Knee

What It Is

Plica syndrome is a knee condition caused by irritation of a fold in the lining of the knee that is left over from development in the womb. Early in fetal development, the knee is divided into compartments by membranes. These normally shrink away before birth, leaving behind folds of the joint lining (synovial folds) called plicae (Lee et al., 2017). Most people have several of these folds in each knee (Cleveland Clinic, 2021). In certain individuals, the plica tends to be more prominent, which makes it prone to irritation.

Plica syndrome is more common than many people think. Experts estimate that about 10 percent of people develop it at some point, but it often goes undiagnosed because its symptoms are similar to other knee problems (Cleveland Clinic, 2021; Lee et al., 2017).

The plica on the inner (medial) side of the knee is the one most likely to cause problems (Lee et al., 2017; Cleveland Clinic, 2021). It can be irritated by a direct blow, such as hitting the knee on the dashboard in a car accident, or by overusing the joint, and it is common in athletes who run or cycle (Cleveland Clinic, 2021). Whenever the plica becomes inflamed and irritated, plica syndrome develops.

Common symptoms include (Cleveland Clinic, 2021)

Pain at the front and inner side of the knee
A clicking or popping sound when bending or straightening the knee
Pain that gets worse after bending, squatting or climbing stairs
Difficulty sitting for long periods of time

Plica Syndrome Anatomy

The knee is one of the biggest and most complex of all joints found in the body. It joins the shin bone and the thigh bone together. The smaller bone running alongside of the tibia and the kneecap are the two other bones that complete the knee joint. Tendons keep the leg muscles and knee bones connected to enable the knee joint to move. Ligaments join all of the knee bones and deliver stability to the knee.

The anterior cruciate ligament stops the shin bone (tibia) sliding too far forward under the femur (thigh bone), and the posterior cruciate ligament stops it sliding too far backward. The medial and lateral collateral ligaments control side-to-side movement of the knee.

Plica literally means "fold" in Latin. This fold of synovial tissue can become trapped between the femur and the patella (kneecap) (Lee et al., 2017). Pain is most commonly felt on the inside front area of the knee.

Not a diagnosis — for more information, contact me or another trusted healthcare provider.

Treatment

Self-Care & Treatment

How to Treat Plica Syndrome

Exercises to strengthen the thigh muscles (quadriceps) and stretches for tight hamstrings can help take extra stress off the front of the knee (Cleveland Clinic, 2021). I can guide you through these, with hands-on work for the thigh and knee. See the My Approach tab for how I work.

1. Anti-Inflammatory Medication

Cleveland Clinic lists non-steroidal anti-inflammatory drugs (NSAIDs) among the non-surgical treatments for plica syndrome, to help reduce inflammation and discomfort (Cleveland Clinic, 2021). (This medicine information comes from Cleveland Clinic, not from me. Always check with a pharmacist or your family doctor or nurse practitioner before taking any medicine.)

2. Rest or Reduce Activity

Refrain from any activities that are causing you pain or that led to the flare-up (Cleveland Clinic, 2021). Allowing the knee to rest can help to improve upon the current state of the plica syndrome.

3. Therapy

Physiotherapy and osteopathy can help to reduce pain at the front of the knee. I can help with this too, with hands-on work and exercises to improve the movement of your knee and reduce any swelling (see the My Approach tab).

Treatments you may want to discuss with your family doctor or nurse practitioner

Options outside my scope

Steroid injection: an injection of a corticosteroid medicine into the knee to ease the pain (Lee et al., 2017; Cleveland Clinic, 2021).
Surgery (arthroscopic resection): if non-surgical treatment does not help, the plica can be removed or trimmed through keyhole surgery, using a small camera and small instruments inserted through small cuts in the knee (Cleveland Clinic, 2021). It is only done when the plica is clearly the main cause of the problem. A recent review found that both non-surgical care and surgery improve knee function, with no clear advantage of one over the other (Franco et al., 2025).

