Knee Pain Treatment in Midtown NYC

For knee pain on stairs, runs, or squats — or a knee that keeps flaring up.

Hiro Nakano, DC, DACBSP · USA Fencing medical staff · 2021 Tokyo Olympic Games, Team USA volunteer medical staff

How I treat it

Find what’s wrong — and why

A diagnosis from your history and a full exam of your knee, hip, and ankle. Scans often show changes that don’t explain the pain.^[1]^[2] Then why it happened — how your hip, thigh, and foot control the knee, and how training, sitting, and sleep play in.

How I work →

Hands-on care, checked on the spot

Hands-on care is the core of my work, learned in our family’s clinic in Japan, opened in 1926, and the same approach I use with USA Fencing’s national team. I choose the method and pressure from that day’s exam, then recheck how you squat, step down, and walk right after treatment.

My background →

Home exercise that fits your life

You don’t need to come in three times a week. For knee pain, much of the work happens above and below the knee — hip, thigh, calf, and foot — and most of it can be done at home.^[4]^[7] I teach it here, we record it on your phone, and I check and adjust it at each visit.

Your first visit →

The knee pain I see

Most of the knees I see are pain around or behind the kneecap (patellofemoral pain), meniscus tears, early knee arthritis, and irritated tendons from running or jumping. If you need an injection or surgery, I work with you before and after those procedures, too.

With knee pain, the knee is usually where it hurts — but often not where the problem starts. Your hip, your foot, the way you walk, and the way you squat decide how much load lands on the knee. So I always check them, and finding that “why” is the most important part of my care.

Once the pain settles, the local irritation has calmed down. That’s the time to fix the real issue. Strength and good movement patterns are what keep your knees working for decades and help prevent the next injury.

Here is how care usually unfolds.

1. Today’s pain: find what’s wrong — and ease it

Even when the real problem sits outside the knee, an accurate diagnosis of the knee itself comes first. Without it, I can’t understand the mechanism of injury — how your knee actually got hurt. My job is to work that mechanism backward and leave your knee stronger and more stable than it was before the injury. So we need to know which structures may be injured or causing your symptoms, and what needs protecting. I work from a differential diagnosis — a short, ranked list of what’s most likely going on. It comes from your history — how it started, whether you twisted it, whether it swelled — and an exam of how your knee bends, straightens, and holds up under load. When it’s needed, I order X-rays or an MRI directly.

A scan on its own can mislead. Meniscus tears and arthritis changes are common in knees that don’t hurt. So I rarely read a scan finding as “the cause” on its own. Often it is closer to a result — of how your knee has been moving and the load it has been carrying.

What the research shows: in a study of middle-aged and older adults, 61% of those whose MRI showed a meniscus tear had no knee pain, aching, or stiffness in the past month.^[1] A review of MRI studies found arthritis-type changes in 19–43% of pain-free, uninjured knees in adults 40 and over.^[2]

Then hands-on care to ease pain and restore motion — on the knee, and on the hip and ankle when they’re part of the problem — and we recheck how you squat, step down, and walk right after treatment.

What the research shows: people with knee arthritis who had physical therapy, including hands-on treatment and exercise, had less pain and disability at one year than those who had a steroid injection.^[3]

Some knees do need an injection or surgery — a knee that locks, a major ligament injury, or a knee that isn’t improving as expected. When that’s the case, I’ll tell you why and refer you.

2. Why it happened: the part most people skip

“You’re getting older.” “You run too much.” “Your knees cave in.” Those can all be part of it — but they’re rarely the whole answer.

The knee sits between the hip and the ankle, and it often takes the load when one of them isn’t doing its share. So I look at how you stand on one leg, step down, squat, land, and run — and whether your hip, thigh, calf, and foot have the strength and control your activities ask for.

Then your daily life: how quickly your running or training increased, how long you sit, your shoes, the stairs at work. Poor sleep or nutrition can also keep tissue from settling down, no matter how good the exercises are.

Find what is wrong, then why it happened. That’s where my treatment starts.

3. When the pain improves, we check what you can do

Feeling better is meaningful progress. The next question is whether your knee is ready for what you want to do.

At follow-up visits, I reassess both your symptoms and how you move. Can you step down a stair without your knee drifting in? Squat to a chair and stand on one leg? Hop or run without the pain coming back? These observations help me decide what to work on next.

Train around the knee, not just the knee

For most knee pain, the knee is where it hurts — but the hip, thigh, calf, and foot are where much of the fix happens. Strengthening the hip along with the thigh does better than working the knee alone.

What the research shows: for pain around the kneecap, adding hip strengthening to thigh exercises reduced pain more, and the benefit lasted at one year.^[4] In knee arthritis, adding hip exercises to thigh strengthening improved pain, function, and walking.^[5] A 2024 best practice guide for kneecap pain puts exercise and education first, with other treatments chosen after a thorough assessment.^[6]

Movement and strength that protect your knees later

How your knee moves when you land, cut, or step down — and how strong the muscles around it are — matters beyond today’s pain. A knee that drifts inward under load, weak hamstrings, or a big strength gap between your legs can raise the risk of a future injury. I don’t judge you on one test. I look at how these pieces fit your body and your activities, and we train what’s missing.

