Are You a Runner With Knee Pain? It’s All In The Hips.

Imagine a long piece of strong plastic; together it is strong enough to withstand fair amounts of pressure. Now, anchor one end strongly and allow the opposite end to move freely back and forth without control of the forces placed on it. Over time where do you think this piece of plastic will deform or fail? Usually in the middle.  The portion that fails is your knee; the free flowing end is your hip. Without proper control of our proximal joint, the hip, other distal joints can fail without being the causation of the problem. The knee may be the painful area but it may not be the culprit. Joints that are distal and proximal to the painful joint can have a substantial effect on the area involved.

Current and emerging research has shown that various manifestations of knee pain may be a result of weak hip musculature, particularly the abductors and external rotators. Weakness of the hip abductor muscles was found in both male and female distance runners with illiotibial band syndrome when compared to their non-injured leg. Females with patellofemoral pain had lower strength measures in hip strength when compared to healthy uninjured females.

Hip strengthening exercises have been shown to assist in preventing knee pain, as well as decreasing current pain levels. Sample exercises that best activate these muscles include:

1. Single Limb Squat




2. Single Limb Deadlift



3. Single Limb Wall Squat



Visit a physical therapist; a trained movement specialist that can assist you in determining your cause of pain, proper exercise execution, and put you on a path to injury free training.


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2. Distefano LJ, Blackburn JT, et al.  Gluteal muscle activation during common therapeutic exercises.  Journal of Orthopedic and Sports Physical Therapy.  2009. 39: 532-540.

3. Dolak KL, Silman C, et al.  Hip strengthening prior to functional exercises reduces pain sooner than quadriceps strengthening in females with patellofemoral pain syndrome: a randomized clinical trial.  Journal of Orthopedic and Sports Physical Therapy.  2011.  41: 560-570. 

4. Fredericson M, Cookingham CL, et al.  Hip abductor weakness in distance runners with iliotibial band syndrome.  Clinical Journal of Sports Medicine. 2000; 10: 169-175.

5. Ireland, ML, Wilson JD, et al.  Hip strength in females with and without patellofemoral pain.  Journal of Orthopedic and Sports Physical Therapy.  2003; 33: 671-676.

6. Krause DA, Jacobs RS, et al.  Electromyographic analysis of the gluteus medius in five weight-bearing exercises.  Journal of Strength and Conditioning Research.  2009.  23: 2689-2694.