LACEY (WA)– Over the past few weeks, we’ve covered a lot about knee pain. We’ve talked about three everyday habits that make knee pain worse—like wearing the wrong shoes, sitting with bent legs, and being too inactive. We also looked at three so-called “quick fixes” that don’t actually help: painkillers, resting, and wearing a knee support. After that, we explored whether knee replacement surgery can be avoided, and how. And most recently, we discussed how to stop arthritis before it stops you.
That’s quite a bit in just four weeks—and we’re not done yet! Knee pain is something many people struggle with year-round, but it often flares up more in the warmer months as people become more active. Which brings me to this week’s question…
A reader recently wrote in:
“Jennifer, I’ve been dealing with off-and-on knee pain for over a year. I’m not sure when it started or why. What’s confusing is that the pain gets worse as the day goes on. When I wake up, it’s either gone or much better—but by the evening, especially after a long walk with my dog, my knee aches, feels hot and swollen, and I’m in real pain. Any ideas?”
– Beth, 58, Lacey
What Beth is describing is likely caused by weak muscles around the knee joint. These muscles just aren’t strong enough to support her throughout the day or keep up with her activity level.
Think of it like this: by bedtime, your whole body—including your muscles—is tired from the energy you’ve used throughout the day. After a night’s rest, your muscles feel refreshed and less sore. But if those muscles are already weak or slightly damaged, they won’t be able to give your knee the support it needs for long.
By the end of the day—especially after being on your feet a lot—those muscles are exhausted and can no longer do their job effectively. That leaves your knee joint to take on the full burden, which often leads to swelling, aching, and increased pain.
This is especially important for people over 45, when cartilage wear becomes more common and arthritis starts to set in. Without strong muscles to cushion and support your joints, pain is more likely.
This same pattern happens with neck and shoulder pain too—ever notice how you feel worse at night when you have the flu or a cold? Or how a child with a virus seems crankier as the day goes on? That’s your body’s strength wearing down over time, giving pain and inflammation the upper hand.
So what’s the solution for Beth?
It starts with strengthening the muscles around the knee—and also the hip and lower back muscles. But here’s the part that often surprises people: daily dog walks or general activity won’t build muscle strength. In fact, if your muscles are already weak, this kind of daily strain can actually make things worse.
The key isn’t more exercise—it’s the right kind of exercise. Targeted strength training builds the muscle support your knees need to handle walking and daily movement without pain by day’s end. That way, you can stay active, keep your heart and lungs healthy, and do it all with less discomfort.
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Jennifer Penrose is a Physical Therapist and owner of Penrose Physical Therapy in Lacey, WA. Have a question about knee pain? Call (360) 456-1444 or email jennifer@penrosept.com.
P.S. Want more health tips from Dr. Penrose? Listen to her monthly podcast, Stay Healthy South Sound, available on iTunes, Google Play, and Spotify.
