The 2026 Guide to Natural Relief for Knee Pain and Arthritis
The 2026 Guide for Natural Relief for Knee Pain and Arthritis
Chances are if you are reading this, either you or a loved one is suffering from knee pain including pain from arthritis, bone-on-bone knees, runners knee, or pickleball knee.
If you have knee pain, stiffness, or aches, it's very tempting to think that it will go away on its own. You might want to pass it off as having just "stepped awkwardly," or tell yourself it's just a little pain that everyone your age suffers from.
There's no obvious reason why it happened—but it doesn't seem to be going away!
If that's happening to you, you're not alone: we hear this type of thing all the time. In fact, knee pain and arthritis are one of the most common problems that we see at Body Mechanix Physiotherapy and Fitness
And when it comes to living with knee pain, everybody we see wants to know:
"Why is this happening to me"
or
"Why am I still Suffering from Knee Pain after
Putting up with it for 6 months(or more)"
Most people hope that they will wake up one morning and their knee pain will disappear "like magic" just like it never happened...but it doesn't and the longer people wait, the worse their suffering becomes
Sound like you?
Another thing we commonly see all the time is that the Doctor told them to rest for at least 6 weeks, "try these painkillers" and "see how it goes". But, this is rarely the best advice. More often, after 6 weeks of resting, they go back to their doctor, no better, and need more and stronger painkillers(or worse) just to get through the day.
Maybe you think your knee pain was caused by doing something—like lifting or stepping wrong—but it was ACTUALLY caused by decades of poor posture, which caused your core muscles and knee stabilizers to weaken. The lifting or the awkward step could be a SIDE EFFECT of that! Do you want your doctor treating the effects, or do you want to get to the root CAUSE of your problem so you can PREVENT it from happening again and again? If you are currently living with Knee Pain, here are
7 Reasons why Knee Pain lasts Longer than it Should
1. You thought the pain would go away on its own, but it doesn't
2. You went to the doctor, who prescribed you some painkillers and told you to rest, but the pills just masked the problem and once they wore off, the chronic pain returned.
3. A friend or relative told you that everybody gets knee pain when they get older, so you just accepted it.
4. You've tried other providers including chiropractors and other physical therapists but the pain kept coming back and nothing worked.
5. You tried exercises you saw on YouTube but they only made things worse.
6. You tried resting but your knee only got stiffer and weaker.
7. You got a few massages that felt good but didn't do anything to fix the issue long term.
It can be impossible to find a comfortable position to sit, stand, or sleep let alone try to make it through the day.
It often feels like it will never go away(at least that’s how I felt when dealing with it). Though each morning you wake up hoping that today will be different.
There are so, so many voices giving advice, often contradicting each other.
Is it posture? Is something out of place? Where’s the best place to take care of the issue? Do I need imaging? What’s really going on?
Hopefully this guide will help you start to figure out the right answer for you.
In addition to this guide, we are publishing 4 articles in our series, use these links to learn more about:
Dry Needling for Natural Relief of Joint Aches and Stiffness due to Bone-on-Bone knees and arthritis
Reproduction ethos: Feel free to share this E-Book with family, friends, enemies, or all three. It would be less cool to copy it and pass it off as your own.
I make every effort to ensure that we accurately represent the injury advice and prognosis displayed throughout this book. However, examples of injuries and their prognosis are based on typical representations of those injuries that I commonly see in my physiotherapy clinic. The information given is not intended as representations of every individual’s potential injury. As with any injury, each person’s symptoms can vary widely and each person’s recovery from injury can also vary depending upon background, genetics, previous medical history, application of exercises, posture, motivation to follow your physio’s advice and various other physical factors. It is impossible to give a 100% complete accurate diagnosis and prognosis without a thorough physical examination and likewise the advice given for management of an injury cannot be deemed fully accurate in the absence of this examination from me as a Doctor of Physical Therapy at Body Mechanics Physiotherapy and Fitness, LLC. Significant injury risk is possible if you do not follow due diligence and seek suitable professional advice about your injury. No guarantees of specific results are expressly made or implied in this e-book and no treatment relationship is implied by this book.
When Knee Pain Might Be an Emergency
I want to start this book off with who this book is not for. The following are examples, though not exhaustive, of when you should not wait for a consult with a Physio or Physical Therapist but should rather seek urgent medical care.
