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Why Your Knee Still Hurts – And What Actually Helps It Heal

March 9, 2026/in Movement/by Carrie Jose

Advice From a Knee Pain Specialist in Portsmouth, NH

Knee pain has an annoying way of sneaking into everyday life. At first, it might just feel a little stiff when you stand up from a chair. Then you start noticing it when walking down stairs or getting in and out of the car. Before long, you realize you’re avoiding things you used to enjoy – long walks, hiking, exercise classes, or even playing with your kids or grandkids.

For many adults over 40 in the Seacoast area, knee pain becomes something they simply learn to live with. And when they finally decide to seek help, they are often given a familiar set of options: rest, pain medication, cortisone injections, or eventually surgery.

Sometimes the advice is even worse.

A woman I recently spoke with was told: “Just look it up online – there are exercises you can do on your own for this.”

Yes – I was horrified.

But here’s what many people in and around Portsmouth don’t realize: most knee pain is far more treatable than people think, and in many cases it can improve naturally. That means you may not need medication, injections, or invasive procedures.

But first, you have to understand what is actually causing your pain.

Most Knee Pain Isn’t What You Think

When people experience persistent knee pain, the first instinct is often to look for structural damage. X-rays and MRIs frequently reveal things like arthritis, meniscus tears, or cartilage degeneration.

Those findings can sound alarming.

But research has consistently shown something surprising – many people with these exact findings have no knee pain at all.

In fact, studies have found that more than half of adults over 50 show signs of meniscus tears or arthritis on imaging even when their knees feel perfectly fine.

This tells us something important.

What shows up on imaging is not always the true cause of pain.

In many cases – nearly 80 percent – knee pain is actually mechanical. This means it is related to how the body moves and distributes force through the joints rather than damage to the structures themselves.

Small issues in movement patterns, muscle strength, flexibility, or joint mobility can place excessive stress on the knee. Over time, that stress leads to irritation, inflammation, and pain.

The encouraging part is that mechanical knee pain is highly treatable once it is identified.

Why Quick Fixes Often Fall Short

Because knee pain can be frustrating and limiting, many people look for fast relief.

Cortisone injections are one of the most common treatments recommended for knee pain. They work by reducing inflammation in the joint, which can temporarily decrease pain.

But cortisone injections come with an important limitation – they do not address the root cause of the problem.

Instead, they simply quiet the symptoms.

This can create a situation where the underlying issue continues to worsen while the pain is temporarily masked. Some people then end up receiving repeated injections over time and eventually undergo total knee replacement due to progressive joint damage.

Research has also shown that repeated cortisone injections may accelerate joint deterioration and contribute to cartilage breakdown over time.

Even more important, cortisone suppresses the body’s natural inflammatory response, which plays a critical role in tissue repair and healing.

In other words, cortisone shots may reduce symptoms in the short term, but they can interfere with your body’s ability to truly recover.

What Actually Helps Knee Pain Heal

The good news is that the body is remarkably capable of healing and adapting when given the right environment.

Instead of masking pain, the goal should be to restore proper movement and support the tissues around the knee so they can function the way they were designed to.

Strengthening the Muscles That Support the Knee

Your knee does not operate in isolation. The muscles of your hips, glutes, and core play a major role in controlling how force moves through your leg.

When these muscles are weak or poorly coordinated, the knee often ends up absorbing more stress than it should.

Strengthening these supporting muscles can significantly reduce pressure on the knee joint and improve stability during walking, climbing stairs, and exercise.

Improving Mobility and Flexibility

Mobility is equally important for healthy knees.

Tight muscles and stiff joints can change the way your body moves. When the hips, hamstrings, or quadriceps lack flexibility, the knee often compensates by taking on additional strain.

Improving mobility throughout the lower body helps distribute forces more evenly and allows the knee to move more efficiently.

Continuing to Move

One of the biggest misconceptions about knee pain is that rest is the best solution.

