Medial Knee Pain

Written By: Chloe Wilson, BSc(Hons) Physiotherapy
Reviewed by: KPE Medical Review Board

Find out about the common causes and symptoms of medial knee pain and how to treat inner knee pain

Medial knee pain is a common problem that causes pain on the inner side of the knee.

There are a number of structures on the inner side of the knee and problems in any one of them can cause medial knee pain.

Symptoms of inner knee pain may come on gradually over time or may develop suddenly after a knee injury. There may be a general inner side of knee pain, movement may be restricted or there may be a sharp pain. There may also be some medial knee swelling.

It is very common to get medial knee pain, because any muscle weakness and/or tightness around the knee can subtly change the way the knee moves and how pressure is distributed through the joint.

Here we will look at the common causes and symptoms of medial knee pain, how to work out which one you have and the best treatment options.

What Causes Medial Knee Pain?

The most common causes of inner knee pain are:

  • MCL Sprain/Tear: Overstretching of the inner knee ligament
  • Meniscus Tear: damage to the cartilage lining the knee
  • Pes Anserine Bursitis: inflammation on the inner side of the knee
  • Knee Arthritis: Wear and tear of the bones and cartilage
  • Plica Syndrome: inflammation of the synovial lining
  • Bone Spurs: Excess growths of bone that stick out
  • Hamstring Tendonitis: Inflammation of hamstring tendon

Each of these causes of medial knee pain will present slightly differently and will require specific treatment. The symptoms of each will vary depending on what is wrong and on the severity of the injury. If there is pain on inside of knee but no swelling, it is likely only a minor injury that will likely settle down quickly, but if there is significant swelling, there is something more serious going on.

Here we'll look at each cause of inner knee pain, how they present, what causes them and how to treat them.

1. MCL Tear

Medial knee pain is often the result of an MCL tear

An MCL tear is the most common cause of medial knee pain in people under the age of 50.

With an MCL tear, there is damage to some or all of the fibers of the medial collateral ligament on the inner side of the knee.

MCL tears are one of the most common medial knee injuries in sports, usually from either a force through the outer side of the knee or twisting the knee while the foot is fixed to the ground e.g. with cleats.

Typical symptoms of an MCL tear include:

  • Medial Knee Pain: particularly when bending the knee, walking, going up and down stairs or playing sports
  • Swelling: bruising and tenderness over the injured ligament
  • Knee Instability: the knee may feel like it is going to give way, particularly with twisting movements
  • Knee Stiffness: knee movement may be limited

There are three grades of MCL tear, depending on how severely you have damaged the ligament and treatment usually involves a combination of PRICE, knee brace, exercises and physical therapy.

You can find out loads more about the causes, symptoms and treatment options for this cause of medial knee pain in the MCL Tear section.

2. Medial Meniscus Tear

A cartilage tear is a common cause of medial knee pain.

Another common cause of medial knee pain is a tear in the thick cartilage that lines the inner side of the knee joint, known as the meniscus.

Typical features of a medial meniscus tear include inner knee pain, swelling, locking (where the knee gets stuck), instability and difficulty straightening the leg.

Symptoms typically get worse with walking, running, squatting and on stairs, especially going up. Meniscus tears may develop:

  • Suddenly: usually from awkward twisting or a force through the knee
  • Gradually: over a period of weeks or month due to wear and tear in the knee

Treatment for an MCL medial knee injury usually consists of rest, ice, compression, elevation, strengthening and stretching exercises and physical therapy. If the ligament tears completely, then surgery may be necessary to repair the damage.

If you want to know more about the common causes, treatment option and recovery process for this common cause of inner knee pain, visit the Meniscus Tears section.

3. Pes Anserine Bursitis

Pes Anserine Bursitis is one of the less common causes of medial knee pain

Inflammation of the pes anserine bursa, a small fluid-filled sac the reduces friction, can also cause inner knee pain.

In most cases of pes anserine bursitis, there is a gradual onset of medial knee pain, around 2-3 inches below the knee joint, swelling, stiffness, weakness and sleep may be affected. 

Inner knee pain from pes anserine bursitis usually gets worse with resisted knee flexion and exercise, as well as when climbing stairs. It most commonly affects overweight middle aged women or runners and swimmers.

Treatment usually involves a combination of rest, ice, stretching and strengthening exercises to reduce the medial knee pain and regain stability at the knee. In some cases, your doctor may advise corticosteroid injections or even surgery. 

You can find out loads more about the causes, symptoms and treatment options for this cause of medial knee pain in the Pes Anserine Bursitis section.

4. Knee Arthritis

Osteoarthritis most commonly affects the inner side of the knee joint causing medial knee pain.

Wear and tear in the cartilage lining the medial side of the joint from knee arthritis is the most common cause of medial knee pain in the over 50's.

Arthritis is more prevalent in the inner side of the knee, rather than the outer side due to the angles at the hip, knee and ankle.

Symptoms of medial knee arthritis typically develop gradually and include morning stiffness, inner knee pain, swelling, clicking/grinding and knee stiffness. Medial knee pain from arthritis tends to be worse after prolonged rest and in cold weather.

There are three classification stages of arthritis, mild, moderate and severe based on how badly the joint is affected. Knee arthritis treatment will depend on the severity of the symptoms but typically includes exercises, medication, heat/ice, acupuncture, injections and knee braces.

Find out everything you need to know about arthritis, including causes, stages, treatment and surgical options in the dedicated Knee Arthritis section.

5. Medial Plica Syndrome

Medial Plica Syndrome causes inner knee pain. Find out about the common causes, symptoms and treatment of medial knee pain

One of the more unusual causes of medial knee pain is inflammation of a fold in the synovial membrane (plica) on the inner side of the knee. 