If you have developed numbness or tingling to the area around your bottom and genitals to your inner thighs especially when it started with the onset of your pain.
If you have started developing an inability to control your bowel or bladder(either starting or stopping/controlling).
Significant weakness to your legs including but not limited to your foot dropping or hitting the floor in an uncontrolled way when you are trying to walk. Also if you notice a growing clumsiness to your legs or walking or are having loss of balance associated with your onset of pain.
If you’re unable to place weight on your leg especially after a traumatic event to your knee.
If you have a past history of cancer and are experiencing weight loss or weight gain that you can not explain.
If you are experiencing a fever along with your onset of knee pain.
If you are experiencing any of those, please don’t continue reading. Once you have the all clear from your Physician, then read on. This guide is not intended as medical advice or physical therapy. It is meant for educational purposes only. Please seek qualified medical advice if unsure.
This guide’s goal is to help you understand not only what’s going on when you’re dealing with knee pain, arthritis, bone-on-bone knees, runner’s and pickleball knee along with patellofemoral pain syndrome, jumpers knee and more… but also to be empowered in making decisions to find the relief you’re looking for.
The Purpose of Pain is Protection: Understanding Knee Pain
The question most everybody really wants to know is “Why am I in pain?”. Before about 2000, our understanding of pain was very different than it is today. We used to think that pain is all about damage. And, the more the pain, the more damage you had. This was often supported by imaging, especially MRIs where they could “see why you hurt”.
But soon doctors and researchers started noticing something. Bone spurs, arthritis, patella alta(high kneecaps), and bone-on-bone knees were found in people with absolutely no pain. What’s more, the older you got, the more likely you were to have these findings.
This doesn’t mean that older people don’t get knee pain, it just means that age does not matter as much as what we once thought. .
So, if knee pain isn’t just about being bone-on-bone and arthritis, what is it about?
Your body has a living alarm system called your nervous system. While some parts of your nervous system focus on movement, some parts focus on seeing or hearing things, one part focuses on keeping you safe. Its job is to notice anything that seems dangerous and let the rest of you know about it.
While their fancy name is a nociceptor, I prefer to call it our “danger detector”. This danger detector wakes up when it is stretched, pressured, or has something happen really close to it. This can come from actual damage(think stepping on a nail or spraining your ankle), moving awkwardly and pulling a muscle, or from inflammation(which comes from your immune system).
This lets the rest of your nervous system know that something dangerous might have just happened. What it doesn’t do is let you know that the body part is in pain…just possibly in danger. Our alarm system can also get tricked that there’s a threat(more on that in a bit)
The rest of our nervous system including our spinal cord and brain now have to figure out just how dangerous the alarm is. To do this, it figures out if pain actually helps you. For example, if you are walking across Thomasville Rd and you sprain your ankle…and there’s somebody driving right at you(texting) your nervous system says that the car is the bigger danger and actually shuts down the ankles danger signal so you can run and get out of the way(then it allows you to feel pain once the threat is gone).
There’s a lot of cool neuroscience going on with this. Long story short, your brain and spinal cord have ways of shutting down the message about the ankle(or any other part of your body that’s in danger) if there’s a greater danger.
For somebody dealing with chronic knee pain, the brain and spinal cord can also amplify the signal coming in because they are convinced that the knee really needs protecting. This spinal amplifier makes it so that even small movements become excruciating because it creates a protective bubble around your knee to keep you from getting anywhere close to damage.
In fact, pain’s job is to keep you from getting to damage. It acts like a fence along the edge of a cliff. Usually this fence is right along the edge. With chronic pain, the fence moves back 20-30 feet or more so you are nowhere close to danger(but it still hurts).
What’s more, several things can either move the fence closer or further away from the “cliff” meaning some days your pain is aggravated by 30 minutes of walking while other days you just can’t get comfortable even with just a few minutes.
Why? Your alarm system and danger detectors have several sensors on them to let them “know about the world around them”. These sensors get triggered by several things. You have sensors for temperature change, stress chemicals, immune system activation(like when you’re sick), pressure, and blood flow.
This is why:
Cold fronts flare your knee pain
Stress makes it worse
Sitting for too long makes it worse and makes it harder to get out of a chair.
If you get sick, everything seems to hurt or if you have an auto-immune condition your symptoms seem to flare when it does.
