Hip and knee conditions

Hips and knees have a habit of hurting somewhere other than where the problem is. That single fact explains most of the frustration people bring to us about them.

A knee that aches after a long walk frequently starts at the hip that cannot control rotation, or the foot that collapses under load. Pain deep in the buttock is often referred from the lower back rather than coming from the hip at all. Treating the part that hurts settles it and does not fix it, which is why the same problem returns three months later.

More information

Which page do I need

For the hip, where it hurts is the most useful clue. Groin and front of hip pain points towards the joint itself. Pain on the outside, sore to lie on at night and worse on stairs, is usually a tendon problem rather than the joint. Start with hip pain and it explains all three patterns.

For the knee, if there was no injury and it has built gradually, read knee pain. If it came on with running and arrives at a predictable distance, read runner's knee. If there was a twisting incident with a pop, swelling within the hour and the knee giving way, read ACL injury. If somebody has told you the cartilage is torn, read meniscus tear, particularly if you are over forty.

Two things worth knowing before a scan worries you

Degenerative changes and meniscal tears show up on scans in a large proportion of people who have no pain whatsoever, and become more common with age in everybody. So a report describing wear is not describing a disaster, and how much a worn joint hurts correlates far better with strength and activity than with how it looks on film.

For degenerative meniscal tears specifically, good quality trials have compared arthroscopic surgery with exercise therapy and with placebo surgery, and have not found a meaningful advantage for the operation. That has changed practice considerably.

What treatment involves

An assessment of the whole leg rather than only the painful part, treatment to settle symptoms, and a progressive strength programme aimed at the actual cause. NICE recommends exercise as a core treatment for osteoarthritis regardless of age or severity, and it does not wear joints out. Expect the strength work to matter more than anything we do with our hands.

When a knee needs seeing promptly

If it gave way, locked so you could not straighten it, swelled within an hour of an injury, or you cannot put weight on it.

Person lying on padded table receives hands-on hip treatment with red-highlighted hip area
Two hands pressing a bare knee while person sits, beige fitness band on wristRunner clutching red-highlighted knee while standing on a paved park path

Frequently Asked Questions

Why does my knee hurt when nothing happened to it?
Knee pain frequently builds from how load is being managed above and below it, meaning the hip and the foot, rather than from an injury to the knee itself. That is why an assessment looks at the whole leg, and why treatment aimed only at the knee often settles the pain without stopping it returning.
Do I need a scan for a knee injury?
Sometimes, particularly where a ligament or meniscus injury is suspected after a twisting incident. Often not, because many knee problems are diagnosed accurately from the history and examination. We will tell you which situation you are in and write to your GP if imaging or a consultant opinion is warranted.
Is knee pain after fifty just wear and tear?
Some changes on a scan are normal with age and are found in plenty of people with no pain at all, so wear is not the whole explanation. Strength, load and how you move all affect how much those changes hurt, and all three respond to treatment.