The knee complains loudest on the way down: the steps of Mont Boron, the descent from a hike in the hills above Nice, the stairs of an old-town apartment, or the last kilometres of a long run on the Promenade des Anglais. Pain at the front of the knee, on the outside, behind the kneecap or deep inside after a twist each tells a different story, and most of them respond well to manual therapy combined with the right loading. As an osteopath, I find out which structure is responsible and treat the knee together with the hip, ankle and lower back that load it.
I am Aloïs Ruetsch, an English-speaking osteopath and manual therapist in central Nice, with 15 years of practice and more than 10,000 consultations. If you see a chiropractor or a manual therapist back home, a French osteopath is the closest equivalent.
This article covers runner’s knee, iliotibial band pain, tendon pain, cartilage and arthritis, what osteopathy can and cannot do, and when the knee needs a doctor first.
The essentials
- Pain at the front of the knee on stairs and after sitting is usually runner’s knee; pain on the outside after downhill running or hiking is often the iliotibial band; pain and stiffness in older knees is usually osteoarthritis.
- For most knee pain, strengthening the hip and thigh is the core treatment and manual therapy is a useful add-on that eases pain and restores movement; for arthritis the guidelines say the same.
- Most knee problems need two to four sessions; tendon pain and arthritis are managed over months with spaced sessions and a loading plan.
- Reduce hills and volume for a few weeks rather than stopping, keep the knee moving, and build back gradually with shorter, flatter runs.
- A knee that swells within hours of an injury, locks, gives way, cannot bear weight, or is hot and red with fever needs a doctor. In France, dial 15 or 112 for emergencies.
What causes knee pain?
Most knee pain comes from how the knee is loaded rather than from damage. Pain around or behind the kneecap, worse on stairs, downhill and after sitting in a cinema or on a flight, is patellofemoral pain, better known as runner’s knee, and it usually follows a jump in running volume or hills, weak hip and thigh muscles or a stiff ankle. Pain on the outside of the knee that appears a few kilometres into a run or on a long descent is iliotibial band syndrome, common among hikers coming down from the hills above Nice. Pain just below the kneecap in people who jump, play padel or tennis is patellar tendinopathy.
A twist with the foot planted, on the beach pebbles or the court, can tear the meniscus, the cartilage shock absorber, producing pain on the inside or outside of the joint, swelling over a day or two and sometimes catching or locking. Ligament sprains follow a wrench or a fall, and a knee that swells within hours of an injury and feels unstable needs a doctor. In people over fifty, osteoarthritis causes stiffness, swelling after activity and pain on stairs; a cyst behind the knee often goes with it. The hip and the lower back refer pain to the knee too, which is why I always examine both.
What does an osteopath actually do for knee pain?
I begin by working out which structure is responsible and why it is overloaded. I watch you walk, squat, step down and stand on one leg, test the ligaments, the meniscus, the kneecap and the tendons, check the movement of the hip and ankle and the lower back, and screen for anything that needs a scan or a doctor.
Treatment combines soft-tissue work on the thigh, the iliotibial band region, the calf and the muscles around the kneecap, gentle articulation and mobilisation of the knee joint, the kneecap and the small joint at the top of the fibula, mobilisation of a stiff ankle or hip that is shifting load onto the knee, and muscle energy techniques for the hip and thigh. Where the lower back or pelvis is involved and it is appropriate, I use a short-lever manipulation with your consent. For runner’s knee and tendon pain, the hands-on work settles the pain and frees the movement, and then the loading plan does the long-term job. Every session ends with that plan: what to run, how far, how flat, and how to build back.
Does osteopathy work for knee pain?
For runner’s knee, the strongest evidence is for strengthening the hip and thigh muscles, with manual therapy on the knee, hip and ankle giving useful short-term pain relief and improved movement as an add-on. For iliotibial band pain and patellar tendinopathy, the same picture applies: load management and gradual strengthening heal the problem, and hands-on treatment helps you get there more comfortably. For knee osteoarthritis, the guidelines recommend exercise, weight management and information as the core treatment and suggest manual therapy alongside exercise, which is exactly how I use it.
For meniscus tears in adults over forty, the evidence shows that most do well with exercise and time rather than surgery, and osteopathy fits into that approach, unless the knee is locked. I do not claim that manual therapy changes arthritis or repairs cartilage, and I say so. Osteopaths in France do not make medical diagnoses, and osteopathy complements the care of your doctor; it does not replace it.
How many sessions will I need?
A knee that flared after a hike or a race usually needs two to four sessions of manual therapy over four to six weeks, with the loading plan doing much of the work between visits. Visitors to Nice often come once or twice and continue at home.
