“I've had a pain in both knees going downstairs for quite a while. Probably for several years, and it's gotten steadily more intense.”  


“I saw a sports medicine doc about six or eight months ago. And he did an X-ray and said, ‘It's bone on bone.’”

Gavin* continued by telling me, “I saw a trainer who’s old enough to understand aging bodies, and he had me doing squats with a 45-pound bar using the correct form.”  

* Gavin is not his actual name

to protect his privacy. 


“It was manageable, but there was some knee discomfort.”


“But I really stopped doing them because my left knee was waking me up at night.  


“I would wake up, and I’d have to move my knee around before the pain would sort of go away.”



“I also tried lunges and more squats and all this stuff for about a year, and it just hurt.”  


“My knees didn't get any better.”

What was causing Gavin’s knee pain?

“I was not enormously physically active when I was young and working a lot. I didn't have time nor the inclination,” Gavin admitted. 



Now he and his wife walk a lot.  


“When I walk three or four or five miles, I don't have any pain. But my left knee sort of hurts at night after I do.”



Gavin and his wife went to Ireland a year ago and then to England more recently. They walked ten to 18 miles a day. 


And his knees hurt, especially when he walked down hills.  



“I went down 30-degree or 45-degree slopes with hiking sticks. I had to take slow steps because of the pain.”


“I loaded up with a prescription dose of Naproxen twice a day.”



“But I'd like to be able to go on these walks a couple of times a year, and not have to worry.”  


“And I'd like to avoid a knee replacement.”

Gavin’s Critical Question

“I'm not going to ask myself to do stuff I never did before.”


“I'm never going to be playing tennis.” Gavin laughed, “I never did, and I'm not going to start now.”


“I mean, I'm not trying to win any contests. So how much leg strength do I really need?”

How much leg strength is really necessary?

Gavin’s question about leg strength is insightful.


Not everyone needs the same amount of strength.  



The activities you want to enjoy without knee pain will determine how much strength you need.  



In Gavin’s case, he wants to be able to walk unlevel trails. 


He wants to descend hills and stairs. 


And he doesn’t want to wake up later that night with knee pain.

Two types of leg strength

When most people think about improving their leg strength, they think about muscles.  


Muscles move your legs when you’re walking.


They lift your body as you walk up stairs, and they control your descent as you go down hills or stairs.  



If Gavin’s muscles were too weak to complete these activities, he would have complained about fatigue and discomfort in his muscles – on the front of his thighs, on the back or outer sides of his hips.  


But he wasn’t hurting in these places.  



His pain was in his knees, not in his leg muscles.  



So while strength around the knees (outside the knees) – like muscles – is very important, this wasn’t the type of strength that was limiting Gavin. 



Instead Gavin needed to improve the other type of leg strength, the strength inside his knees.  


This includes both the surfaces (the cartilage) and the quality of the fluid (synovial fluid) inside Gavin’s knees.

When both structures inside your knees are strong and healthy, they better withstand forces like the repetitive impact of walking thousands of steps each day. 


And they protect and prevent your knees from harm as they bend during activities like taking the stairs.  



Gavin’s trainer recommended squats with a 45-pound bar, focusing on muscle strengthening.  


It’s not a bad exercise, but it placed extra force on his knees before they could tolerate that amount of load, causing more knee pain.

Instead, my recommendation was to follow the Inside Out Knee Strength approach – to start by improving the inside of his knees. 



Better, thicker knee fluid will provide shock absorption for your knees with each step you take – regardless of whether you’re walking, hiking, skipping, jogging, etc. 


And stronger cartilage, the coating on the end of your bones, assure that you can withstand the force from your bodyweight (plus the weight of whatever you may be carrying) as you bend your knees when you’re taking the stairs.  



This means your knees feel good, and are protected from getting worse (sometimes bad enough to require a knee replacement). 


And it means your knees will be able to withstand more challenging forces, if you decide to perform even harder exercises and activities.   



Curious about whether this approach will work for your knees?  

Find out by scheduling here. 


Interested in more insights on this topic?  

Watch this video.

Key Takeaways:

  • Improvement is still possible even with a diagnosis of “bone on bone” knees. 

  • Muscle strengthening alone isn’t enough because it won’t always increase Load Tolerance. (Low load tolerance = pain.)

  • Stronger, healthier cartilage and thicker synovial fluid increase your knees’ ability to absorb shock and handle load.

  • Improving these two structures inside your knees improves Load Tolerance, resulting in stronger pain-free knees.

Related Articles

For Inside Out Knee Health,

here's a guide to get started:

You can access it here. 


For personalized guidance to build Better Knees:

Schedule a free 20-minute Strategy Session.  (Find your best time here.)


Disclaimer: The information in this blog post is for educational and informational purposes only and is not intended as medical advice. It should not be used to diagnose, treat, or prevent any health issue or disease without consulting with a qualified healthcare professional. The author of this blog and the website do not bear any responsibility for any actions taken based on the information provided in this blog.