What Causes Knee Pain in Females? A Physio Explains

Knee pain is one of the most common reasons women visit the physio. As our understanding of women’s health has deepened, so has our grasp of the gender-specific factors that drive it. Despite how common it is, knee pain in women is often brushed off or poorly understood, with the causes usually more complex than a simple overuse injury.

This piece explores some of the most common issues behind knee pain in females, unpacks the warning signs worth paying attention to, and looks at when it’s time to book in with a physio.

Why Females Are More Prone to Certain Types of Knee Pain

There’s a growing body of research exploring the gender imbalance in knee pain, with a range of anatomical and hormonal factors found to play a role.

Firstly, women tend to have a wider Q-angle than men (the angle between the hip and the knee). This can put extra strain on the knee joint, particularly the kneecap, which may cause it to sit or move slightly out of alignment during everyday activities. Over time, this added stress can contribute to ongoing issues if it isn’t managed.

Hormonal fluctuations have also been shown to increase ligament laxity, or looseness. This can mean women are more prone to ligament strain around their period, with some studies even showing female athletes are more susceptible to ACL injuries while menstruating.

Women also tend to activate the muscles around the hip and knee differently to men, and these patterns can place additional load on the knee joint over time.

While these factors can all play a part, it’s worth noting that the root cause of knee pain isn’t always gender-based.

The Most Common Causes of Knee Pain in Females

Here’s a non-exhaustive list of the most common drivers of knee pain we see in women.

Patellofemoral Pain Syndrome (Runner’s Knee)

Patellofemoral pain syndrome, commonly known as runner’s knee, is one of the most frequent knee complaints we see in women. It causes pain around or behind the kneecap, often flaring up on stairs, when squatting, or after sitting for long periods. The wider Q-angle many women have can cause the kneecap to track slightly off-course, creating friction and irritation over time.

IT Band Syndrome

IT band syndrome refers to pain on the outer side of the knee. It’s more common in active women and is often triggered by activities such as running or cycling, caused by tightness in the iliotibial band (the connective tissue running from your hip to your shin) pulling on the knee.

ACL Injuries

The ACL, or anterior cruciate ligament, is one of the key ligaments that stabilises the knee joint, and injuries can range from a partial tear to a complete rupture. Women are 2–8x more likely than men to sustain ACL injuries, largely due to biomechanical and hormonal factors affecting ligament laxity. While the pain is often less acute than expected, ACL injuries are serious and can take months of rehab to recover from.

Osteoarthritis of the Knee

Osteoarthritis is another condition that disproportionately affects women, particularly post-menopause. It causes a gradual wearing down of the cartilage around the knee, leading to stiffness, aching, and swelling. There’s no cure for osteoarthritis, but physiotherapy can play an important role in managing its symptoms and maintaining knee function.

Knee Pain During Pregnancy

Caused by a combination of hormonal fluctuations, weight gain, and altered gait, knee pain is experienced by around 30% of pregnant women. It most commonly presents as an aching or pressure around the front of the knee and can worsen with prolonged standing or climbing stairs. The good news is it’s rarely serious, and pregnancy physiotherapy can help ease symptoms and keep you moving comfortably.

Symptoms Worth Paying Attention To

While some knee discomfort can settle on its own with rest, certain symptoms are worth getting checked out rather than toughing out. If you notice any of the following, it’s worth booking in with a physio:

• Pain that persists beyond a week or two without improving
• Swelling around the knee joint
• A feeling of the knee locking, catching, or giving way
• Pain that worsens with activity or returns every time you exercise
• Discomfort that interrupts your sleep

How Physiotherapy Can Help

Many women see significant improvements in knee pain through ongoing physiotherapy, without needing imaging or surgery. A physio starts with a holistic assessment of your medical history, lifestyle, habits, and specific symptoms — part conversation, part physical assessment.

From there, your physio works to identify the root causes of your knee pain, addresses contributing factors such as hip strength and movement mechanics, and builds a personalised rehabilitation plan around it.

At Physiophi, we don’t just hand over a generic checklist that ends up ignored. We work with you to build a program that fits your lifestyle and goals. Maysam and the team at Physiophi’s Jindalee clinics offer one-on-one care in private rooms, with particular experience treating women’s health and musculoskeletal conditions.