Tendon pain follows a slower clock, typically two to three months of gradual loading with sessions every few weeks. Knee osteoarthritis is managed over the long term, with a short course during a flare and then spaced sessions every one to three months alongside daily walking and strength work. If the knee is not behaving as expected, if it swells repeatedly or if it locks, I stop and suggest a medical review and imaging rather than more sessions.
What can I do myself in the meantime?
Reduce the load rather than stopping: shorter, flatter runs on the Promenade instead of the hills, hiking poles and smaller steps on descents, and a pause from jumping sports while a tendon settles. Keep the knee moving, cycling on an easy gear and swimming are usually comfortable, and avoid long periods with the knee bent in one position.
Ice for short periods after activity calms a swollen or irritated knee; heat helps a stiff arthritic one before movement. Check your running shoes if they are old, and build mileage gradually when you return. For arthritis, keeping a healthy weight and strong thigh muscles makes a measurable difference to pain. A pharmacist in Nice can advise on over-the-counter pain relief. Pain that is settling week by week is a good sign; a knee that is swelling, locking or giving way needs another look.
When should you see a doctor instead?
Call for emergency help or go to the emergency department if you cannot put weight on the leg after an injury, if the knee or leg looks deformed, or if you have a hot, red, swollen knee with fever or feel unwell, which may be an infected joint. A painful, swollen, warm calf, especially after a long flight into Nice, can be a blood clot and needs a doctor urgently. In France, dial 15 (SAMU) or 112.
See a doctor the same day for a knee that swelled within a few hours of an injury, which suggests bleeding inside the joint from a ligament or cartilage tear; for a knee that is locked and will not straighten; for a knee that gives way; and for a child or teenager with knee pain and a limp. See a doctor promptly for night pain unrelated to movement, unexplained weight loss, a history of cancer, a sudden very painful swollen joint without injury, which can be gout, or pain that keeps getting worse despite rest. In all of these I refer rather than treat.
Osteopath, chiropractor or physio: who should I see in Nice?
For knee pain without warning signs, an osteopath is a sensible first stop in Nice, and no referral is needed. Osteopaths and chiropractors are very similar hands-on professions; in France the osteopath is the everyday equivalent, with a five-year state-recognised degree, and chiropractors are far fewer. A physiotherapist (kinésithérapeute) works on prescription and is the right person for a supervised strengthening programme after a ligament injury, surgery or for arthritis, and I often work alongside one.
Your médecin généraliste can see you without a referral, arrange an X-ray, ultrasound or MRI, prescribe physiotherapy and refer you to a sports doctor or an orthopaedic surgeon when needed. Pharmacies advise on pain relief and supports, SOS Médecins visits hotels and homes, and 15 or 112 are for emergencies. Osteopathy complements this care; it does not replace it.
How do I see an English-speaking osteopath in Nice?
Message me on WhatsApp at +33 7 71 27 24 25 or book online via Doctolib. My clinic, Pôle Ostéo, is at 22 rue Gounod in the Musicians’ quarter of central Nice, with a lift. A session lasts about 45 minutes and costs €90 at the clinic. I am open seven days a week, often with same-day availability, and I consult in English, Spanish and French.
I also visit hotels, villas, apartments and yachts at berth in Nice and along the nearby Côte d’Azur coast for €120, with no surcharge for evenings, weekends or same-day calls. I take card or cash and give you a receipt for your insurance, in English on request. No referral is needed in France to see an osteopath or manual therapist.
In practice
Illustrative example, details changed. A German hiker on a week’s holiday in Nice developed a sharp pain on the outside of the right knee on the long descent from a walk in the hills, which returned every time she walked downhill or down the stairs of her hotel. The ligaments and meniscus tested normal, the outside of the knee was tender where the iliotibial band crosses it, the hip was weak and the ankle stiff, and there were no warning signs. Two sessions of soft-tissue work on the thigh and hip, mobilisation of the knee, ankle and hip and muscle energy techniques, with hiking poles, shorter steps on descents and a simple hip-strengthening routine to continue at home, let her finish her holiday on the flat coastal paths and go home with a plan.
Frequently asked questions
Is an osteopath the same as a chiropractor?
Can I keep running with runner’s knee?
Do I need an MRI for my knee?
Can osteopathy help knee osteoarthritis?
Why do you treat my hip and ankle for a knee problem?
Book an English-speaking osteopath in Nice
Clinic at 22 rue Gounod (€90) or a visit to your hotel, villa, yacht or home in Nice (€120, no surcharge). Seven days a week, often same day. Write in English, Spanish or French.