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Knee MediBilbao Salud

Pain on the Inside of the Knee: Causes, Treatment and When to Worry

The inner side of the knee is one of the most common places for knee pain. It can follow a twist or a knock during sport, or it can appear gradually with running, walking or age. The structures that hurt most often there are the medial collateral ligament, the medial meniscus, the joint cartilage and the tendons that attach just below the joint. This guide explains, from a physiotherapy point of view, how to tell these causes apart, what helps and when to get it checked.

Topic
Physical therapy
Updated
Reading time
5 minutes
Reviewed by
Dr. Itziar Gotxi Erezuma · Medical doctor (ENT) · Bizkaia Medical Association no. 484809757

What is on the inside of the knee

The inner side of the knee contains the medial collateral ligament, which stops the knee bending inwards, the medial meniscus, a C-shaped cushion inside the joint, and the inner part of the joint cartilage. Just below the joint, three tendons from the thigh (sartorius, gracilis and semitendinosus) attach to the shin bone in an area called the pes anserinus, with a small bursa underneath.

Because these structures are close together, the exact spot that hurts and how the pain started are the most useful clues.

Causes after an injury

  • MCL sprain or tear: a blow to the outside of the knee or a twist pushes the knee inwards. Pain along the inner edge, tenderness and, in more severe tears, a feeling of instability.
  • Medial meniscus tear: twisting on a bent knee. Pain on the joint line, swelling over 24 to 48 hours, catching or locking; see meniscus tear.
  • Combined injuries: MCL injuries can occur with ACL or meniscus tears, especially in contact sports and skiing.
  • Bone bruise: a hard knock can bruise the bone, causing deep pain.

Causes without an injury

  • Osteoarthritis: the inner compartment is the most commonly affected. Stiffness in the morning or after sitting, aching after activity and sometimes bow-legged alignment.
  • Pes anserine bursitis or tendinopathy: pain 4 to 6 cm below the joint on the inner side, worse with stairs, getting out of a car and at night when the knees touch.
  • Degenerative meniscus tear: common after 40, sometimes after a minor movement like squatting.
  • Medial plica: an irritated fold of joint lining, causing clicking and pain on the inner side of the kneecap.
  • Patellofemoral pain: pain around the kneecap that can be felt on the inner side; see runner’s knee.

Inner knee pain without swelling

When the inner knee hurts but does not swell, a tendon or bursa problem, early arthritis or a mild MCL strain are the most likely causes. Pes anserine irritation is typical in runners who have increased their distance, in people with tight hamstrings and in people with knee arthritis or diabetes.

In children and teenagers, knee pain without a knee problem can come from the hip. A limp and knee pain in an overweight adolescent needs prompt assessment to rule out a slipped growth plate in the hip.

What you can do at home

  • Reduce the activities that provoke pain for a while, without stopping all movement.
  • Use ice for 15 minutes after activity in the first days; heat can ease stiffness from arthritis; see ice or heat for knee pain.
  • Place a pillow between your knees when sleeping on your side.
  • Wear supportive footwear and avoid deep squats and twisting at first.
  • Start gentle strengthening such as straight leg raises and bridges as pain allows.

How physiotherapy helps

A physiotherapist examines the knee to identify the structure involved, tests the ligaments and meniscus and checks hip and foot mechanics. Treatment usually includes a progressive strengthening programme for the quadriceps, hamstrings and hip muscles, flexibility work for tight hamstrings and adductors, balance training and advice on load, running volume and footwear.

Mild and moderate MCL injuries heal well without surgery, often with a hinged brace for a few weeks. Knee taping can reduce pain during activity; see KT tape for the knee. For arthritis, exercise is one of the most effective treatments.

Recovery times

  • Mild MCL sprain: 1 to 3 weeks.
  • Moderate MCL tear: 3 to 6 weeks.
  • Complete MCL tear: 6 to 12 weeks, sometimes longer.
  • Pes anserine bursitis: often 6 to 8 weeks with treatment.
  • Arthritis: a long-term condition, but symptoms usually improve with regular exercise and weight management.

When to see a doctor

  • Swelling soon after an injury, or a pop at the time of injury.
  • The knee locks, gives way or you cannot put weight on it.
  • A hot, red, swollen knee or fever.
  • Pain that wakes you every night or keeps getting worse.
  • A child or teenager with knee pain and a limp.

Key points to remember

  • After an injury, inner knee pain often comes from the MCL or medial meniscus.
  • Without injury, arthritis and pes anserine irritation are common causes.
  • Most cases improve with load management and strengthening.
  • Locking, giving way or a hot swollen knee need assessment.

Questions about pain on the inside of the knee

These answers are general information and do not replace an examination or individual medical advice.

What causes pain on the inside of the knee without injury?

Common causes are early arthritis, pes anserine bursitis or tendinopathy, degenerative meniscus tears and kneecap problems.

How do I know if I tore my MCL or meniscus?

MCL pain is along the inner edge of the knee; meniscus tears cause joint line pain, swelling and catching. An examination helps tell them apart.

Is walking good for inner knee pain?

Walking within comfort is usually fine and helps. Avoid long walks downhill or on uneven ground at first.

Why does the inside of my knee hurt when I bend it?

Meniscus tears, arthritis and kneecap problems often hurt with deep bending or squatting.

Why does the inside of my knee hurt after running?

Pes anserine irritation and patellofemoral pain are common in runners, often after increasing distance too fast.

Should I wear a knee brace?

A hinged brace helps after MCL injuries. For other causes, a brace is optional and exercise matters more.

Sources

  1. NHS · Knee pain
  2. MedlinePlus (NIH) · Knee pain
  3. OrthoInfo (AAOS) · Collateral ligament injuries
  4. OrthoInfo (AAOS) · Meniscus tears

This guide is for general information and does not replace medical advice. How a problem is diagnosed and treated depends on your examination and medical history. If you think you have an emergency, contact your local emergency services.