But, when my patients tell me that their pain changes from day to day, hour to hour, or even from minute to minute, I can confidently say that the changeability of their pain is the best thing they could have told me.
Why?
Because the past 25 years of research into pain show that your MRI doesn’t look different on a good day as compared to a bad day. Your X-ray doesn’t look different on a good day as compared to a bad day. What changes is how protective your alarm system is that day.
One example. Think about what would happen if you stepped on a nail. You’d have this piercing pain which would make you stop, pull the nail out, and take care of it, right? Your alarm system doesn’t immediately go back to normal. It stays extra-protective for days just to make sure you don’t go stepping on any more nails or do anything dangerous with your feet. But…it eventually calms down.
And for many people with knee pain, their knee does the same thing. They step wrong, maybe put too many miles on a run or play too many matches of pickleball, the knee flares but it calms back down.
But
The truth is that for a lot of people, their alarm system never calms down(for lots of different reasons).
It isn’t their fault
Many were told to
“Take 6 weeks off and rest their knee”
“Take some medications or steroids and if it hasn’t gone away we’ll talk about surgery”
“That they have to “fail” physical therapy before they can get an MRI”
“They’ve got “bad posture” or a “weak core””
Unfortunately, if we just rest or take time away from exercising, we just come back weaker and able to do less and less
If we just take medications, we’re just putting a band-aid on it.
If the doctor tells you that you have to fail therapy in order to get what they think is the right answer…you were set up to fail.
Posture experts can’t even agree on what the right posture is and the core feels weak because of the pain(see the myths section).
Understanding Imaging
If you look up issues surrounding your knee on Dr. Google or Chat, you may notice that the results that jump to the top of the search are usually the worst case scenarios full of scary images of cartilage with holes in it, angry red inflammation etc…
What you also may notice is an abundance of information telling you how fragile your knee is and how you need protection from life if you want to be able to do something as simple as walk.
The simple truth is that the knee is remarkably strong, even when you are in pain. Ever rolled your ankle or skinned your knee? It heals, right? One of the things we understand about the knee is that it can heal too. While some areas heal more quickly than others, many find that they feel great long before the X-ray improves(if it improves at all).
So, a little bit about how you are built. Your knee has 3 “compartments” along with several supporting ligaments backed up by strong muscles and tendons.
The main thing we think of as our knee is the hinge joint between the thigh bone and shin bone(your femur and tibia). On the ends of these bones is thick cartilage along with structures of padding called the meniscus.
When we walk, run, or exercise, the movement of our joint causes it to produce something called lubricin which basically coats the joints with a slick layer of lubrication(which is why sitting for too long or not moving often stiffens up the joints).
The other joint of our knee is called the patellofemoral joint or the groove that our kneecap slides up and down in. It is the part of the knee that is most prone to being impacted from weakness at the hip or stiffness at the ankle and foot(we’ll have a full segment on this later)
Any one of these structures can be involved in pain and they each have their own symptoms and ways to fix them.
Some other parts of the knee include the bursa that surround the kneecap above and below which can easily become inflamed and contribute to pain. The infrapatellar fat pad which is usually tender to the touch with runners knee or pickleball knee and usually hurts to kneel on when you’re dealing with patellofemoral pain syndrome(PFPS).
Back to the thigh bone and shin bone. They are stabilized front and back with the ACL or anterior cruciate ligament and the PCL or posterior cruciate ligament. These keep the knee stable in a front to back direction and each have their own ways of getting injured(more on this later).
Stabilizing from side to side are the LCL or lateral collateral ligament and the MCL or medial collateral ligament.
What most pictures don’t show is that on top of these bones is a lot of really strong connectors (ligaments, fascia, muscles). On top of that is, of course, your skin. Each one of those can contribute when we have knee pain.
There are several sets of muscles that surround our knee and either move it or stabilize it. These include the quadriceps(which is named after its 4 heads of the muscle), our hamstrings(which is actually 3 separate muscles), our adductors(or inner thigh muscles) and there are about 5 of these.
In addition, several muscles at the hip serve to stabilize the knee from side to side including your glutes(specifically your glute medius and minimus)and your deep rotators of the hip including your piriformis. In fact, weakness in these muscles often leads to kneecap tracking issues including patellofemoral pain syndrome, runner’s knee, and pickleball knee as well as plantar fasciitis and foot pain.
