knee strengthening

Why Strength Isn’t Enough, and What Will Really Fix Your Knee Pain

The Resilient Knee Project

Why Strength Isn’t Enough, and What Will Really Fix Your Knee Pain

When you’re struggling with knee pain, the first instinct is often to get stronger.

You’re told by well-meaning therapists, trainers, and experts, “If you’re in pain, just build up your muscles.”

And on the surface, that makes sense, right?

After all, strength equals stability, and stability should equal less pain.

But here’s the harsh truth: Strength alone won’t fix your pain.

In fact, if all you’re doing is trying to get stronger without addressing the bigger picture, you could be making things worse.

The Problem: Chasing Strength Without Capacity

Let’s use a simple metaphor: Imagine you’re really thirsty.

You grab a small cup and start filling it with water, but before long, it overflows—water spills everywhere.

That overflow? That’s your soreness, your pain.

Naturally, you think, “I need a stronger cup!”

So, you reinforce the cup, making it sturdier and thicker.

But here’s the catch—now, the cup is more rigid.

And what do we know about rigid things?

They’re more likely to crack or break under pressure.

This is exactly what happens when you chase strength without increasing your capacity.

Sure, you’re getting stronger, but without expanding how much your body can handle, you’re setting yourself up for failure.

When you overload a rigid, small cup (i.e., only focus on strength without increasing function), you’ll keep overflowing.

You might even break the cup.

What you really need is a bigger cup—more capacity, not just more strength.

The Truth About Strength: It’s Not the Only Answer

The “strength fixes pain” myth is powerful, but misleading.

Strength alone won’t solve the issue because it doesn’t address the root of the problem—your body’s capacity to handle load, recover, and adapt.

Without increasing your overall capacity—how well your muscles, tendons, bones, and joints can deal with stress and recover from it—focusing on strength alone makes you more fragile.

It’s like having a stronger but still small and rigid cup. Eventually, it will crack under the pressure of all the load you’re placing on it.

And here’s where it gets worse: The simplistic advice of “just get stronger” carries a subtle but harmful message that you’re “weak,” which can make you feel fragile.

It reinforces the idea that your body isn’t capable, and this fear creates a vicious cycle—making you feel more out of control over your symptoms.

The Solution: Capacity and Functional Resilience

What you truly need is functional capacity.

Instead of focusing on just getting stronger, focus on expanding your body’s ability to handle load without breaking down.

Think of this as building a bigger cup—one that can hold more without spilling over.

Capacity is your body’s ability to not only manage the load but also clear out the “waste” that builds up—like lactate, a byproduct of intense activity.

When your body can’t clear this waste efficiently, it contributes to soreness and pain.

Here’s the good news: Your body is designed to use lactate as fuel when your systems are functioning well.

And that’s where mitochondrial health comes in.

The more mitochondria you have, and the healthier they are, the better your body can clear waste and generate energy.

That’s capacity in action—building not just strength but the ability to handle and recover from stress over the long term.

The Resilient Knee Project: A Different, Innovative Approach to Knee Health

This is exactly what The Resilient Knee Project is all about.

It’s not just about building strength; it’s about creating resilience through functional capacity.

And running, believe it or not, is the perfect way to do this.

We need to respect the high load and force that running provides.

If channeled correctly, those forces can create resilience in your bones, muscles, tendons, and joints.

This is the real strength we’re after: genuine, long-term capacity.

Running builds capacity, but here’s the catch—it takes time.

Months, even years, to fully develop.

You won’t see immediate results.

This isn’t a quick-fix solution, but it’s one of the best long-term investments you can make in your body’s health.

What you’re developing is a powerful physical asset that will serve you for the rest of your life.

Once you build this capacity, you’ll have the knowledge and skills to manage your knee pain independently.

You’ll become the expert on your own body, and you’ll no longer need to rely on therapists or experts to “fix you” with simplistic solutions.

No more embarrassing narratives about being weak.

No more relying on medication, surgery, or avoiding movement out of fear.

Why the Desire for Strength is So Intuitive

Now, let’s address something important: the desire to get stronger is incredibly intuitive.

