What I Would Tell My Best Friend: When It’s Not Really Your Knee

What I Would Tell My Best Friend, a Valivera Health series

If you told me your knee hurt, I'd ask a few simple questions. Where does it hurt? When did it start? What makes it better or worse? Was there an injury?

But if you told me it's your knee this year, your Achilles last year, and your wrist the year before, I'd probably put my coffee down. At that point, I'd stop thinking only about your knee.

As an orthopedic surgeon, I was trained to evaluate the problem in front of me. If you have tendinitis, there are well-established ways to treat it: activity modification, anti-inflammatory medications, physical therapy, strength work, weight management, or other conservative treatments. Very often, that is exactly the right place to start.

But if you were my best friend sitting across the table, I'd keep asking questions.

When One Injury Starts to Look Like a Pattern

I'd want to know what else has been going on. How are you sleeping? Have you noticed changes in your energy or weight? Are you moving as much as you used to? How is your nutrition? Has your blood sugar changed? Is your thyroid functioning the way it should? Are you going through perimenopause or menopause? What has stress looked like over the past several years?

Maybe you've been caring for aging parents while raising teenagers. Maybe work has been relentless. Maybe you're sleeping six hours a night and calling it good because that's what you've gotten used to. And maybe somewhere along the way, you started moving less because something always seems to hurt.

None of these automatically explains your knee pain, and having multiple aches or injuries doesn't necessarily mean there's one underlying cause. But together, they may be a reason to look beyond the joint that hurts today.

Your Musculoskeletal Health Doesn't Exist in Isolation

Your muscles, bones, joints, and tendons are part of a much larger system. Sleep affects recovery. Nutrition provides the building blocks to maintain muscle and repair tissue. Metabolic health can influence inflammation and healing. Stress can shape sleep, movement, eating habits, and even how we experience pain. And hormonal changes during midlife can coincide with changes in bone, muscle, body composition, and musculoskeletal symptoms.

That's why I don't believe these factors should be looked at in isolation. It's something I became increasingly curious about during my years in orthopedic surgery. I'd see people with similar diagnoses or procedures have very different experiences with pain, healing, and recovery, and I wanted to understand not only what was happening, but why.

That question eventually changed the way I practice medicine.

Treat the Knee. But Ask Why, Too

Looking at the whole person doesn't mean ignoring the orthopedic diagnosis. If your knee needs physical therapy, we address your knee. If your Achilles needs time and rehabilitation, we treat the Achilles. And if something truly requires an orthopedic procedure, that needs to be recognized, too.

But sometimes treating the body part in front of us is only one piece of the plan. If you keep moving from one injury or pain point to the next, I want to understand whether other factors are making it harder for your body to recover, maintain strength, or stay resilient. That's where the conversation becomes much more personal.

The Right Plan Won't Look the Same for Everyone

Once we understand the bigger picture, we can decide what makes the most sense for you. For one person, the best place to start may be sleep, nutrition, strength training, or changing the way they move. Someone else may benefit from physical therapy, working with a trainer, therapeutic yoga, or acupuncture. Depending on your health history, we may also talk about supplements, hormone therapy, medications (including GLP-1 medications when clinically appropriate), or other evidence-based treatments.

The point isn't to use everything. Good medicine is often about knowing what to use, when to use it, and in what order. I don't want to hand anyone a list of ten things to change tomorrow. I want to identify what matters most, start there, see how your body responds, and build from it.

You're More Than the Joint That Hurts

So if you were my best friend and you told me, "It's my knee again," I'd absolutely want to help you figure out what's going on. But if I started hearing a pattern, I'd ask you to let me look a little wider. Because sometimes the question isn't simply, "How do we make this knee feel better?" It's, "Why does your body keep asking for our attention?"

You're not a knee. You're not a tendon. You're a whole person.

And sometimes the best way to treat what hurts is to understand what else is going on.

Dr. Liz Dulaney-Cripe