All of these work together to help you do all the stuff you want to do. In many people, they are strong enough to do everyday activities. But before that, let’s cover some terms you might see in your X-ray or MRI and what they mean for you.
Bone Spurs or Osteophytes: This is where often you may have had small injuries that over time, the body decided to stabilize with bone. What this means is that the area of tendon where the radiologist expects to see a tendon looks more like bone. It is usually not like it sounds, a bony spur that is tearing things up in the knee.
Cartilage Defects or Chondral Defects: This is where the cartilage is thinner than the radiologist expects and is usually one of the “gray hairs on the inside”. Usually when someone is told that they are “bone-on-bone” the doctor is talking about these cartilage defects.
Meniscus Tears: In the extra padding in the knee, sometimes it can develop a split either in a segment or a flap can be pulled back(called a buckethandle tear).
Bone marrow lesion: These are basically bruises inside the bone and are quite common. Most go away without any intervention.
Facts about MRIs and the Knee(in people with no pain)
Knee imaging is perhaps the most striking example of how "wear and tear" is a normal part of life. In many cases, what a radiology report calls a "tear" or "defect" is simply the knee's version of a wrinkle—a sign of a life well-lived (and walked).
The data below is primarily sourced from the high-impact systematic review by Culvenor et al. (2019), which synthesized data from 5,397 asymptomatic knees across 63 studies.
Age-Specific Prevalence(How often do they find this) of Asymptomatic(Pain Free) Knee Findings (%)
Imaging Finding | 20s | 30s | 40s | 50s | 60s | 70s | 80s+ |
Cartilage Defects | 11% | 14% | 19% | 30% | 43% | 56% | 69% |
Meniscal Tear | 2% | 3% | 4% | 11% | 19% | 31% | 46% |
Osteophytes (Bone Spurs) | 1% | 2% | 7% | 18% | 37% | 60% | 81% |
Bone Marrow Lesions | 10% | 13% | 18% | 24% | 32% | 41% | 52% |
Subchondral Cysts | 2% | 3% | 5% | 9% | 15% | 23% | 34% |
Joint Effusion (Fluid) | 7% | 8% | 10% | 13% | 17% | 22% | 28% |
Key Takeaways for the Knee
The "Asymptomatic Explosion": Notice the massive jump in Osteophytes (bone spurs) between age 50 and 70 (from 18% to 60%). While these are a hallmark of osteoarthritis, most people in their 70s have them and feel zero pain.
Meniscal "Tears" vs. Attrition: In younger populations (20s-30s), a meniscal tear is often an acute injury. However, after age 50, the prevalence triples every decade. Many surgeons now view these as "degenerative fraying" rather than a structural failure requiring surgery.
Cartilage is Resilient: Nearly half of all 60-year-olds walking around today have a cartilage defect (the start of "bone-on-bone"), yet they remain pain free.
Bone Marrow Lesions (BMLs): These are essentially "bruises" inside the bone. They are quite common (18% in 40-year-olds) and often fluctuate or disappear entirely without intervention.
Clinical Pearl: If you have knee pain and your MRI shows a "meniscal tear" or "cartilage loss," it is statistically possible—even likely—that those findings were there long before your pain started.
4 Things you can do Today to quickly get rid of Knee Pain
1. Make a decision to get help. Most people wait for weeks, months, and even years before trying to get help and often it leads to more time spent away from work, recreation, and enjoying time with family
2. Do the right exercises. We treat knee pain by finding the right exercises to not only begin to turn off the pain but to help you rebuild your strength and ultimately get back to doing what you love.
3. Avoid sitting for long periods of time if you are able, especially if your pain is worse in the morning or after sitting and is one of the worst things you can do for your knee. Remember, the best position is the next position.
4. Get real hands-on Physiotherapy. Physiotherapy, especially hands on manual physiotherapy is proven to help people with knee pain. In fact, it is one of our specialties. If knee pain is holding you back from doing the things you love, being able to focus at work, or limiting you when spending time with family, physiotherapy can help you get back to the active life you deserve.
Knee Pain Myths
These days, it can be really hard to know what to believe when it comes to knee pain.
Is it my age?
Is something out of place?
Do I need an MRI?
Should I stretch it?
Should I strengthen it?
Is it my core?????
