Knee PainPatellofemoral Syndrome, IT Band & Tendinopathy

Pain on descent rather than ascent is a classic pattern for patellofemoral pain, where the kneecap isn't tracking well under load. Going downstairs increases the load on the quadriceps (the thigh muscles that control the descent) and compresses the kneecap into its groove, which is provocative when the mechanics are off or the cartilage is inflamed. This pattern guides the assessment and helps distinguish patellofemoral pain from a meniscal problem or other issue inside the joint, which tends to behave differently under load.

Not necessarily. Degenerative tears are those found incidentally on MRI and not associated with mechanical symptoms such as locking or catching. They are common findings in imaging of people over 35 who may have no significant symptoms at all. For that presentation, research consistently shows conservative management produces outcomes comparable to APM (arthroscopic partial meniscectomy) at 12 months. Physical therapy alone produces similar outcomes to APM combined with physical therapy. Five-year follow-up data found no sustained benefit from APM and a slightly higher rate of progression to osteoarthritis. Traumatic tears in younger patients from a specific incident have a higher surgical rate, but even then, a trial of conservative care is often reasonable first. I'll assess which category your presentation falls into and give you an honest view of what the evidence says for your situation.

It can be treated, rest alone doesn't address the underlying cause. IT band syndrome is associated with hip abductor weakness and altered running or cycling mechanics, not by the band itself being too tight (it can't be stretched significantly). Treatment focuses on hip strengthening, load management, and correcting the movement pattern that's provoking it. Foam rolling the IT band gives temporary relief but doesn't change the underlying mechanics. I'll assess what's driving it and build a rehabilitation plan accordingly.

Yes, depending on what's persisting. Post-surgical knee pain at 6 months is often related to quad inhibition, altered movement patterns, scar tissue sensitivity, or adjacent joint dysfunction, not necessarily a sign that something went wrong structurally. I'll assess what's contributing and work alongside your surgical team's rehabilitation plan. If you're not already working with a physiotherapist post-surgery, that's typically the right primary referral. If I think something warrants reassessment by your surgeon, I'll tell you directly.

Patellofemoral pain with identified mechanics issues often shows meaningful improvement within weeks to months of consistent rehabilitation when combined with targeted hip and quad strengthening, though individual timelines vary and longer-standing presentations often take more time. IT band syndrome often follows a similar rehabilitation arc when training load is managed alongside hip strengthening, though individual timelines vary. Degenerative meniscal presentations take longer. In my clinical experience, often 8–12 weeks to show consistent change. Post-surgical rehabilitation timelines depend on what was done and how far along healing is. I'll give you a realistic estimate based on your presentation after the first visit. If you have a race or event coming up, that timeline factors directly into how we sequence the rehabilitation plan.