Where knee pain comes from
Osteoarthritis is the most common cause after middle age: cartilage thins, the joint surfaces take more load, and the knee becomes stiff in the morning, achy after activity and difficult on stairs. It is not simply “wear and tear” and it is not uniformly progressive — plenty of arthritic knees stay stable for years with the right loading.
Patellofemoral pain — pain at the front of the knee, around or behind the kneecap. Worse going downstairs, worse after long periods sitting. Frequently driven by how the kneecap is being pulled, which is a quadriceps and hip problem as much as a knee problem.
Meniscal and ligament injury, including old injuries that never fully settled, producing catching, locking or a sense of instability.
Tendon problems — patellar tendinopathy at the front, pes anserine or iliotibial band issues at the sides, each with its own tender point and its own aggravating activity.
Referred pain from the hip, which is common enough to be worth ruling out in every knee.
The appointment
An examination that includes the hip and the way you walk, not just the knee. Palpation to locate the tender structure precisely. Ligament and meniscal testing. An assessment of quadriceps and gluteal strength, because weakness there loads the knee in ways that no injection will compensate for.
Then a clear statement of what is thought to be causing the pain, and what can be done about it.
Non-surgical options
Joint injections to settle inflammation in an irritated joint. Useful in their own right and useful diagnostically — a knee that responds tells you something a scan cannot.
PRP where the aim is to support repair rather than only suppress inflammation. Best suited to mild and moderate osteoarthritis and to certain tendon problems; less effective in severe, bone-on-bone disease, and you will be told which yours is.
Trigger point injections where the surrounding musculature has become part of the problem.
Rehabilitation, which is where the durable improvement comes from. Strength in the quadriceps and the hip changes the load the knee carries with every step, and that is the variable most under your control.
The honest framing
Injections buy time and comfort. What decides how the next five years go is usually strength, load and weight, and any practice that tells you otherwise is selling injections. Dr. D’Alessio is board-certified in Physical Medicine & Rehabilitation — a specialty whose entire premise is restoring function — and the treatment plan will reflect that.