Knee pain on the Costa del Sol: causes, diagnosis & physiotherapy treatment

By Flora | Physio Flora — Physiotherapist, Riviera del Sol, Costa del Sol

Reading time: approx. 8-9 minutes

It starts as a niggle on the stairs. Then it's there on the morning walk along the promenade. Before long, it's affecting your golf swing, your padel game, or simply the pleasure of exploring the white villages above Mijas on foot. Knee pain has a way of quietly taking over — and yet it is one of the conditions that responds best to physiotherapy when treated correctly.

Assessment of the knee joint.

Physiotherapy treats most types of knee pain without surgery or medication. Whether your pain came on suddenly during sport, crept up gradually over months, or returned after years of being manageable, understanding the cause is the essential first step — and that is exactly what we do at Physio Flora.

In this guide, you'll find:

• The most common causes of knee pain and how to tell them apart

• How we diagnose the root cause at Physio Flora

• Our physiotherapy treatment options for knee pain

• Three physiotherapist-approved exercises to start today

• Answers to the questions our patients ask most

Common causes of knee pain

The knee is the largest joint in the body and one of the most mechanically complex. It absorbs enormous forces during everyday activity — walking, climbing stairs, standing up from a chair — and exponentially more during sport. Understanding what is causing your pain is fundamental to treating it effectively. Here are the most common presentations we see:

Osteoarthritis is the most frequently diagnosed cause of knee pain in adults over 50, and it is particularly prevalent among the expat community on the Costa del Sol. Often described as "wear and tear," osteoarthritis involves the gradual breakdown of the cartilage that cushions the joint surfaces, leading to pain, stiffness, swelling, and a characteristic grinding or creaking sensation. Morning stiffness that eases after 20–30 minutes of movement is a classic sign. Importantly, the degree of arthritis visible on an X-ray does not always correlate with the level of pain — many people with significant arthritic changes live pain-free, and physiotherapy plays a crucial role in achieving that.

Patellofemoral pain syndrome — commonly known as runner's knee — produces pain at the front of the knee, around or behind the kneecap. It is aggravated by stairs, squatting, kneeling, and prolonged sitting with the knee bent. Despite the name, it affects far more than just runners: cyclists, hikers on the hillside trails above Mijas, and anyone whose training load has recently increased are all susceptible.

Meniscus tears can occur acutely — from a twisting movement during football, padel, or skiing — or develop gradually as part of the ageing process. The menisci are two C-shaped cartilage pads that sit between the thigh bone and shin bone, acting as shock absorbers. A torn meniscus typically causes pain on the inner or outer line of the knee joint, swelling, and sometimes a locking or catching sensation. Physiotherapy is highly effective for many meniscus tears, including those that might otherwise be considered surgical candidates.

IT band syndrome affects the iliotibial band — a thick strip of connective tissue running down the outer thigh to the knee. It produces sharp or burning pain on the outer side of the knee, particularly during running or cycling, and is closely associated with the sloped terrain and cambered paths along the Costa del Sol coastline. It is almost always driven by a combination of training load and hip weakness, both of which physiotherapy addresses directly.

Ligament injuries — most commonly to the anterior cruciate ligament (ACL) or medial collateral ligament (MCL) — can cause significant acute pain, swelling, and instability. These typically occur during contact sport or a sudden change of direction. Physiotherapy is central to recovery whether the treatment path is surgical or conservative.

Bursitis involves inflammation of the bursae — small fluid-filled sacs that cushion the knee joint. Prepatellar bursitis (swelling over the kneecap) and pes anserine bursitis (inner knee, common in osteoarthritis patients) both respond well to physiotherapy and targeted treatment.

Tendinopathy — particularly patellar tendinopathy (pain just below the kneecap) — is common in athletes who perform repetitive jumping, sprinting, or lunging. It is increasingly recognised as a degenerative, load-related condition rather than an inflammatory one, which means the treatment approach is fundamentally different from what was recommended even a decade ago.

How do we diagnose the cause of your knee pain?

Imaging alone — X-rays and MRI scans — does not tell the full story. Structural findings on a scan need to be interpreted in the context of your symptoms, your movement patterns, your history, and your goals. A clinical assessment by an experienced physiotherapist is the most meaningful starting point.

