Causes and Treatments for Bilateral Knee Pain

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There are many different things that can cause bilateral knee pain, which is when both of your knees hurt at the same time. While some of these conditions are quite common and can be easily managed, others are rarer and may require significant medical intervention. Taking a closer look at your symptoms can help you identify and treat the pain.

Potential Causes of Bilateral Knee Pain

Verywell / Jessica Olah

Common Causes


Knee osteoarthritis is the most common form of osteoarthritis. At the end of your body's bones is a smooth coating called cartilage which helps bones easily move on one another when they meet at a joint. In people with osteoarthritis, this cartilage tissue gets thinner and rougher which impacts the knee's ability to move properly.

Commonly thought of as "wear and tear," knee osteoarthritis can cause pain that increases with activity and improves when you sit or lie down. Stiffness in your knees is also common, particularly when you wake up. You may also notice swelling in the joints and "creaking and cracking" when you move your knees.

There is no cure for knee osteoarthritis, but medication, nondrug methods, and assistive devices can help to ease the pain. As a last resort, a damaged joint can be surgically replaced with a metal, plastic, or ceramic one. 

Obesity and Osteoarthritis

Obesity is a major risk factor for osteoarthritis. While the extra weight certainly can contribute to developing osteoarthritis, recent studies have shown that leptin is a possible link between obesity and osteoarthritis. Leptin is produced by adipose (fat) cells. The level of its production is thus in proportion to body fat. When body fat levels increase, so do levels of leptin, which can put you at a greater risk of osteoarthritis.


One of the more serious causes of pain in both knees is trauma to your legs. When this occurs, one or more of the bones that make up your knee joint (the tibia, the fibula, and the patella) are subjected to a high energy force that causes a fracture. If both knees are affected simultaneously, this is usually the result of a motor vehicle accident or a fall from a high surface.

Traumatic injuries to the knee occur abruptly and are usually accompanied by significant pain and later by large amounts of bruising. Often times, these injuries can make it difficult to bend or straighten your knees. You may also be left unable to bear weight through your legs because of either pain or instability. This type of condition requires immediate medical attention and may need surgical intervention.

Patellofemoral Pain Syndrome

Another frequently seen cause of bilateral knee pain is patellofemoral pain syndrome (PFPS). This condition, which is actually more of a catch-all term, refers to pain in the front of the knee that typically worsens with squatting or bending the knees while standing. Other activities like going downstairs or sitting may also increase your soreness.

While the symptoms of PFPS can be similar to those of osteoarthritis, this condition is usually seen in adolescents and in people under the age of 60. In addition, the syndrome does not show up on x-rays which helps differentiate it from arthritis. Typically, the pain associated with PFPS is well managed with rest, over-the-counter pain medication, and physical therapy that focuses on increasing the strength in your leg and core muscles.

Torn Meniscus

The meniscus is a band of cartilage attached to your shinbone (tibia) that helps spread and absorb the forces placed on your knee joint. While many meniscal tears occur traumatically when a knee is twisted on a planted leg, other types occur more gradually. This slower-paced onset is more common if your menisci are to blame for your bilateral knee pain.

As you age, the meniscus loses its pliability and can begin to fray and tear. This degenerative tearing can lead to pain along the inside or outside the joint line of the knee. The soreness is typically prevalent when you perform repetitive tasks like squatting, stair climbing, or walking.

In addition, bilateral meniscal tears can make it difficult to fully extend or straighten your knees and may also cause swelling. While many non-traumatic meniscal tears are successfully treated with physical therapy and strengthening, more significant ones may require surgery to remove the damaged section.

IT Band Syndrome

Illiotibial (IT) band syndrome may be the cause of the pain in your joints if your soreness is isolated to the outside of both knees. The IT band is a thick strip of tissue that runs from the hip to the knee along the outside of your leg. In IT band syndrome, this band is thought to cause pain by repeatedly rubbing or compressing against the bone or soft tissue on the outside of the knee.

This syndrome is an overuse condition and is primarily seen in endurance runners or cyclists who repeatedly bend and strengthen their knees while performing their sport. It is usually treated by temporarily resting from the aggravating activity and by modifying your footwear or cycling position. More severe cases may require formal physical therapy to modify your running or cycling technique or a cortisone injection.