The sad truth is that many of the things we once thought about knee pain have gone the way of bigfoot, myths that are hard to shake. Heck, even AI will tell you to do ball squeezes(which make runner’s knee and pickleball knee worse), kick your leg straight, do bridges…and most of these things can help a little bit, they don’t train your body in how to actually handle the stresses and movement that’s required of the knee. Moreover, not all knee issues are coming from the knee(in fact most knee issues are back, glute, or foot issues in disguise).
Myth: You need an MRI or X-ray to “see what’s going on
Have you been told that you have changes on your x-ray or MRI? These usually go by the names of arthritis, bone-on-bone knees, osteophytes, chrondromalacia patella…and more. Often these words are tossed around pretty casually and usually not explained in any great detail...which then leads people to ask Professor Google what those words mean and guess what is top of the search rankings? A picture that looks like this. So, let’s break down some of the real meanings of these terms and what they tell us about our knees.
Chondromalacia patella
This is one of the conditions that is usually a foot or hip issue in disguise. Chondromalacia patella is where the kneecap doesn’t track straight up and down in the groove that it sits in and rubs against the “guardrails” known as the lateral and medial femoral condyles. When we get enough irritation behind the kneecap, it starts to get a bit frayed and you can get some swelling behind it.
What’s more, is that the older you are, the more likely you are to have this happening and not know it(because you didn’t have pain).
Meniscus Tear
The meniscus is a type of extra padding between your shinbone and your thighbone. If you have a tear in your meniscus in your teens and 20’s it is often more of a traumatic occurrence that happens in sport. Once you’ve reached your 50s, it is more often to be a coincidental finding and one of the “gray hairs on the inside” that MRIs find in many people. When studied side-by-side, Physiotherapy and Surgery to “correct” the meniscus comes out with the same outcomes as far as pain, mobility, and impact to daily living. This changes, however, if your knee routinely locks on you(either you can’t bend or straighten it). This is usually because of a “bucket handle” tear or a loose piece inside the joint that locks the joint. Usually if your joint is locking, surgery is the better option followed by a short course of physiotherapy to prevent it from happening again.
Osteophytes(Bone Spurs)
Often when we have small injuries over our lifespans, our body will routinely replace/repair frequently irritated structures with something a bit more durable. In this case, it is repaired with bone. When an MRI or X-ray sees “bone spurs”, this is typically what it is seeing. Efforts of the body to repair an area. What’s more, this is more likely with age and is found in most people in their 60s and 70s without any pain.
Your insurance company is aware of this myth too because they see that an MRI is usually the pathway into more and more invasive procedures, shots, or dangerous painkillers. That is why they are having people go to the more effective and less expensive(how often to you see those together) of seeing a Physiotherapist first before going to do more invasive procedures.
Don’t get me wrong, MRI’s do have a role, especially if your Physician suspects something serious going on but as a Physio, I treat the person, not their picture.
Bone-on-bone:
So, what exactly does it mean to be “bone-on-bone”. For most, it is a way of saying that the radiologist or physician sees less space between the thigh bone and the shin bone than is typically found in a much younger knee. This is another one of those findings that used to be sent straightaway for a knee replacement. But, more recently, researchers are finding that when we improve the shock absorbers(your muscles around the knees)and clean up how you’re moving a bit(fix some compensations that you’re doing that place extra stress on the joint), that we often find that knee pain significantly reduces(and you won’t have any change to your MRI from when it was bad). Sometimes we need to unload it further and strengthen you in a pool for a short period of time until your shock absorption is improved.
Myth: You hurt because something’s out of place
Did you know that it takes over 2000 pounds of force to stretch fascia(or the glue that holds you together) by 1%.
Or that it takes over an hour with a hammer and chisel to separate an SI joint with 2 people on a cadaver(that’s not fighting back)?
But yet, when we’re dealing with knee pain it can feel like something is out of place, or like the knee is about to crumble underneath you if you step wrong.
What we've understood for about the last 20 years about pain is that it has very little to do with positioning of the joints. So what is really happening when you something pops or cracks in your knee and you get relief.
Or how about when those knots disappear after a massage?
Or how about if you've been "shown" an X-ray with the "answers" as to why you hurt. Maybe you've been told you’re bone-on-bone
The simple truth is that when something pops or cracks, we get an adjustment or a massage, we give our joints, muscles, and especially nerves the three things they need to thrive. We give them movement, blood, and space. I don't mean that the adjustment somehow "opened" up anything or that you've now made your muscles longer or even "broken up scar tissue" unless you or your massage therapist or chiropractor is superhuman and can move a ton with their bare hands.
