Why Do My Knees Hurt? A Comprehensive Look at Knee Osteoarthritis

Maria is forty nine, active, and works long hours on her feet. For years she brushed off the morning stiffness, the ache after long walks, and the way her knee always felt a little swollen at the end of the day. When the pain started waking her up at night, she finally went to her doctor. She was told it was arthritis, given a cortisone injection, and told to “take it easy.”

The shot helped for a few weeks, but the pain always returned. Her knee felt weaker, stairs became stressful, and she found herself avoiding the activities she loved.

Most people who develop knee pain go through a version of this story, and many are left believing that their joint is simply “wearing out” and that nothing can really change. The truth is much more hopeful. When you understand what knee osteoarthritis actually is, and what causes it, you start to see that the knee is not the problem by itself. The entire system that loads the knee is the problem, and that means you can change it.

What Is Knee Osteoarthritis?

Knee osteoarthritis is a condition where the joint slowly changes over time. It involves the cartilage, the bone underneath, the joint capsule, the ligaments, and the surrounding muscles. These tissues can become irritated or overloaded, and the joint responds by developing stiffness, swelling, pain, and eventually structural changes such as joint space narrowing or bone spurs.

It does not happen overnight. It is the result of years of how your body has absorbed force, how you have moved, how strong your muscles are, and how well the joint has been supported.

Your Knee Pain Is More Than A Knee Issue

Knee OA is not only a problem inside the knee.

It is a force distribution problem.

The joints above and below the knee determine how load travels through it, and when those mechanics are off, the knee becomes the place where stress accumulates.

Your knee does not generate the forces that travel through it. Instead, it only accepts the forces your hips, trunk, feet, and ankles create.

How the Body Shares Load

When you stand, walk, run, or climb stairs, force moves through your entire lower body in a chain. Each segment is supposed to do its part.

• Your hips control how your thigh rotates and how your pelvis stays level.

• Your ankles and feet determine how you strike the ground and how your leg absorbs impact.

• Your trunk position influences how much force shifts forward or backward.

• Your stride length and cadence change the timing and size of the load.

When everything works together, pressure is spread evenly across the knee joint. Cartilage stays nourished. Synovial fluid circulates. The joint stays healthy.

What Happens When Mechanics Fail

If one part of the chain is weak, stiff, or poorly coordinated, the pressure no longer spreads evenly.

It targets one region of the knee over and over again.

For example:

• Weak hips can let the knee collapse inward, increasing stress on the inner joint surface.

• Limited ankle mobility can shift force upward into the knee instead of absorbing it through the foot.

• A stiff, protective walking pattern can reduce knee flexion, which increases peak compressive forces.

Over time that localized pressure creates a predictable chain of events.

A Biological Cascade

When force concentrates in one region, you see:

• Reduced blood flow to that area.

• Limited movement of synovial fluid, which is how cartilage receives nutrients.

• Cartilage becoming thinner and less resilient.

• The underlying bone thickening and forming osteophytes.

• Inflammation that leads to swelling and stiffness.

This is what we call osteoarthritis. It is not random. It is a result of years of altered mechanics and uneven load.

Why Cortisone Injections Are Not the Best Long Term Solution

Cortisone injections reduce inflammation and may temporarily help with pain, but they do not correct the reason the knee is overloaded. Research shows that repeated cortisone injections can accelerate cartilage loss, increase joint space narrowing, and increase the likelihood of total knee replacement.

Multiple studies have found:

• Faster progression of osteoarthritis after frequent injections.

• Higher rates of cartilage thinning compared to people who did not receive injections.

• Increased probability of eventually needing knee replacement surgery.

Cortisone may help you get through a flare, but it does not fix the force distribution problem. That means the relief is temporary, and the underlying issue continues to grow.

Where Traditional PT Misses the Mark

Most people who try physical therapy for knee OA do not fail because exercise is ineffective. They fail because the approach is incomplete.

The plan focuses only on the knee

There is rarely a detailed assessment of hip strength, ankle mobility, walking mechanics, or balance. If the forces are coming from somewhere else, treating the knee alone will not work.

The exercises are not progressive

Light band work forever does not strengthen the system enough to redistribute load. Without meaningful strength training, the knee continues to absorb too much force.

No walking or aerobic progression

Aerobic training is one of the most proven interventions for reducing OA pain and improving function, yet most PT plans do not include it.

Lifestyle and recovery are ignored

Stress, sleep, nutrition, and muscle quality all influence pain and inflammation, but they are rarely addressed in traditional care.

Our 10-Step Process Addresses the Underlying Issue

Most people are given a handful of exercises, a rubber band, and a “come back in two weeks” plan. That is not enough to change how forces move through your knee, and it is definitely not enough to reverse years of poor load distribution.

Our 10-Step Process was built to fix that problem.

It is a structured, evidence-based roadmap that helps us assess your entire body, understand exactly where your mechanics are breaking down, and rebuild your capacity step by step. Instead of guessing or treating only symptoms, we use the system to guide you from pain and stiffness all the way back to the activities you want to do again.

The process starts by calming things down so you can move without guarding and fear. Then we address mobility through the hips, knees, and ankles so your joints can actually share load. From there, we progress into targeted strengthening that restores the shock absorption your knees have been missing. We retrain balance, coordination, and force absorption so the joint stops taking the brunt of every step, then build the strength and power you need for stairs, hiking, lifting, running, or whatever “better” looks like for you.

The real value is that nothing is random. Every step builds on the last and every decision is based on how your body is responding, where force is being misdirected, and which parts of the chain are not doing their job. We follow your progress with objective measures so we know you are moving forward, not just “feeling a little better.”

By the time you reach the later phases, you are not just out of pain. You move better, absorb force better, and produce force better. Your gait looks different, your strength and endurance look different, and your body finally works together again (instead of dumping stress into one sensitive area of the knee).

Most importantly, you return to the things you love with confidence because the plan rebuilt you from the ground up. Not with quick fixes. Not with passive treatments. With a system designed to restore the way your entire body handles load.

That is how we help people with knee osteoarthritis make lasting progress, even when injections, traditional PT, and rest have failed.

The Bottom Line

Your knee pain is not a sign that your joint is “wearing out” or that you are running out of time. It is a sign that your body has been absorbing force in a way that is too much for one region of the joint. That can change.

When you address the full system that loads the knee, strengthen the right areas, retrain how your body moves, and rebuild confidence step by step, knee osteoarthritis becomes something you can manage, improve, and often dramatically change.

You do not have to settle for temporary relief.

You do not have to stop doing the things you love.

You just need the right process.

If you want help figuring out where your force distribution is breaking down, our 10-Step Recovery Process was built for exactly that.

We guide you from pain to performance, one step at a time.

Click here to schedule a free Discovery Call to learn more.