It makes sense—if you’re in pain or feeling fragile, getting stronger seems like the most logical response.

Most healthcare professionals will validate this desire, telling you strength is the solution.

But remember, strength alone isn’t enough.

Think of it like David vs. Goliath. David didn’t win by matching Goliath’s strength—he won with strategy.

And that’s exactly what you need: a strategy, not just a single-focus tactic like strength.

Your desire to be stronger is good, but we need to unpack it and turn that motivation into something more useful.

The real solution lies in building capacity.

This means not just lifting more weight but knowing when to push, when to back off, and how to recover. You’ll know exactly what to do when flare-ups occur (because let’s be real—they will still happen, just less often and less severe).

The Bottom Line: Invest in Capacity, Not Just Strength

If you’ve been chasing strength to fix your knee pain, it’s time to take a step back and look at the bigger picture.

Strength is important, but it’s only part of the solution.

What you need is to build capacity—giving your body the tools to handle life’s demands without breaking down.

Next time you feel the urge to just “get stronger,” remember: It’s not about building a stronger cup—it’s about building a bigger, more resilient one.

And if that sounds like a good plan to you, know this: It’s going to take investment.

But think of it as the best investment you’ll ever make.

Once you restore function and capacity, no one can take that away from you.

Imagine all the years ahead filled with physical activity, running races, hiking mountains, enjoying great times with friends and family—all without the fear of your knee letting you down, without being stuck in the endless cycle of rehab purgatory.

The Resilient Knee Project isn’t just about fixing pain.

It’s about empowering you to take control of your body, build long-term resilience, and live without limits.

Dan O'Grady is a results driven qualified Physiotherapist and member of the Australian Physiotherapy Association.  Dan has a special interest in treating knee pain.  He has been working in private practice for 20 years. He is passionate about helping people to move better, feel better and get back to doing what they love.

Knee Osteoarthritis - Part 1 Your Options

Osteoarthritis (OA) is the most prevalent joint disease and a leading source of chronic pain and disability worldwide.

There is a common perception among people with knee arthritis that nothing can really be done, (outside of taking medications or having knee replacement surgery).

This study by Mitchell and Hurley (2008) showed that many people were unaware of the options available to them, despite consulting with their general practitioner.

Research indicates less than 4% of people attending a GP clinic with knee osteoarhritis are referred to a Physiotherapist.

The intention behind this blog post is to inform you of some of your options, so you can make an educated decision about what is best for your situation.


Knee OA…what options do you have?

1. Ignore the pain

This can be an effective strategy in the beginning. Ignoring the pain and getting on with things can be actually be quite helpful.

This usually works particularly well when you are young and resilient.

Our bodies are masters at compensating and this means you can still do what you want in the short-term as your body may be able to transfer load from the knee into the hip or lower back.

As you get older though (around the age of 30+), this strategy has less effect as the compensatory patterns have a limited capacity.

As your body runs out of options and strategies, you will eventually find yourself not recovering like you did before and the stiffness and pain starts to get stronger.

2. Rest the knee and avoid using it

Advice to rest and avoid pain is commonly provided to people with knee and other joint pains - advice that is often wrong, and harmful.

Unfortunately the majority of people with knee OA reduce moving due to fear they will wear the knees out and make things worse.

This leads to a downward spiral of pain, weakness and a loss of confidence.

Interestingly, we know that weak thigh muscles are one of the biggest risk factors for ongoing knee pain. When you stop moving and become inactive, muscle loss accelerates significantly.

dHPLn.jpg

Sarcopenia

At some point in your 30's you naturally start to lose muscle mass and function.

Physically inactive people lose an average 3-5% of their muscle loss per decade after the age 30. The technical name for this is sarcopenia.

The picture above demonstrates the dramatic consequences of an inactive lifestyle and severe muscle wasting.

Adipose tissue refers to the fat layer around the muscles.

Clearly, avoiding movement is not going to be your best solution.

What about running, won’t that lead to increased OA?

