Knee Pain? Why Physical Therapy Should Be Your First Stop (Not Imaging or Injections)

brittany5183
1 day ago
3 min read

Knee pain has a way of sneaking into daily life. One day you’re squatting, running, hiking, or playing pickleball without thinking twice—and the next, your knee hurts going up stairs or getting out of the car.

For many people, the first instinct is to seek imaging, injections, or a referral to an orthopedic specialist. But in most cases, physical therapy should be the first step, not the last.

At Nashville Physical Therapy & Performance, we regularly help active adults resolve knee pain without unnecessary imaging, medications, or procedures—by addressing the actual drivers of pain.

Why Knee Pain Is So Common (and So Misunderstood)

The knee sits between two major players: the hip and the ankle. When movement or strength is limited above or below, the knee often takes the hit.

Common contributors to knee pain include:

Hip weakness or poor control
Limited ankle mobility
Quad or hamstring strength imbalances
Training errors (too much, too fast)
Prior injuries that were never fully rehabilitated

Because of this, knee pain is rarely “just a knee problem.”

The Most Common Knee Pain Diagnoses PT Treats

Physical therapists routinely evaluate and treat:

Patellofemoral pain (“runner’s knee”)
Tendinopathies (patellar or quadriceps tendon pain)
Meniscus-related pain (degenerative or non-surgical cases)
Early osteoarthritis
Post-activity knee swelling or stiffness
Pain with squatting, stairs, running, or kneeling

Many of these conditions respond exceptionally well to targeted, progressive rehab, not rest alone.

Do You Really Need Imaging First?

Short answer: usually, no.

Research consistently shows that:

Imaging findings often don’t correlate with pain
Many people without knee pain show “abnormalities” on MRI
Early imaging rarely changes the initial plan of care

In the absence of red flags (significant trauma, locking, infection, or neurological symptoms), clinical evaluation and movement assessment are the recommended first step (AAOS, 2021).

What Physical Therapy Does Differently for Knee Pain

Knee Pain? Why Physical Therapy Should Be Your First Stop (Not Imaging or Injections):

Physical therapy focuses on function, not just structures on a scan.

At Nashville PT, a knee pain evaluation may include:

Strength testing of the hips, quads, and calves
Assessment of ankle and hip mobility
Gait, squat, and movement analysis
Review of training history, footwear, and daily demands

From there, we build a plan that restores capacity—not just reduces symptoms.

Why Rest Alone Often Backfires

While short-term activity modification can help calm symptoms, prolonged rest leads to:

Muscle weakness
Reduced joint tolerance
Increased stiffness
Slower return to activity

Knees need progressive loading to heal properly. The key is knowing how much and when—which is where PT excels.

Physical Therapy vs. “Wait and See”

Waiting it out often turns a manageable issue into a chronic one.

Early PT helps:

Reduce pain faster
Restore confidence in movement
Prevent compensation injuries
Avoid unnecessary injections or procedures

In many cases, starting PT early shortens total recovery time significantly.

Why Cash-Based PT Is Ideal for Knee Pain

Knee pain rarely resolves in rushed, generic sessions.

Our cash-based, one-on-one model allows for:

Full 60-minute visits focused on your movement
No insurance-driven visit caps
Individualized loading progressions
Faster adjustments based on response

This approach is especially effective for knee pain, where precision and progression matter.

When You Should Seek Medical Referral

PTs work collaboratively with physicians and will refer out when appropriate, including:

Significant trauma
True mechanical locking
Suspected infection
Progressive neurological symptoms

Starting with PT does not delay care—it often streamlines it.