At Physio Flora, your initial appointment includes:

A detailed clinical history — when the pain started, what makes it better or worse, how it affects your daily life and sport, and whether there was a specific triggering event or a gradual onset.

Movement and strength testing — assessing how your knee moves, where in the range pain occurs, how strong the surrounding muscles are, and whether movement patterns in the hip, ankle, and foot are contributing to the problem.

Special orthopaedic tests — hands-on clinical tests that help identify specific structures: the menisci, ligaments, patellofemoral joint, and bursae all have validated tests that give us diagnostic confidence.

Referral for imaging when needed — if your assessment indicates that an X-ray or MRI would provide clinically useful information, we will advise you on where to access this locally. For patients with private health insurance, imaging is often covered. We also work collaboratively with local traumatologists (orthopaedic surgeons) in Marbella, Estepona and Málaga when a second opinion or surgical assessment is warranted.

You do not need a referral or a doctor's letter to book an appointment. We can assess you, begin treatment, and coordinate any further investigations from within the clinic.

Physiotherapy treatment options for knee pain

Treatment at Physio Flora is always tailored to the individual — the diagnosis, the severity, your lifestyle, and your goals. There is no one-size-fits-all approach to the knee. Here are the tools we use:

Manual therapy and joint mobilisation improve the mechanics of the knee joint itself — restoring range of movement, reducing stiffness, and decreasing pain. For osteoarthritis patients in particular, mobilisation techniques can provide significant relief and are safe to perform at any stage.

Quadriceps and hip strengthening is one of the most evidence-based interventions for knee pain of almost any cause. Weakness in the quadriceps and the hip abductors places increased stress on the knee joint and alters the tracking of the kneecap. A structured strengthening programme that targets these muscle groups — progressively and specifically — is central to almost every knee rehabilitation plan we design.

Dry needling and trigger point therapy address muscle tension in the quadriceps, hamstrings, calf, and iliotibial band that contributes to abnormal forces across the knee. Many patients with chronic knee pain carry significant myofascial tension that is a key driver of their symptoms.

Electrotherapy — also known as TENS — can help reduce pain and facilitate tissue healing, particularly in the early stages of bursitis, tendinopathy, and post-surgical recovery. It's often used as a home treatment as TENS machines are, nowadays, easy to buy and operate.

Taping and bracing guidance — kinesiology tape applied around the kneecap is highly effective for patellofemoral pain syndrome and can provide immediate symptom relief. We also advise on off-the-shelf bracing options for ligament instability and osteoarthritis.

Post-surgical rehabilitation is a specialised area of our practice. Whether you have had a knee replacement (total or partial), ACL reconstruction, or meniscus repair, the quality of your physiotherapy rehabilitation is the single biggest determinant of your outcome. We design structured, milestone-based programmes for post-surgical patients and work closely with the operating surgeon's timeline and protocols.

Activity modification and return-to-sport planning — we help you understand what you can and cannot do at each stage of recovery, and build a realistic pathway back to full activity. For golfers, padel players, and runners, this includes sport-specific movement analysis and a progressive return-to-training plan.

Did you know that knee pain is the most common injury for runners?

3 physiotherapist-approved exercises for knee pain

These exercises are appropriate for most types of knee pain and can be started at home. Move within a comfortable range — pushing into significant pain is counterproductive. If your pain is severe or the cause is unknown, book an assessment before beginning any exercise programme.

1. Seated leg extensions (low resistance)

Sit in a firm chair with both feet flat on the floor. Slowly straighten one leg until it is fully extended, hold for 3 seconds, then lower slowly. Keep the movement controlled throughout — particularly on the way down. Complete 3 sets of 12–15 repetitions on each leg. This activates the quadriceps without placing compressive load on the joint, making it safe for most presentations including osteoarthritis.

2. Wall sit (shallow range)

Stand with your back flat against a wall, feet hip-width apart and about 30 cm from the wall. Slowly slide down until your knees are bent at approximately 30–45 degrees — do not go below 90 degrees unless instructed. Hold for 20–30 seconds, then slide back up. Repeat 3–5 times. This builds quadriceps and glute endurance, which directly reduces load through the knee during daily activities.

3. Straight leg raise

Lie on your back with one knee bent (foot flat on the floor) and the other leg straight. Tighten the quadriceps of the straight leg, then raise it to the height of the opposite knee. Hold for 2 seconds, lower slowly. Complete 3 sets of 15 repetitions on each side. This strengthens the quadriceps without bending the knee at all, making it ideal in the early stages of recovery from surgery, meniscus issues, or significant osteoarthritis.

