Knee pain has a way of creeping into everyday life and often gets shrugged aside as “part of getting older”. But is that correct? Is knee pain inevitable? Does it only affect older people? What causes knee pain and why is it so often misunderstood?

Here’s our take.

Yes, knee pain is more common in older adults. Research suggests that around 25% of people aged 55 and over have at least one persistent knee pain episode during a 12-month period. Some of this pain is caused by osteoporosis, which is found in around 10% of the 55+ age group.

But just because knee pain is more common doesn’t mean it’s inevitable or untreatable. It’s also something you can experience at any age, and early treatment can often provide better outcomes.

Knee pain can have multiple causes

Sometimes, knee pain has a clear starting point, like a run, a ski trip, or a gym injury, but there won’t always be an obvious trigger.

For some people, symptoms build gradually over time until they suddenly realise they’re avoiding stairs, changing how they squat at the gym, or thinking twice before long walks. Others notice their knee feels stiff getting out of the car or uncomfortable after sitting through a film or long train journey.

Knee pain often develops in this slow, frustrating way, which is one reason people delay getting it assessed.

It’s worth getting some advice from a physiotherapist or GP if you find the problem never quite settles, even after a few days’ rest or some careful stretching or exercise.

Something we often hear from patients when they first come to The Physio Box is that everyone seems to have (conflicting) advice about what causes knee pain and how to treat it. This can be truly frustrating for the person in pain and one of the reasons this type of pain is misunderstood.

For every person who tells you to rest completely, they’ll be another who tells you to exercise. And let’s not forget the doomsayers, who tell you it’s “just wear and tear” or “runner’s knee” (i.e. an inevitable part of your favourite exercise) or “part of getting older”.

The reality is that knee pain is often far more complex, and far more treatable, than people realise. Professional support will help you cut through the noise to find the right treatment plan.

Why knee pain is so commonly misunderstood

For such an important joint, the knee is a surprisingly poor storyteller. This is largely because it carries so much information from other parts of the body that you can’t always spot what originated in the knee.

Different structures can create very similar symptoms. Pain from the kneecap can feel surprisingly similar to tendon pain. Hip weakness can present as knee discomfort. Reduced ankle mobility can overload the knee without the ankle ever hurting at all.

This is one reason why people often spend months treating the wrong problem.

We regularly meet patients who have:

  • Stopped exercising completely because they feared damage
  • Stretched too much, when the issue was irritation and overload
  • Focused only on the knee itself when the real problem sat elsewhere
  • Continued pushing through pain because scans didn’t show anything “serious”

Knee pain also tends to trigger anxiety in a way some other injuries don’t. People worry about cartilage damage, arthritis, or surgery remarkably quickly, especially if the pain has lingered longer than expected.

But pain doesn’t always equal serious injury, which is an important thing to understand early.

Of course, some knee symptoms should always be assessed promptly. Significant swelling, true locking of the joint, repeated giving way, or difficulty bearing weight can point to more serious injury and need to be properly checked.

“Runner’s knee” isn’t always about running

Pain around the front of the knee is one of the most common things we treat, particularly in active people.

Patients usually describe:

  • Pain going downstairs
  • Discomfort after long periods sitting
  • Irritation during squats or lunges
  • Stiffness after exercise
  • Aching around or behind the kneecap

This often gets labelled broadly as “runner’s knee,” but that term can oversimplify what’s happening. It can also make people dismiss the pain if they’re not a runner or assume they have to endure it if running is a favourite pastime.

In many cases, the issue is less about the knee itself and more about how the whole body is managing movement and load.

The way you walk, run, squat, land, or transfer weight through the leg can all influence how much stress the knee absorbs over time.

We might find weakness around the hip, reduced stability and control when weight is going through one leg, stiffness through the ankle, or training loads that increased too quickly for the body to adapt. Sometimes pain around the front of the knee is linked to a sudden return to exercise after a long break. Sometimes it appears after people start training harder in midlife while their recovery capacity is changing.

This is why generic online exercises can be hit and miss. Two people can have pain in almost the same area but need very different rehabilitation approaches.

