You may develop knee pain if you have misalignments in your feet, hips, or lower back that alter your body mechanics. Imbalances in the natural alignment of your musculoskeletal system place excessive stress on your knees. Even having one of your hips higher than the other can put a lot more strain and weight on one particular knee. Unbalanced muscle tension on one side of your knee could pull the knee cap to the tighter side, causing increased wear and pain.