In reality, too much rest often makes knee pain worse.

Movement helps circulate nutrients through the joint, lubricate cartilage, and maintain strength in surrounding muscles. Low-impact activities such as walking, cycling, swimming, and Pilates can help support joint health without overloading the knee.

Treatments That Support Natural Healing

In some cases, additional treatments can stimulate the body’s natural healing response.

Technologies such as regenerative shockwave therapy and electromagnetic transduction therapy (EMTT) are designed to increase blood flow, stimulate cellular repair, and reduce inflammation without medications or injections.

These treatments work with the body’s natural healing processes rather than suppressing them.

A Different Way to Think About Knee Pain

One of the most important mindset shifts people can make is moving away from the idea that knee pain is simply the result of “wear and tear” that must inevitably worsen with age.

Our bodies are far more adaptable than that.

With the right combination of movement, strength, mobility, and professional guidance, many people can reduce pain, restore function, and return to the activities they love without injections, medications, or surgery.

The knee is a remarkably resilient joint when it is supported properly.

And for many people, the path back to healthy knees begins with restoring the way the body moves.

Dr. Carrie Jose is a Physical Therapy Specialist and Mechanical Knee Pain expert and owner of CJ Physical Therapy & Pilates. She helps active adults across the Seacoast stay mobile, avoid unnecessary surgery, and get back to the activities they love.

For a free copy of her Guide to Knee Pain or information about an upcoming Knee Pain Masterclass, visit cjphysicaltherapy.com or call 603-380-7902.

Before You Consider Knee Surgery: Read This

March 6, 2026/in Movement/by Carrie Jose

Before You Consider Knee Surgery – Read This

Arthroscopic knee surgery is one of the most commonly performed orthopedic procedures in the United States, and total knee replacement isn’t far behind. Both procedures are frequently recommended for people suffering from knee pain, especially when imaging shows arthritis, meniscus tears, or other degenerative changes inside the joint.

But here’s what many people don’t realize – the presence of those findings doesn’t automatically mean surgery is necessary. In fact, research over the past two decades has repeatedly shown that many knee surgeries are performed on people who could have improved with conservative treatment like physical therapy and movement-based care.

For people dealing with chronic knee pain in Portsmouth, NH and throughout the Seacoast, understanding your options before committing to surgery is critical.

The Truth About Arthroscopic Knee Surgery

Let’s start with arthroscopic knee surgery.

Arthroscopy is considered minimally invasive. A small camera is inserted into the joint and the surgeon may trim damaged meniscus tissue or “clean up” arthritic debris. Because the incisions are small and recovery is relatively quick, it’s often presented as a simple solution for knee pain.

But research tells a more complicated story.

A landmark study published in the New England Journal of Medicine by Dr. JB Moseley and colleagues compared arthroscopic surgery to placebo surgery in patients with advanced knee arthritis. Some patients received the full procedure – while others only received small incisions without any surgical repair.

The results were surprising. Patients who received the placebo surgery improved just as much as those who had the real operation.

Since that study, numerous others have confirmed similar findings, suggesting that for many cases of degenerative knee pain and arthritis, arthroscopic surgery provides little additional benefit over conservative care like targeted physical therapy, strengthening, and mobility work.

That doesn’t mean arthroscopic surgery never helps. It simply means it’s often used in situations where other treatments could be just as effective.

In some cases, undergoing surgery when it isn’t truly necessary can even accelerate problems inside the knee joint – increasing your likelihood of needing a total knee replacement later on. Ironically, many people choose arthroscopic surgery in hopes of avoiding that major procedure down the road.

When Is Total Knee Replacement Necessary?

Which brings us to total knee replacement surgery – another procedure that has become increasingly common and, in many cases, more avoidable than you might think.

Unlike arthroscopy, knee replacement is a major operation. The damaged joint surfaces are removed and replaced with artificial components designed to restore function and reduce pain.