Pes Anserine Bursitis

Another common overuse syndrome that can lead to bilateral knee pain is pes anserine bursitis. This condition occurs when a bursa (a fluid-filled sac that reduces friction between a muscle and a bone) on the inside of your knee becomes inflamed from repetitive friction in the area.

Pes anserine bursitis is also usually seen in bikers or runners and causes tenderness about two to three inches below the inside of your knee joints. It may also cause stair climbing and exercising to be quite painful. Treatment typically involves rest, ice, anti-inflammatory pain medication, and occasionally physical therapy, or a pain-relieving injection into the bursa.

Osgood-Schlatter Disease

Osgood-Schlatter disease is a common issue that can lead to pain in both knee joints. It is usually seen in kids who are entering puberty and is caused by the repeated pulling of the patellar tendon on a boney prominence under the knee cap called the tibial tubercle. Typically, Osgood-Schlatter disease causes pinpoint soreness over this bone bump below the knee and can make things like running, jumping, and squatting quite painful for kids. Symptoms are usually managed with physical therapy and pain medication, however, the syndrome usually goes away on its own as the child leaves puberty and enters skeletal maturity.

Rare Causes

Knee Dislocation

In uncommon instances, one of the three knee bones can dislocate or move out of place. While some people with extremely lax tendons or ligaments may experience this issue, if both knees are simultaneously affected it is most commonly caused by a traumatic fall, car accident, or sports injury.

A knee dislocation typically causes significant pain and swelling. Individuals who experience this type of injury are usually unable to bear weight or move their legs normally. Because a dislocation can also cause nerve damage or tearing in the leg's blood vessels, it is considered a medical emergency and immediate care should be sought.


Infrequently, gout can also cause bilateral knee pain. This inflammatory condition occurs when high levels of a substance called uric acid cause crystals to develop in the body's joints and tissues. This buildup of crystals causes intense pain, warmth, redness, and swelling to develop. While gout typically affects the big toe joint, it can also infrequently impact your knees.

Gout flare-ups can last for several days or even weeks. The pain is usually managed with over-the-counter or prescription pain medication. In the long term, changes to your diet or uric-acid managing medication can also prevent future gout attacks.


While many of the conditions listed above can be well managed, some knee pain may remain in spite of the treatments suggested. One of the best ways to cope with the remaining symptoms is to stay active. Keeping your legs moving and your muscles strong will help decrease the forces placed on your knees. In addition, maintaining a healthy body weight can significantly reduce the amount of stress that your joints are subjected to. This is another important factor in helping you deal with your pain.

A Word From Verywell

If the bilateral knee pain you are experiencing occurs after a traumatic event or if your symptoms are worsening, it is important to seek the care of a physician. Not only will a doctor help diagnose the cause of your pain, but they'll be able to determine which treatment is right for you.

Frequently Asked Questions

  • Which pain reliever is best for knee pain?

    For common osteoarthritis pain, try weight loss and exercise to relieve chronic pain. For intermittent pain, topical nonsteroidal anti-inflammatory drugs (NSAIDs) are usually recommended. As far as oral medication, NSAIDs such as Advil, Motrin, and Aleve are usually the most effective. These drugs are not appropriate for everyone, so discuss the pros and cons with your healthcare provider. 

  • How can I manage nighttime knee pain?

    Experts often recommend that you use pillows to ease pressure on the knees when lying down. If you sleep on your back, try a pillow or two under the knees. If you sleep on your side, try placing a pillow or two between the knees.

  • Can you get both knees replaced at the same time?

    Yes. Replacing both knees in one procedure is known as a bilateral total knee replacement. Some research shows that doing both knees at once has advantages since it requires only one surgery. In certain studies, there was less pain and a quicker recovery for bilateral knee replacements compared to separate surgeries for each knee, but other studies contradict those findings. It’s best to discuss with your healthcare provider whether this type of surgery is right for you.

13 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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By Tim Petrie, DPT, OCS
Tim Petrie, DPT, OCS, is a board-certified orthopedic specialist who has practiced as a physical therapist for more than a decade.