Interestingly, recreational runners (3.5% risk) had a lower occurrence of developing knee OA compared with non-runners (10.2%).

One of the main ways running protects you from arthritis is by maintaining you at a healthy weight. This leads us to our next point.

3. Weight Loss

Obesity is a strong risk factor for knee pain and increases the risk of symptomatic knee osteoarthritis.

Women who are overweight are four times more likely to develop knee OA than women who are a healthy weight. And men who are overweight are five times more likely to develop OA than men who are a healthy weight.

Scales.jpg

But losing even a small amount of weight can be beneficial. For people who are overweight, every 5 kg of weight loss can reduce the risk of knee OA by more than 50 percent.

4. Medication

Medications such as panadol and anti-inflammatories have their place when you have an acute flare-up of knee pain.

But they are not designed for long-term use, due to their side effects on the liver and gastro-intestinal system.

5. Arthroscopic Surgery

Traditionally, arthroscopic surgery has been performed for chronic knee pain. Over the past few years however the research has indicated that for people with degenerative knee pain (including meniscal lesions), performing arthroscopic surgery does not improve outcomes.

The evidence refuting arthroscopy to treat meniscal degeneration and knee osteoarthritis (OA) is now clear and compelling. In Australia, the number of arthroscopies for degenerative knee pain has halved since 2011.

If the knee pain and degeneration is severe, conservative measures have been tried and you are having difficulty functioning day to day, then a Total Knee Replacement would be a logical thing to consider in consultation with your doctor.

However, the point being made here is that arthroscopic surgery is not required for degenerative knees.

Of course with any surgery there is the risk of infection and blood clots forming in the leg, as well as post-op recovery and rehabilitation for a few months afterwards.

6. Exercise therapy: the treatment of choice for Knee OA

Exercise therapy has the best evidence providing both short and long term benefits to people with knee OA.

High-quality evidence suggest that land-based therapeutic exercise provides benefits in terms of reduced knee pain and improved quality of life (Bennell et al 2015). This benefit can be sustained for 2-6 months after cessation of formal treatment.

Exercise therapy involves a combination of supervised sessions with a health professional to target:

  • strength

  • cardiovascular fitness

  • flexibility

  • neuro-muscular retraining

Getting all the pieces of the puzzle to get you back to doing what you love.

Getting all the pieces of the puzzle to get you back to doing what you love.

As you begin an exercise program, you may need to allow a period of 'body tuning' i.e. using manual therapy, taping, massage and dry needling to improve tissue quality and joint alignment.

Similar to playing an instrument, tuning up before hand makes things perform much better and reduces pain and tightness.

This is where are a good Physio comes in, who has a deep understanding of knee pain and a passion for helping people overcome it.

We do that everyday of the week and you can find out more about us here.

Summary

We know that movement and exercise can be what truly helps knee pain.

The evidence is compelling.

It addresses all of the modifiable factors that can get you out of reactive mode, and into building your foundation.

But what type of exercise specifically helps?

READ PART 2 OF THE BLOG —> CLICK HERE

If you have any questions in the meantime, please feel free to contact us.

If you'd like to see how we can help set you up with a plan of attack to overcome your knee pain, please use our easy online booking system to schedule an initial appointment.


References:

Mitchell HL, Hurley MV. Management of chronic knee pain: a survey of patient preferences and treatment received. BMC Musculoskelet Disord. 2008 Sep 18;9:123


Exercise for osteoarthritis of the knee: a Cochrane systematic review.

Fransen M, McConnell S, Harmer AR, Van der Esch M, Simic M, Bennell KL.

Br J Sports Med. 2015 Dec;49(24):1554-7

The Association of Recreational and Competitive Running With Hip and Knee Osteoarthritis: A Systematic Review and Meta-analysis.

Alentorn-Geli E, Samuelsson K, Musahl V, Green CL, Bhandari M, Karlsson J.

J Orthop Sports Phys Ther. 2017 Jun;47(6):373-390.

"Surgery versus Physical Therapy for a Meniscal Tear and Osteoarthritis, The New England Journal of Medicine, 2013"