What they've really done is move your muscles, joints, or nerves in a certain way that "resets" your body's living alarm system i.e. your nerves. Unfortunately, without you doing the right kind of movement to reinforce this, your alarm system will often "trip" requiring another trip to the massage therapist or chiropractor and the cycle begins again.
This "reset" to your alarm system is why you feel more aligned, with better posture, and feel looser and with less pain after an adjustment or massage. This is a good thing in that it means that you are a rapid responder to the right kind of movement and that you have the ability to heal yourself and get back to running, lifting, and enjoying life. You just have to make sure for a short period of time to minimize the movements that provoke and feed your system the right movements. Have questions? Speak with a knee pain specialist for free.
Myth: Rest is Best when it comes to pain
When it comes to knee pain, motion is lotion. Yes, the first day or 2(tops) after a knee injury, the R.I.C.E. method of rest, ice, compression, and elevation seems to help but if you’ve been resting longer than a couple of days, often this makes pain worse and makes it last far longer than it should. Now the question comes, what movement should I do to deal with knee pain especially if everything hurts(especially getting out of a chair or walking). First off, after 2 days tops of the RICE way of dealing with things we need to replace it with MEAT or Movement, Exercise, Analgesics, and Treatment(I’ll explain more below).
Movement – Deliberate, controlled motions of the injured area to maintain joint range of motion, prevent muscle atrophy, improve blood flow, and stimulate synovial fluid production. Why? When we rest too long, joints stiffen, we don’t produce the lubrication inside our joints which then leads to more inflammation and pain. This maintains mobility and helps you actually heal faster.
Exercise – Targeted rehabilitation activities to strengthen muscles, improve stability, enhance proprioception, and support tissue repair Why? This phase helps us prevent future injury through improving the shock absorbers of the knee(your thigh muscles act like springs that take the load and spread it around instead of it going into the joint surface).
Analgesics – Pain management (e.g., medication, heat, or other modalities) to allow safe movement and exercise without discomfort. Anti-inflammatories can slow the healing process especially since some inflammation in the joint after the injury is your body’s way of cleaning up the “accident”, getting rid of damaged tissue, and laying down repairs.
Treatment – Sometimes it is unclear exactly what to do, especially when everything hurts. At Body Mechanix, our Doctors of Physiotherapy figure out the exact right movement to help you calm down your injury. Often we find that gentle hands on guided care along with helping you understand what’s really going on with pain gets people suffering from knee pain back faster than they thought possible.
If you’ve tried exercises online and you notice no change-don’t worry, it could be that your knee wasn’t ready for that just yet(but checking in with a pain specialist like a physio wouldn’t be a bad idea to find out what would help). You can pick a time that works to get the help you deserve here.
Myth: You hurt because you’re getting older
Does this story sound familiar? I just recently was working someone in their mid 30s and was told by her doctor “You know, you’re getting older and knee pain is part of that”? The doctor didn’t stop there. This person is a runner and a mom who wanted to be active and be able to play with her kids and also get the stress relief that she got from running.
Her doctor told her to “rest 6 weeks, take some anti-inflammatories, and maybe think about giving up running”.
And this person wasn’t alone.
I’ve heard this way too many times from 20 and 30 year olds.
And if this wasn’t bad enough, once you reach your 40s and 50s, you’ll often be told you have the knees of an 80 year old.
Often this is because they see on the MRI more “wrinkles” than they might have expected. But when we study when people actually report knee pain the most, these “wrinkles” start to multiply in pain free people around age 50, people reporting pain actually goes down from there even though our knees keep showing more wrinkles on the inside the older we get.
Myth: You hurt because you have a weak core
For about 20 years, from the late 90s there was a focus on the core as being the source of all pain or better put, a weak core. Hence a focus on things like planks, sit ups, posture exercises, and more. Yet, even with a focus on strengthening, knee pain did not get better. Often the weakness was a result, not the cause of the knee pain. Often the body would limit how much power the core could produce because your alarm system wasn’t sure it was safe for you to tighten your abs.
