1888587
- ESSKA meniscus consensus: Kopf S, et al. 2019 (PMID 32052121) and Beaufils P, et al. 2016 (PMID 28210788)
- StatPearls. Iliotibial Band Syndrome. NCBI Bookshelf NBK542185. https://www.ncbi.nlm.nih.gov/books/NBK542185/
- van der Worp MP, et al. Iliotibial band syndrome in runners: a systematic review. Sports Med. 2012;42(11):969-992. PMID 22994651
- nidirect. Knee pain. https://www.nidirect.gov.uk/conditions/knee-pain
- NHS. Joint pain. https://www.nhs.uk/symptoms/joint-pain/
- NHS. Meniscus tear (knee cartilage damage). https://www.nhs.uk/conditions/meniscus-tear/
- Stiell IG, et al. Derivation of a decision rule for the use of radiography in acute knee injuries. Ann Emerg Med. 1995;26(4):405-413. PMID 7574120
- Smith BE, et al. Special tests for assessing meniscal tears within the knee: a systematic review and meta-analysis. BMJ Evid Based Med. 2015;20(3):88-97. PMID 25724195
Final next step
Final next step
Next step
Final next step
Reading about a problem is a starting point. An assessment brings together the history, an examination where needed and any useful tests, and helps you and your clinician decide what to do next. How much physical examination is needed is a matter of clinical judgement. It may be limited when pain makes an examination unreliable, or when imaging clearly shows a problem that matches the symptoms, such as a fracture seen on an X-ray or an MRI scan that clearly shows an injury consistent with the symptoms. The Singapore Medical Council and the UK General Medical Council both allow remote medical consultations, where a physical examination is not possible, with safeguards: the doctor must be clear about the limits of an opinion formed without an examination, and whether an in-person examination is needed, or referral to other services, is left to the clinical judgement of the attending doctor.
Signs that need urgent help
Some symptoms should not wait for a routine appointment. Each item below says where to go.
After an injury
- The kneecap has slipped out of place and is still out, or the knee looks deformed. Go to an emergency department. If the kneecap went back into place by itself, arrange an early assessment.
- The leg looks twisted or bent, a bone is showing, there is a deep cut, or the foot or leg turns cold, pale, numb, blue or white. Go to an emergency department or call 995.
- You cannot lift your leg up with the knee kept straight, and you may feel a gap just above or just below the kneecap. Arrange an urgent same-day assessment.
At any time
- The knee is stuck and will not straighten, or it is very painful and you cannot move it or put weight on it. Arrange an urgent same-day assessment.
- The knee is suddenly very painful, hot, red and swollen, especially with a fever or feeling generally unwell. Go to an emergency department or call 995.
- One calf or thigh is newly painful and swollen. Arrange an urgent same-day assessment. If you also feel short of breath or have chest pain, call 995.
After knee surgery
- The operated knee becomes more painful, swollen or red, a wound is leaking, or you develop a fever. Contact your surgical team straight away. If you cannot reach them the same day, go to an emergency department. If you feel very unwell, go to an emergency department. If you are short of breath or have chest pain, call 995.
If you are admitted by the doctor at the urgent care centre of one of these private hospitals, the Parkway Pantai hospitals (Mount Elizabeth Orchard, Mount Elizabeth Novena, Gleneagles and Parkway East), Farrer Park Hospital and Thomson Medical Centre, you may ask for Dr Sean Leo to be your attending orthopaedic surgeon. If you are instead discharged and referred for orthopaedic follow-up, you may contact the clinic to arrange an appointment. Both are subject to the hospital’s admission processes and to Dr Leo’s availability.
Was this page helpful?
Arrange a consultation
Appointments are arranged through the OrthoSports clinic team. Send your details below, or message or call the clinic.
Leave your details and the clinic team will reply to arrange a time.
Message the clinic on WhatsApp
-
38 Irrawaddy Road, #10-41 Mount Elizabeth Novena Specialist Centre, Singapore 329563 Map for Orthosports@Novena (opens Google Maps)
-
1 Farrer Park Station Road, #15-17 Connexion, Singapore 217562 Map for Orthosports@Connexion (opens Google Maps)
WhatsApp is for clinic enquiries only. It is not an emergency service and is not monitored for urgent care. Website or messaging contact is not an emergency-response service. For a medical emergency, use your local emergency service.
- OrthoKinetics does not provide emergency or urgent care through this webpage or its WhatsApp contact.