Tendon pain is one of the most misunderstood problems we see

Tendon-related knee pain often affects runners, footballers, gym-goers, padel players (the UK’s fastest growing sport), and people doing intensive or repetitive training.

One of the difficulties with tendon pain is that it behaves differently from many other injuries.

Resting completely may calm it temporarily, but the tendon often becomes more sensitive when activity suddenly resumes. On the other hand, repeatedly pushing through significant pain can keep the irritation cycle going.

Patients often end up trapped between those two extremes, resting until things feel slightly better, then flaring the pain all over again the moment they try to return to normal activity.

Good rehabilitation usually sits somewhere in the middle.

Tendons generally respond well to gradual, progressive loading when the programme is tailored properly. That process takes patience, but it’s often far more effective than bouncing between complete rest and overdoing things every few weeks.

This is another area where early assessment makes a genuine difference. The sooner you understand what the tendon is reacting to, the easier it becomes to guide recovery properly.

The problem with “wear and tear”

In our experience, this phrase causes a huge amount of unnecessary fear.

Many patients arrive worried because they have been told their knee is “bone on bone” or that their scan showed degeneration or arthritis.

What often gets missed in those conversations is that many people with degenerative changes remain highly active and function extremely well.

Scans are only one piece of the picture.

We frequently see people who have become less active because they’re frightened of making the knee worse, rather than because the knee itself has truly stopped them moving. Over time, that reduction in movement can lead to weakness, stiffness, reduced confidence, poorer balance, and more discomfort.

That doesn’t mean arthritis should be ignored, of course. It simply means the situation is rarely as hopeless as patients are sometimes led to believe.

Appropriate strength work, movement retraining, mobility work, and load management can make an enormous difference to pain levels and function.

Many people can do far more than they think once they understand what their knee can tolerate.

Sometimes the knee is not the main problem

One of the most important parts of physiotherapy assessment is looking beyond the painful area.

As we’ve already seen, a knee doesn’t work in isolation. It’s influenced constantly by what is happening above and below it.

A stiff ankle changes force through the knee during walking and running. Reduced hip strength can alter alignment and control during movement. If you’ve had a previous injury elsewhere in the body, you may have been compensating with movements that affect your knee for so long that you haven’t yet joined the dots between the old pain and the knee pain.

We also increasingly see patients whose symptoms are affected by broader lifestyle and physiological factors, such as:

  • Poor recovery
  • Disrupted sleep
  • Sudden increases in training load
  • Stress
  • Hormonal changes

For some women, perimenopause can coincide with new tendon irritation, increased stiffness, or slower recovery from activities that previously felt manageable. That connection is still not discussed nearly enough.

It’s vital to understand the bigger picture because successful rehabilitation is about addressing underlying causes, rather than individual symptoms.

Why getting the right assessment early matters

Many knee problems become harder to resolve simply because people spend too long trying to self-manage the wrong issue.

During that time, the body often adapts around the pain.

People limp slightly. They stop loading one side properly, lose strength, or avoid certain movements. These changes in your physical capacity can have a huge impact on your confidence.

The earlier we identify what’s really happening, the easier it is to create a plan that supports proper recovery rather than temporary symptom management.

You might need to focus on strengthening, reducing overload, or even rebuilding confidence in movement after months of fear and uncertainty. Usually, it involves a combination of things rather than a single “magic” exercise. Good rehabilitation is not simply about calming pain down for a few weeks. It’s about helping the knee tolerate everyday life, exercise, sport, and movement more confidently long term.

What surprises patients most

One of the things patients often tell us after assessment is, “I thought I’d damaged my knee far more badly than this”.

Very often, people arrive expecting to be told to stop exercising altogether. Instead, we usually help them understand how to move better, load better, and recover better.

That’s exactly where a good assessment can make all the difference.

Struggling with ongoing knee pain?

Whether your symptoms started after a particular event (e.g. a twist or fall) or developed gradually over time, the right assessment can often provide clarity much earlier than people expect.

At The Physio Box, we take an individual approach to knee pain treatment, looking beyond the symptoms alone to understand what may actually be driving your pain.

Learn more about our physiotherapy-led approach to knee pain treatment in Kensington or book an appointment with our team.