Babies don't have kneecaps

Pain ScienceMSK PainJing Method™ Massage

Apr 17

Design hiccup:

Babies don't have kneecaps. I mean it. Humans don't develop a patella until somewhere between ages 3 and 5, and before that we've got these little blobs of cartilage just sitting there with potential. Which feels like a fitting start, because knees in general are a bit… unfinished.

They're classified as a modified hinge joint, which sounds straightforward until you look at them properly. Thomas Myers described the knee as 'an elbow designed by committee'. I think of it as the anatomy equivalent of MPs designing SEND reform. Money saving over actual function.

Nearly 1 in 5 adults over 45 in England has knee osteoarthritis. Around half of people over 75 report knee pain. And if you're a woman, you're roughly twice as likely to experience it as a man, with that gap widening as you get older. Knee pain is also one of the most common musculoskeletal complaints GPs see, second only to lower back pain.

The committee's work, everyone.

Most of us will have hurty knees at some point. And hurty knees…. like hurty backs… are scary. Because our cautious, catastrophising mind doesn't land on "this might settle down." It goes straight to knee replacement via arthritis. Do not pass go, do not collect £200.

And we're not helping ourselves, culturally. There's so much noise about knees.

Don't run! The impact! The load! Don't let your knees go over your toes when you squat. Pain is inevitable, your knees are just falling apart. And the worst one: bone on bone 😱. Said in the kind of tone that implies your joint is essentially gravel. There's also the classic, if your knees crack, something is definitely wrong…… (It's probably not.)

Here's what the evidence actually says:

Running: Recreational runners have lower rates of hip and knee osteoarthritis than non-runners (3.5% vs 10.2% in a 2017 meta-analysis). It's sustained elite-level running that edges the risk up, not a couple of parkruns.
Knees over toes: The original study that launched this fear (Fry et al., 2003) found that stopping the knees travelling forward did reduce knee torque by 22% - but shifted a whopping 1,070% more load into the hips and lower back. The body's meant to share the work.
Knee cracking (crepitus): A 2024 meta-analysis found 36% of pain-free people have crepitus. It's associated with some structural changes on MRI but isn't linked to pain, function, or strength. Noisy knees are often just… noisy.
"Bone on bone:" This is a particularly sticky one. Research on patient beliefs has shown that being told you're "bone on bone" reliably leads to fear, avoidance of movement, and worse outcomes; even when it doesn't accurately describe the joint. And what shows up on a knee scan often doesn't match what someone actually feels, plenty of people with 'bad' scans have no pain, and plenty of people with painful knees have unremarkable scans.

Doing everything right….

Here's the thing though. I'm working with a client right now who is doing everything right. Walks regularly, swims, has just started strength training. And their intermittent knee pain has flared up. Got louder. They're frustrated (understandably) and asking all the questions you'd ask.

Was it the fall a few months ago / has moving differently set it off? Is it the deadlifts? Is it their age? Their hamstrings have always been tight, is it them? And then, quietly: is this it now?

My honest answer to all but the last one is: could be. Any of those things could be contributing. Probably some combination of them. Pain doesn't tend to have a single clean origin story.

Because pain is complicated. It's an extraordinary mix of the body signalling the brain and the brain interpreting and signalling back. Both responsive and protective. Our past experiences, our mindset, our fears… they all feed into it. As do hormones, sleep, nutrition, stress. Things we don't always think of as physical.

And then there's the world. We're living in a non-stop information environment, and our nervous systems are absorbing not just our own stress but the stress of everyone around us, and the wider world. The rise of the far right, Gaza, Ukraine, Congo, the climate crisis, the cost of living. None of that stays outside our minds and bodies. All of it turns up the dial on our nervous systems. And a system that's already overwhelmed is going to be a more sensitive one.

Even if you're doing everything right: eating the protein, exercising, sleeping 8 hours, meditating, taking time for yourself… sometimes things still hurt. And sometimes there isn't a clean narrative: I did this thing, it caused that thing, I will heal in this amount of time. Sometimes it's messier than that.

Pain isn't a failing.

Sometimes it gets better on its own. Sometimes it feels endless, and that's the hardest bit. Sometimes you need support to help you understand what's going on and figure out what might actually help…. to look at the whole picture, not just the joint.

If your knees are talking to you and you're not sure what they're saying, that's exactly the kind of thing I work with. You can find me in Newhaven or Brighton or a Jing Method™ therapist in your area.

And if you think honestly this feels more like life stuff than knee stuff - my wife Cloe is a creative counsellor and that instinct is probably right.

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Babies don't have kneecaps

Design hiccup:

Here's what the evidence actually says:

Doing everything right….

Pain isn't a failing.

Further reading for the inquisitive and science-minded

How knees (and kneecaps) actually develop

Epidemiology of knee pain and osteoarthritis in the UK

Myths that scare people about their knees

Pain is more than tissue damage

Sleep, stress and how the world turns the volume up

A book recommendation if you prefer a paperback

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