Why Knee Pain Persists and becomes Chronic Pain
When people have been studied who have pain, at least 25% of them will have their pain become chronic(longer than 12 weeks). As of the writing of this, we aren’t quite sure why this 25% has their knee pain become chronic pain but there are a couple of things that make it more likely to happen.
One of the first things to understand is that things other than new damage(or old damage) can contribute to pain. If you remember the sensors that I talked about on your alarm system earlier, this is where they contribute to pain(even when you’re resting and trying to not bother your knee).
So you don’t have to scroll back, these sensors are for stress, temperature change, immune system activation(like when you’re sick and fighting off an illness), pressure(like sitting), and blood flow(the nerve is compressed and not getting as much blood flow as it likes).
One of the metaphors I use in the clinic when explaining pain is that of an overflowing cup. Imagine that everything you can handle is represented by a cup. There are things that can fill up your cup and when it overflows, you’re in pain. If you think about your pain over the last week or so, you might notice some trends. If I’m under a lot of stress from work, family, expectations then my stress sensor on my danger detector will get poked(and with our cup metaphor, stress is filling up my cup). Or if I’m fighting an auto-immune condition or dealing with something like fibromyalgia now my immune system is filling up my cup as well.
The cup might be nearly full and you haven’t even moved yet. And then you get up out of a chair, climb the stairs, or stand for too long and it is agony. Your cup just overflowed but other things filled it up.
Now, if your pain has gone on a long time, your cup is steadily getting smaller and can handle less. So you try to do the right thing and exercise but the cup is so full that everything you do seems to set you back.
So you rest some more and your cup gets even smaller.
It is not your fault-and there is hope.
Frequently Asked Questions: Knee Pain
1. Why is my knee pain not going away on its own?
It is common to hope knee pain will disappear "like magic," but waiting often makes the suffering worse. Many people mistake the initial injury (like stepping wrong) as the cause, when the root issue is often decades of poor posture and weakened muscles. Without addressing these underlying causes, the pain is likely to persist or return.
2. My doctor told me to rest and take painkillers. Is this good advice?
While rest and medication are common suggestions, they are rarely the best long-term solutions. Painkillers often mask the problem rather than fixing it. Prolonged rest can actually lead to increased stiffness and weakness. Most patients find that once the medication wears off, the chronic pain returns because the root cause was never addressed.
3. Is knee pain just a normal part of getting older?
No. While many people accept kneepain as an inevitable part of aging, it doesn't have to be. Accepting it as "normal" often prevents people from seeking the treatment they need to live a pain-free, active life.
4. Why didn’t my previous treatments (Chiropractic, Massage, or YouTube exercises) work?
Chiropractic/PT: If the root cause wasn't identified, the relief may only be temporary.
Massage: While it feels good in the moment, it often fails to provide a long-term fix for structural or muscular issues.
YouTube Exercises: Exercises found online are not tailored to your specific condition and can sometimes make the pain worse if they aren't the right movements for your body.
5. What are the common reasons knee pain lasts longer than it should?
Waiting too long to seek help.
Relying on pills that only mask symptoms.
Following generic advice to "just rest." Generic advice gets generic results
Using "fixes" that only address the effects rather than the cause (like temporary massages).
6. How can physiotherapy help me avoid surgery or injections?
Physiotherapy focuses on finding the root cause of your pain through movement analysis. By using hands-on manual therapy and specific exercises to rebuild strength, many patients can eliminate the need for knee replacements or painful injections.
7. What can I do today to start feeling better?
Make a decision to get help: Don't wait weeks or months for the pain to worsen.
Avoid sitting for long periods: "The best position is the next position." Movement is key, especially if you feel stiff in the morning.
Perform the right exercises: Focus on movements that "turn off" the pain and rebuild strength (consult a professional to find which ones are right for you).
Seek hands-on therapy: Professional manual therapy is proven to help with stiffness and pain.
8. What specific results can I expect from treatment?
Patients typically experience:
The ability to sleep through the night without tossing and turning.
Ending reliance on daily pain medication.
Returning to activities like golf, tennis, or running pain-free.
How to know if you are a “rapid responder” and Physiotherapy will help you?
5 things you can do today to ease knee pain(Start doing this)
Try walking in a pool. If the reduced weight on your knee lets you move more freely and without pain, then it is likely a load issue. Your supporting muscles right now aren’t strong enough to prevent pain.