With medial plica syndrome there tends to be anterior and medial knee pain and tenderness, and some people notice an audible clicking sound when they move their knee. 

Inner knee pain due to inflamed plica usually gets worse with repetitive knee movements, squatting, on stairs and when getting up after you've been sitting or lying down for a while.

A combination of knee exercises, anti-inflammatory medication, rest and ice is usually sufficient to reduce the medial knee pain and inflammation, but in severe cases, surgery may be necessary to remove the injured plica. 

You can find out more about Plica Syndrome including common causes, symptoms and treatment options.

6. Knee Bone Spurs

A common cause of medial knee pain in people over the age of 60 is knee bone spurs. 

Bone spurs are extra outgrowths of bone that form lumps, typically towards the inner edge of the knee bones. Irritation from repetitive wear and tear and cartilage causes the body to lay down excess bone to try and prevent the joint from further damage.

Knee bone spurs may not cause any symptoms initially but as they increase in size and project into the joint they can cause irritation and friction leading to medial knee pain and stiffness.

Bone spurs can occur anywhere in the knee but are particularly prevalent on the inner side of the joint due to more pressure going through the medial knee.

You can find out all about the common causes, symptoms, diagnosis and treatment options for this cause of medial knee pain in the bone spurs in knee section.

7. Hamstring Tendonitis

Medial knee pain that is at the back of the knee may be due to hamstring tendonitis.

Hamstring tendonitis is an overuse injury which causes inflammation and irritation of one of the two hamstring tendons on the inner side of the knee: 

  • Semitendinosus Tendonitis: inner posterior knee pain
  • Semimembranosus Tendonitis: inner posterior knee pain, slightly lower down and more central

Hamstring tendonitis usually affects atheletes and runners where repetitive stress is frequently placed through then tendon e.g. jumping, kicking, running and cycling.

You can find out all about this cause of posterior medial knee pain including the causes, symptoms, diagnosis and treatment options in the hamstring tendonitis section.

What Is Causing My Inner Knee Pain?

Let's have a look at the common symptoms associated with medial knee pain and what they typically indicate:

Pain On Inside Of Knee No Swelling: If you have inner knee pain but no swelling, it is likely only a minor injury such as a small cartilage tear, small bone spurs or a grade 1 MCL sprain.

Inner Knee Pain Running: Knee pain medial side during or after running is most typically caused by a cartilage tear, hamstring tendonitis or Runners Knee.

Inner Knee Pain When Straightening Leg: Pes Anserine Bursitis is the main culprit here as the bursa can easily get squashed when straightening the knee.

Medial Knee Pain With Flexion: Most medial knee pain gets worse with knee flexion, especially when weight bearing through the leg. If it's worse when standing, it may indicate an MCL tear, bone spurs or meniscus tear. If it happens when you are sitting or bending the knee, it may be pes anserine bursitis or plica syndrome.

Anterior Medial Knee Pain: If your inner knee pain is coming round to the front of the knee, it may actually be a problem with the knee cap or Runners Knee rather than one of the structures on the inner knee.

Medial Knee Pain When Sitting Cross Legged: Pain in the inner side of knee when sitting cross legged is most likely due to a meniscus tear as this position places extra stress on the cartilage.

Medial Knee Pain After Sitting or Lying: Inner knee pain that is at its worse when you first move the knee after sitting or lying down for a while tends to be due to knee arthritis. The pain usually eases once you are up and about. In younger patients, it is more likely to be due to Plica Syndrome.

Medial Knee Injuries: The most common medial knee injuries are MCL tears and medial meniscus tears, which often both happen at the same time as a result of awkward twisting or sporting injuries.

Why Is Medial Knee Pain So Common?

Medial knee injuries are really common because muscle weakness and/or tightness, which is very common, can subtly change the way the knee moves.

This causes more force to go through the inner side of the joint, rather than distributing weight evenly through the whole joint, which results in damage to the inner side of the knee and therefore results in medial knee pain. For example, it is much more common to get osteoarthritis on the inner side of the knee than the outer side.

Medial knee pain may be associated with some knee swelling. If there is pain on inside of knee but no swelling, it is likely only a minor injury that should settle down soon. If there is more significant inner knee swelling, it often indicates a more severe injury that may take longer to recover from.

Want to Know More?

If there is swelling or inflammation alongside your medial knee pain, check out the Swelling On Side Of Knee article.

Just because there is inner knee pain, doesn’t necessarily mean the problem is on the inner side of the joint. Pain can refer from different places such as the knee cap or even the lower back.

If your inside knee pain doesn’t sound quite like any of these problems, visit the Common Causes of Knee Pain section to find out about the most common knee problems.

You might also be interested in the following articles:

Alternatively, if would like some guidance with working out what is causing your problem, visit the knee pain diagnosis chart for help.

Remember, you should always see a doctor with any new onset of pain. To find out more about these common causes of medial knee pain, choose from the links above.

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References

1. Journal of Orthopedics. Medial collateral ligament injuries. August 2017

2. The Surgery Journal. Synovial Plica Syndrome of the Knee: A Commonly Overlooked Cause of Anterior Knee Pain. February 2017

3. Arthritis Research & Therapy Journal. Functional electrical stimulation of gluteus medius reduces the medial joint reaction force of the knee during level walking. November 2016

4. Muscles, Ligaments and Tendons Journal. Meniscus tear surgery and meniscus replacement. May 2016

Page Last Updated: 11/06/24
Next Review Due: 11/06/26