Important: these exercises address the most common contributory factors to knee pain, but they are not a substitute for diagnosis. Some causes of knee pain — acute ligament tears, fractures, infection, or referred pain from the hip — require a different approach entirely. If you are unsure, book an assessment first and we will tell you exactly what is appropriate for you.

Frequently asked questions

Can physiotherapy help with knee osteoarthritis in Spain?

Yes — and the evidence strongly supports it. Exercise therapy and manual physiotherapy are first-line, guideline-recommended treatments for knee osteoarthritis, consistently shown to reduce pain, improve function, and delay the need for surgery. Physiotherapy does not reverse the structural changes of osteoarthritis, but it significantly reduces their impact on your daily life. Many patients who come to us considering knee replacement surgery achieve enough improvement through physiotherapy to postpone or avoid surgery altogether.

How many physiotherapy sessions will I need for knee pain?

This varies with the cause and duration of the problem. Acute presentations such as a recent ligament sprain or post-surgical rehabilitation typically follow structured timelines — we can give you a realistic roadmap at your first appointment. Chronic conditions such as osteoarthritis or tendinopathy often show meaningful improvement within 6–8 sessions, with an ongoing home exercise programme maintaining progress thereafter.

Is there an English-speaking physiotherapist for knee pain near Marbella?

Yes. Physio Flora is based in Riviera del Sol, conveniently located between Fuengirola and Marbella on the Costa del Sol. All consultations, exercise programmes, and follow-up communication are in English, Dutch, German or Spanish. We have extensive experience working with the international community across the Costa del Sol and understand the specific challenges of managing health conditions as an expat in Spain.

Can physiotherapy help me avoid knee surgery?

In many cases, yes. For knee osteoarthritis, meniscus tears, and patellar tendinopathy in particular, physiotherapy is a highly effective alternative to surgery — and it carries none of the surgical risks. The key is committing to the rehabilitation programme fully. Where surgery is genuinely the best option, we will tell you honestly and help you prepare for — and recover from — the procedure.

Do you offer post-knee-replacement rehabilitation on the Costa del Sol?

Yes, this is an important part of our practice. Post-knee-replacement rehabilitation follows a structured, phased protocol and is the single most important factor in determining your final level of function after surgery. We work to the timeline and protocols set by your surgeon, and we provide detailed progress reports for both the surgical team and your insurance provider if required. Many patients travelling to Spain for surgery — or recovering here after surgery performed in the Netherlands, UK or elsewhere — come to us for their rehabilitation.

What is the difference between a physiotherapist and a traumatologist for knee pain?

A traumatologist (orthopaedic surgeon) is a medical specialist who diagnoses and treats musculoskeletal conditions with a focus on whether surgical intervention is needed. A physiotherapist specialises in non-surgical assessment, rehabilitation, and the management of movement and function. For most knee pain, a physiotherapist is the right first step. If surgery is indicated — or needs to be ruled out — we will refer you to a trusted traumatologist locally and work alongside them throughout your care. We have a trusted network of medical specialists in case you need help choosing the right doctor.

Take the first step towards pain-free movement

Knee pain does not have to limit your life on the Costa del Sol. Whether it is stopping you from playing golf, walking the coastal paths, enjoying the steps of your hillside villa, or keeping up with the grandchildren — expert physiotherapy can help, often more quickly than you expect.

At Physio Flora, we combine thorough clinical assessment with evidence-based treatment and a genuine understanding of the active, outdoor lifestyle that brings people to — and keeps people on — the Costa del Sol. We see patients from Riviera del Sol, La Cala de Mijas, Marbella, Fuengirola, Estepona, Benalmádena, Mijas Pueblo, and across the region.

No referral needed. English-language consultations. Appointments available this week.

📞 +34 711 059 592 💬 WhatsApp: +34 711 059 592 📧 hello@physioflora.es 📍 Riviera del Sol, Málaga

Your knees carry you through life — give them the expert care they deserve.

Physio Flora · English-Dutch-German-Spanish-speaking physiotherapy on the Costa del Sol · Specialising in knee rehabilitation, sports injuries, orthopaedic conditions, and post-surgical recovery