Exercise therapy is widely recommended for knee osteoarthritis, yet clinical response varies markedly even when programmes appear similar. The decisive determinant is the neuromuscular dose actually delivered to the joint during functional tasks, rather than the surface similarity of prescriptions. Joint load is shaped by muscle recruitment amplitude, timing, sequencing, and co-contraction; inefficient or overly protective strategies can perpetuate unfavourable mechanical provocation. Such maladaptive loading may sustain a vicious cycle linking pain, guarding, and microenvironmental irritation, limiting durable symptom change even when strength increases. We propose a precision rehabilitation framework that explicitly couples three domains—central state, peripheral execution, and joint load—to guide progression. Surface electromyography can verify whether target muscles are truly recruited and whether antagonistic co-contraction is dominating, and can serve as temporary biofeedback to accelerate motor learning. Electroencephalography can index pain-related arousal, threat reactivity, and sensorimotor readiness, helping clinicians select tasks and dosing that the nervous system is prepared to learn. We emphasize that integrating cerebral and muscular signals is not yet an established superior therapy; its value should be tested in methodologically rigorous, phenotype-based trials that align mechanistic claims with clinically meaningful endpoints, including flare vulnerability, load tolerance, and durable changes in movement strategy.