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Background\ud Knee pain and related disability are important public health problems worldwide. In a systematic review, the prevalence of knee pain varied between 2.4% to 49.2% worldwide and disabilities were greater in those with knee pain compared to those without. The prevalence of knee pain may be higher in mountainous regions. The research student is from Nepal. He has a clinical interest in musculoskeletal disorders and had found at the time of the thesis that there had been no study undertaken across Nepal. Such a study would inform Nepalese health policy.\ud Objectives\ud To estimate the prevalence of knee pain and knee related disability, overall and in different ecological zones, of one region of Nepal.\ud \ud Methods\ud A cross-sectional multistage cluster survey was undertaken using a questionnaire in Nepali delivered face to face to adults aged over 18 years in seven sites across the three ecological zones (plain, hilly and mountainous) of the Western Development Region of Nepal. Crude weighted and age standardised period and point prevalence rates of knee pain were estimated. The prevalence of disability was compared between those who had knee pain and those who did not have knee pain. Binary logistic regression was used to investigate potential independent risk factors for the prevalence of knee pain and knee pain related disability. \ud Results\ud In total 694 participants were recruited; 52.6% were women, the mean age was 41 years and 14.1% lived in the mountainous zone. The period prevalence of knee pain was 22.3% (95% CI 19.2% - 25.5%) and of chronic knee pain was 12.1% (95% CI 9.5 – 14.7%). The point prevalence was 7.6% (95% CI 5.7%-9.6%). Knee pain was higher in the mountainous zone compared to the plain zone. Overall 25.6% of the 694 participants had disability, as measured by the WHO DAS 2.0, and this was significantly higher in those with knee pain compared to those without (81.2% vs. 9.5%). Disability was highest among those with knee pain in the mountainous zone, with all having disability. Despite this only 54.8% of those with knee pain sought advice for their condition, those in the mountainous zone were less likely to seek advice, access hospital treatment or take oral medications. \ud Conclusion\ud Knee pain is highly prevalent in Nepal. Just under half who suffer do not access services for pain management, even though knee pain is associated with high levels of disability. Rates of knee pain are highest in the mountainous areas where access to services is lowest. This demonstration of unmet need, particularly in the poorest and most remote areas of the country, is of importance to policymakers who should focus on raising awareness and improving access to services.