When performed on the right candidate, knee replacement can be very successful. About 90 percent of patients experience significant improvement, and many implants last 20 years or longer.

However, that doesn’t mean everyone with knee arthritis or chronic knee pain needs one.

Why MRI and X-Ray Findings Can Be Misleading

One of the biggest misconceptions about knee pain is that arthritis on an X-ray automatically explains the symptoms.

What’s not a misconception, however, is that joint degeneration is incredibly common as we age.

Studies show that only about 15 percent of people with evidence of knee osteoarthritis actually experience symptoms. The other 85 percent walk around completely pain free despite having the same findings on imaging.

MRI studies reveal similar patterns.

In one well-known study published in 2012, researchers performed MRI scans on more than 500 people who had no knee pain at all. Seventy-two percent showed signs of arthritis and roughly one quarter had meniscus tears.

In other words – structural changes inside the knee are far more normal than most people realize.

This is why basing a treatment decision solely on imaging can be misleading.

Sometimes Knee Pain Isn’t Actually Coming From the Knee

Over my two decades of treating patients with knee pain, the biggest problems I’ve seen after surgery rarely had anything to do with the procedure itself.

Instead, the issue was an incorrect diagnosis before surgery.

Sometimes the knee wasn’t actually the primary source of pain.

Knee pain can originate from the hip, ankle, or even the lower back. Research has shown that a surprising percentage of people with isolated knee pain actually respond to treatment directed at their spine.

That means someone could have arthritis in their knee and still have their symptoms driven by a problem elsewhere.

If that underlying cause isn’t identified first – surgery may be unnecessary, and it certainly won’t solve your problem.

3 Things to Consider Before Knee Surgery

Before considering any type of knee surgery – whether arthroscopic or a full replacement – there are several important things to evaluate.

1. The severity of your pain

If your discomfort is manageable and you can still participate in most of the activities you enjoy, rushing into surgery may not make sense.

Even successful knee replacements involve risks such as infection, blood clots, or complications related to anesthesia. Full recovery can take six to twelve months.

2. Whether your spine could be involved

If your knee pain fluctuates, appears suddenly, or occurs alongside back discomfort, it is worth having your spine evaluated by someone trained in diagnosing mechanical pain patterns.

In many cases, addressing the spinal issue resolves the knee pain without any treatment directed at the knee itself.

3. How stiff your knee actually is

With truly advanced arthritis, stiffness tends to be constant and progressive.

But if your knee mobility improves with movement, stretching, or specific exercises, the limitation may be mechanical rather than structural.

When that happens, restoring the right movement patterns can dramatically improve symptoms without surgery.

The Bottom Line: Surgery Should Be a Last Resort

To be clear – knee surgery is not always avoidable. For some patients, particularly those with severe arthritis and significant functional limitations, knee replacement can be life changing.

But surgery should almost always be considered a last resort, not the first step.

Before going down that road, it’s essential to make sure your knee pain has been accurately diagnosed and that you have explored all appropriate conservative treatment options.

Arthroscopic surgery and knee replacement may be among the most commonly performed orthopedic procedures in the country, but that does not mean they are always the right solution.

In many cases, the right diagnosis and treatment approach can restore knee function and eliminate pain without ever needing surgery.

Knee Pain Treatment in Portsmouth, NH

Dr. Carrie Jose is a Physical Therapy Specialist and Mechanical Knee Pain expert. She is the owner of CJ Physical Therapy & Pilates in Portsmouth, NH, where she helps people across the Seacoast of New Hampshire overcome chronic knee pain and avoid unnecessary surgery through specialized movement-based treatment.

She also hosts educational workshops and classes for people struggling with knee arthritis, meniscus injuries, and persistent knee pain.

To get a free copy of her Guide to Knee Pain or learn about the next Knee Pain Masterclass in Portsmouth, visit cjphysicaltherapy.com or call 603-380-7902.