Make sure you’re moving your knee through its full pain-free range of motion. Doing this, especially making sure your knee is going all the way straight, is often a powerful reset of your body’s pain alarm. Do this several times a day.
Plan for 7-8 hours of sleep per night. Did you know that lack of sleep increases the body's sensitivity the next day. It isn't just that we're grumpy or need 6 cups of coffee just to make it through the day but it also shuts down your body's natural painkillers, amps up the sensitivity of your sensors, and reduces your ability to move well.
See a Physiotherapist. If your pain gets worse or better (i.e. has any variability even from bad to worse) there is likely some pattern that a Physiotherapist can find in what you are doing then give you the exact treatment your knee needs to kickstart the healing process while also reducing pain, helping you sleep better at night, improve mobility, and feel great.
Top 5 mistakes people make when dealing with kneepain(Stop doing this)
Just because something is considered a “treatment”, it does not necessarily mean that it’s in your best interest to try it.
This is especially true if you have not yet been accurately diagnosed by an expert physiotherapist.
Either way, if you have knee pain, I’d recommend avoiding these common treatment mistakes or risk further pain and injury.
Mistake #1 Prolonged Rest
I get it-resting and lying down seems to help but...there is a ton of evidence that prolonged resting is one of the worst things you can do to recover from your knee pain. It leads to
Higher levels of pain and stiffness
Reduced flexibility and muscle strength
A slower(and often worse) recovery
More time away from work
By performing gentle exercises and staying active, your pain will recover faster than just resting
Mistake # 2: Focusing too much on MRI or X-ray results
A common question we get is "Do I need an MRI" to "see what's going on". In most cases, an experienced Physiotherapist will be able to determine what is happening by having you move through a couple of simple tests. In addition, research shows that many people without knee pain will have changes on their MRI or Xray which means they may not be the cause of your pain or require surgery. In addition, the results of the scan rarely change a Physiotherapists plan of care because often you can be helped to feel better with no change to how your knee looks on an MRI.
Mistake #3 Reliance on Medications
Painkillers may initially be helpful, however they are only masking the pain and not treating the cause of the problem. Long-term use of potentially harmful medications can create dependence and require you to take more for same effect while giving you unwanted side effects impacting on your quality of life. Recent studies show that many are no better than Tylenol. The best medicine we know is the right type of exercise and stretching.
Mistake #5 Waiting until it is too late
While it’s true that some types of knee pain can get better over a few weeks, don’t make the mistake of ignoring it for too long. This is especially true if you have recurrent episodes of acute knee pain as it is your body’s way of telling you something is wrong. It could be something simple, such as you're sitting or lifting posture, which could easily be addressed with some advice and a few exercises.
However, if you continue to ignore it, you risk significantly increasing the amount of time to heal, which will require multiple treatment sessions and time away from work, not to mention preventing you from doing the things in life you enjoy most. It is important to see an expert physiotherapist (as soon as you have knee pain) for an accurate diagnosis and so a treatment plan can be established
Confused about where to start? Book a call from the comfort of your home or office and on your schedule with one of our knee Pain Specialists. You can schedule your call here. Need help now? Come by and talk with one of our Doctors of Physical Therapy at no charge. We offer FREE consultations, which give you the opportunity to come in and meet us and see for yourself how we can help you.
Here are just a few of the things you will learn in one of our free consultation:
What is the underlying cause of your pain? (hopefully nothing too serious!)
Roughly, how long will it take to fix the problem?
What to do to help – which doesn’t include painkillers, resting or surgery etc.
What other, natural, drug free methods are there to speed up recovery alongside treatment?
Our consultations are great for anyone that may be “unsure” if physio is right for them, and they give you the opportunity to ask questions and see for yourself if we can help you.
If you’d like one of our limited free consultation sessions, please click here to schedule your free consultation or CALL us on 850-765-2779 to make a no-obligation enquiry.
Dr. Brandon is the owner and a Physio at Body Mechanix Physiotherapy and Fitness. Four of his favorite people call him daddy while he's been married to his other favorite person for 23 years. He enjoys teaching martial arts and is a Mestrando in Capoeira while in the mornings, he can be found working out with the guys in F3 around town. He's the author of 4 pain relief guides for sciatica, low back, shoulder, and knees and the lead contributor to the Active Tallahassee Blog.
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