Knee Pain – Part 1: Is the problem in your hips?

When Susan* first started her training sessions, she was terrified of squats. “I absolutely cannot squat,” she said, “They hurt my knees.” After taking a look at her squat, it was clear why they caused her pain: she would shift all her weight forward into her toes, sending the knees travelling far forward and caving inwards, with no help from her glutes to help her stand up. With a couple quick cues to adjust her stance and to sit the hips back and down, she was amazed that she could perform this movement pain-free that same day. Over the next few months, by focusing on proper form and building strength throughout her hips, Susan no longer felt her knee pain during her every day activities like climbing stairs, and she built the confidence to never be afraid of squatting or lunging again.

Susan is not the only one to have felt this worry. Over the next 3 weeks, we’re going to tackle a common complaint from our clients – knee pain.

Before we dig in, though, we need to be clear that there are many different causes and treatments for pain, and the best thing that you can do is get yourself checked out by a health professional who can diagnose your pain (preferably a physiotherapist – and if you don’t know a good one, we’re happy to give you some names!). The recommendations we touch on here are general mobility and strengthening exercises that can help to build more stability in the structures around the knee, which in many cases can help to alleviate pain, but are not a replacement to the personalized care plan that a physiotherapist can provide for you.

Often, pain in the knee can be traced back to a lack of stability, causing the knee to track improperly during our everyday movements and exercise. This lack of stability can usually be traced back along the chain to originate in the joint below (the ankle) or above (the hip). In the first part of this series, we’ll focus on problems stemming from the hip.

How can you tell if your hips are weak?

  • When you stand on one leg, does the opposite hip drop, or does your pelvis stay level?
  • When you sit and stand, do you feel tension on your knees or notice they cave in together?
  • When you perform squats and lunges, do you feel all the tension in the front of your thighs (or again, notice any caving in of the knees)?

What areas should you focus on stretching/mobilizing?

  • Glute Medius, TFL and IT band: these structures along the top and sides of your hip can feel very tense, many times from being constantly “on”, trying to pull your knee into a proper line of tracking (away from caving in all the time). You can find some release with self-massage techniques using a foam roller or lacrosse ball, and with some mobility work to open up the side of the hips and torso. 
  • Hip Flexors and Quads: tension here can pull your pelvis into an anterior rotation (where the back of your hips sit higher than the front), which in turn puts our glutes in a constantly lengthened position – making it harder for them to generate strength. You can use the foam roller to release tension throughout the front of the thigh and use half kneeling lunges to further release these muscles. 
  • Erector Spinae and QL: similar to what was going on with the hip flexors, tension here can pull the back of the hips upwards, again adding to anterior rotation of the hips and preventing the glutes from doing their job. Try some quadruped rocking and walking child’s pose to help reduce tension in your low back. 

What areas should you focus on strengthening?

  • Glute Medius and TFL: even though these muscles are constantly “on” to pull the knee into place, that doesn’t mean they are strong. Exercises to help build strength here include banded walks, side lunges, and putting a focus on driving the knees out during your squats.
  • Glute Max: the powerhouse of our body, building strength here can go a long way. Incorporate exercises such as squats, deadlifts, bridges, lunges, and step ups/step downs (all the while focusing on “squeezing” through your butt to help complete the movement) to build that booty. 
  • Hamstrings: when your hips rotate forward, the hamstrings get pulled along with the glutes, putting them in a less-than-ideal position. Often, that feeling of “tightness” you notice in the back of your thighs is not because these muscles are tight, but because they are stretched and taught like an elastic band waiting to be snapped. Instead of stretching and stretching some more, build some strength in your hamstrings, using Romanian deadlifts and hamstring curls (you’ll also be using them to help the glutes in all the movements shown above). 
  • Adductors: as much as we need strength in the muscles that pull our knee outward, we need balance along the inner thigh to ensure the knee is stable in every direction. Incorporate movements like side lunges, pallof side steps, and crossover step ups to help here.

Give these a try and check back next week for more tips on building stability at the ankle!

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