How I can help (see the My Approach tab)

Thigh strengthening and hamstring stretches

Hands-on work for the thigh, hamstrings and knee

A gradual return to activity and sport

Tips

Plica syndrome is often overlooked, and other knee problems, such as a torn meniscus, can cause similar symptoms, so make sure you have a proper assessment to rule these out (Cleveland Clinic, 2021).
Sports requiring forceful, repeated bending or straightening of the knee increase the risk of plica syndrome.
Suffering repeated injuries to the knee leaves you susceptible to plica syndrome.
If you sit for long periods of time, get up and walk around every hour for five minutes or so to keep the joints moving.
Try applying a cold pack wrapped in a cloth to the affected knee for 15 minutes every three hours to help ease pain and inflammation (Cleveland Clinic, 2021).

Treatment

My Approach

Plica syndrome is irritation of a fold in the lining of the knee, usually on the inner side near the kneecap. The fold gets pinched and irritated as the knee bends and straightens under load, so my aim is to calm it down and take strain off the front of the knee, mainly by building strength in the thigh and easing the tight muscles around it.

I start by assessing your knee's movement and strength, how your hips, knees and feet line up when you squat, step and walk, and how flexible your hamstrings, calves and outer thigh are. I also ask about your sport, cycling or running and what brings the pain on. Other knee problems can feel similar, so if anything points elsewhere, I'll suggest you see your family doctor or nurse practitioner.

While It's Irritated

Keeping pressure off the tender fold on the inside of the knee
Hands-on work for the thigh, hamstrings, calf and outer thigh, and gentle mobilisation of the kneecap
Warm or cool applications in the clinic, and I'll show you how to use a cold pack safely at home
Pain-free thigh tightening, straight-leg raises and side-lying hip work
Cutting back deep squatting, kneeling and stairs for a while, and getting up to move during long spells of sitting

As It Settles

Hamstring, calf and outer thigh stretches
Building thigh strength through mini-squats, step-ups and slow step-downs, then gym-based work such as leg press and split squats, keeping the knee lined up over the middle of the foot
Hip strengthening, so the knee isn't left to take the load alone
Short-term taping if it helps, and I'll show you how to tape it yourself
A gradual return to running, cycling or sport

If your knee locks, gives way or suddenly swells up, see your family doctor or nurse practitioner.

What to Expect

Typical Course

Typical course: Most people come once or twice a week at first, then weekly, with a reassessment at about 4 to 6 weeks, then less often as you manage more on your own. Many people notice a clear improvement within about 6 to 8 weeks of steady exercise, though some take a few months.

What I Focus On

Assessment

Thigh & Hamstring Release

Quadriceps Strength

Hip & Knee Alignment

Gradual Return to Activity

Sources

References

Lee, P.Y.F., Nixion, A., Chandratreya, A. and Murray, J.M. (2017) 'Synovial plica syndrome of the knee: a commonly overlooked cause of anterior knee pain', Surgery Journal, 3(1), pp. e9–e16. doi: 10.1055/s-0037-1598047
Cleveland Clinic (2021) Plica syndrome. Available at: https://my.clevelandclinic.org/health/diseases/21705-plica-syndrome (Accessed: 7 October 2026).
Franco, P., Baumert, P., Di Maria, F. et al. (2025) 'Surgical and conservative management of medial plica syndrome: a systematic review and meta-analysis of functional outcomes', Journal of Experimental Orthopaedics, 12(4), p. e70473. doi: 10.1002/jeo2.70473

Massage therapy · Kitchener–WaterlooPlica Syndrome

What It Is

Plica Syndrome Anatomy

Self-Care & Treatment

How to Treat Plica Syndrome

1. Anti-Inflammatory Medication

2. Rest or Reduce Activity

3. Therapy

Treatments you may want to discuss with your family doctor or nurse practitioner

Tips

My Approach

While It's Irritated

As It Settles

Typical Course

References

Related Conditions

Book a session

Massage therapy · Kitchener–WaterlooPlica Syndrome

What It Is

Plica Syndrome Anatomy

Self-Care & Treatment

How to Treat Plica Syndrome

1. Anti-Inflammatory Medication

2. Rest or Reduce Activity

3. Therapy

Treatments you may want to discuss with your family doctor or nurse practitioner

Tips

My Approach

While It's Irritated

As It Settles

Typical Course

References

Related Conditions

Adolescent Anterior Knee Pain

Anterior Cruciate Ligament (ACL) Injuries

Chondromalacia Patella

Degenerative Joint Disease

Book a session