What the research shows: female athletes who later tore their ACL landed with more inward knee motion and load^[15] and had weaker hamstrings, though not weaker quadriceps.^[16] Inward knee motion on its own, however, was a poor screening test.^[17] Prevention programs built on strength — Nordic hamstrings, lunges, calf raises — and landing control cut ACL injuries roughly in half.^[18] After ACL surgery, more even quadriceps strength between the legs lowered the reinjury rate.^[19] And programs that include the Nordic hamstring exercise halved hamstring injuries.^[20]

A plan that fits your life

New Yorkers are busy, and fitting three clinic visits a week into your schedule is hard. So I give you a realistic amount of rehab, sized to your life, your schedule, and what your knee can handle right now. Some people do a few step-downs on the stairs in their building, or a set of bridges before bed. That still works, as long as you do it.

Taught in the clinic, done at home

I teach each exercise here, we practice it together, and we record it on your phone. Then you do it at home, on your own time. We build from bridges and step-ups to squats, lunges, and single-leg work, then load back step by step toward stairs, hiking, skiing, or running. How your knee responds the next day guides the next step.

What the research shows: home exercise programs work for knee arthritis, with or without clinic sessions.^[7] In one trial, people who had hands-on care with supervised exercise improved faster in the first month, but at one year both groups had improved about equally.^[8] Reviews suggest the best results come from combining the two.^[9]

That’s why I use visits for hands-on care and checking your progress, and let the daily work happen at home.

The goal isn’t just “no pain.” It’s taking the subway stairs, running in Central Park, hiking downhill, and skiing — without thinking about your knee.

4. Staying active: turning rehab into a habit

I also treat rehab as the start of your future exercise routine. Everyone needs regular exercise, and everyone has to make time for it. A sore knee gives you a reason to start — a good opportunity to begin investing in your long-term health. Once we understand how your knee got hurt, we start with easy rehab and build toward strength and power work. That progression is one of the best ways to prevent the next injury.

That’s why I start small. A few minutes a day that fits into your routine is easier to keep than an hour you can’t find. Once it sticks, we build on it.

What the research shows: habits form when you repeat a simple action in the same daily context — like your morning coffee or the stairs in your building. Simpler actions become automatic faster, and missing a day now and then doesn’t undo the progress. On average, it took about two months.^[10]

For many people, knee pain becomes the reason they finally start strength training — and stick with it. Many come in every two to four weeks to treat what needs attention and update the plan. Some finish when they feel good; others have kept it up for years.

What the research shows: people who do muscle-strengthening activities have about a 10–17% lower risk of death from any cause.^[11]

Why not just an injection — or surgery?

Injections and surgery both have a place. The question is which one, for which knee, and when.

What the research shows: two years of repeated steroid injections into arthritic knees led to more cartilage loss than saline injections, with no better pain relief.^[12] For degenerative meniscus tears in people aged 45 to 70, physical therapy did as well as arthroscopic surgery at two years, and again at five years.^[13]^[14]

That doesn’t mean surgery is never the answer. A new sports injury with locking, instability, or a major ligament tear is a different situation. When surgery makes sense, I’ll tell you and refer you — and help you get strong before and after.

Not sure if this fits your situation?

Send me a text and tell me what’s going on. Most questions are easier to answer once we talk.

Book an Initial Visit Text a Question

Common questions

My MRI shows a meniscus tear. Do I need surgery?

Not always. Meniscus tears — especially ones that develop over time — are common in knees that don’t hurt, and for degenerative tears, physical therapy did as well as surgery.^[1]^[13] A knee that locks, gives way, or was injured suddenly may need a surgeon. I’ll tell you which group you’re in, and refer you if surgery makes sense.

Is running bad for my knees?

For most people, running itself isn’t the problem. Knee pain from running usually comes from how quickly the mileage went up, and from how well the hip, thigh, and calf handle the load. Whenever possible, we adjust your running instead of stopping it.

Should I get a cortisone shot?

It can calm a very painful knee for a while, but it doesn’t fix why it hurt, and repeated shots have downsides.^[12] In one trial, physical therapy did better than an injection at one year.^[3] We can talk through whether it makes sense for you.

Do I need to come in several times a week?

No. Most of the work happens at home. Many people come weekly at first, then every two weeks, then less often as the knee gets stronger.

Is it my knee, my hip, or my back?

It can be any of them. Pain from the hip or lower back can show up around the knee, so I check all three at the first visit.

When should I see a doctor right away?

See a doctor promptly or go to the ER if your knee is hot, red, and swollen with a fever, you can’t put weight on it after an injury, it suddenly locks and won’t straighten, or your calf is swollen and painful.

Ready to get back to what matters?

You don’t need to be fit or confident to start. Tell me what’s bothering you and what you want to be able to do again.