Why Do Some Knees Hurt More Than Others?
Most people assume knee pain — especially knee osteoarthritis — must come from something “wrong” inside the joint. It sounds logical, but the body rarely follows the simple story.
You might have seen this yourself:
- Someone has a scan that looks awful… yet feels pretty good.
- Someone else has a normal-ish scan… and they’re in pain all the time.
So what’s actually happening?
Pain isn’t just about the knee.
It’s about the whole system that the knee sits inside — your habits, stress, sleep, strength, even how you think about movement.
All of these shift how much load your knee (and your nervous system) can tolerate:
- Movement and exercise
- Diet
- Inflammation
- Stress and worry
- Sleep
- Strength and fitness
- Your beliefs about your knee
A change in any of these can nudge pain up or down.
What Is Allostatic Load?
“Allostatic load” is just a way of describing the total strain your body is under — the running tally of everything you’re juggling:
- Poor sleep
- Low movement
- High inflammation
- Low mood
- Stressful days
- Unbalanced diet
When your overall load climbs, your nervous system becomes more reactive. For someone with knee osteoarthritis, that can make even small amounts of activity feel painful on the “high load” days.
This idea sits behind much of what we do in the Healthy Knee Program.
The Bucket Analogy (A Simple Way to Picture Knee Pain)
An easy way to understand this is the “bucket” idea.
- Your bucket size = how much stress/load your knee can handle
- The water = everything your body is dealing with (sleep, stress, inflammation, fear, fitness)
- Pain = when the bucket overflows
Some people just have:
- Smaller buckets (low strength, stiffness, long-term habits)
- Buckets already full (poor sleep, worry, inflammation, stress)
When the bucket is near the top, even a short walk or a rough night’s sleep can overflow it. That’s why pain fluctuates so much even though the knee joint itself hasn’t changed from one day to the next.
Same Knee Scan, Different Pain Levels
John and Jenny are both 65. Both show moderate knee osteoarthritis on their scans. But their lives look nothing alike.
John
- Walks most days
- Does strength training
- Eats well
- Sleeps fairly consistently
- Manages stress
- Plays with grandkids, does hikes
👉 His bucket is bigger, and it’s rarely full.
👉 His pain stays low.
Jenny
- Sleeps poorly
- Works long hours
- Eats whatever she can fit in
- Doesn’t exercise
- Struggles with day-to-day tasks
👉 Her bucket is small and overflowing.
👉 She feels pain daily.
Same scan. Different context. Different pain.
What Can You Do to Reduce Knee Pain?
There are really two broad strategies:
1. Make the bucket bigger
You build capacity through:
- Strength training
- Improving fitness
- Better mobility
- Gaining confidence with movement
The stronger the system, the more you can handle before pain shows up.
2. Lower the water in the bucket
You reduce the overall stress load through:
- Better sleep
- Reducing inflammation
- Healthier food choices
- Gentle, consistent activity
- Reducing worry
- Learning more about your knee
This calms the nervous system, which often softens the pain response.
The 3 Core Ingredients of the Healthy Knee Program
We focus on three simple but powerful areas:
- Activity — Strength and movement that build confidence.
- Inflammation — Sleep, diet, stress, recovery.
- Knowledge — Understanding how pain works so you feel more in control.
Together, these make knee pain far more manageable.
Wrapping Up
The bucket analogy explains why knee pain can shift so much. And more importantly, it reminds you that treatment shouldn’t just zoom in on the joint.
The encouraging part is:
- Your pain can improve
Your knee can grow stronger - You genuinely have influence over your symptoms
With the right mix of exercise, lifestyle support, and education, healthier knees are possible at any stage of life.
Warmly,
Dr Adam Walker
Director & Head of Rehabilitation
Gold Coast Knee Group
📧 adam@gckneegroup.com.au
📞 0408 051 943
🌐 www.gckneegroup.com.au
📝 FAQ: Common Questions About Knee Pain & Knee Osteoarthritis
- Why does my knee hurt even when my scan looks normal?
Pain is influenced by the whole system — sleep, stress, inflammation, fitness — not just the joint. - Can knee osteoarthritis improve without surgery?
Yes. Many people improve with the right exercise, education, and lifestyle changes. - Why does my knee pain change day to day?
Your “overall body load” changes, which alters pain sensitivity. - Does exercise make knee osteoarthritis worse?
No. The right amount of exercise helps the knee become healthier. - What is inflammation, and how does it affect knee pain?
High inflammation can make the knee more sensitive. - How do I know what exercises are right for my knee?
A physiotherapist can match exercises to your strength and mobility. - What’s the best first step to reduce knee pain today?
Small things: gentle movement, better sleep, simple strength work, managing stress, learning about your knee.
