Knee pain is one of the most common musculoskeletal complaints among both physically active and sedentary people. However, increasingly, studies suggest that the hip may also play an important role in this problem.
But ultimately, does weakness in the hip muscles really cause knee pain?
The answer is: it depends. Science shows a strong association between hip weakness and some painful knee conditions, especially patellofemoral pain. However, it is important to emphasize that in some cases, the pain may be a consequence of several other factors.
What is the relationship between the hip and knee?
The hip functions as an important base of stability for the lower limbs. During activities such as walking, running, climbing stairs, or squatting, muscles such as the gluteus medius and gluteus maximus help control the positioning of the pelvis and femur.
When this control is insufficient, an increase in adduction and internal rotation of the hip may occur during movements. As a consequence, the knee tends to shift inward, a phenomenon known as dynamic valgus.
This movement pattern can increase stress on the patellofemoral joint, contributing to the onset or worsening of anterior knee pain.
What do the studies show?
A systematic review published in the British Journal of Sports Medicine analyzed several studies on hip strength in people with patellofemoral pain.
The authors found consistent evidence that individuals with patellofemoral pain have lower hip muscle strength compared to people without pain.
On the other hand, the prospective studies evaluated did not find sufficient evidence to state that hip weakness is a direct risk factor for the development of pain. In other words, weakness may be a consequence of pain and not necessarily its cause.
This is important information because it shows that the relationship between the hip and knee is more complex than a simple cause-and-effect relationship.
If weakness may not be the cause, why does strengthening the hip help?
Although science is still debating the origin of this relationship, the results of treatments are quite consistent. A meta-analysis published in the Journal of Orthopaedic & Sports Physical Therapy demonstrated that programs combining hip and knee exercises reduce pain and improve function more effectively than exercises focused solely on the knee.
Other systematic reviews have reached similar conclusions, showing that strengthening the hip abductors and lateral rotators contributes to improved pain and functional capacity in people with patellofemoral pain syndrome.
This suggests that, regardless of whether weakness is a cause or consequence, working the hip muscles can be part of an effective treatment strategy.
So does all knee pain originate in the hip?
No.
Knee pain is multifactorial. Several factors can contribute to its development, including:
- Training overload;
- Biomechanical alterations;
- Muscle weakness in different muscle groups;
- Joint stiffness;
- History of injuries;
- Individual anatomical factors;
- Psychosocial aspects related to pain.
Therefore, stating that “the cause of your knee pain is weak glutes” may be an oversimplification.
The most appropriate approach is to conduct a complete evaluation to identify which factors are present in each case.
Putting science into practice: Knowing that strengthening the hip can contribute to pain relief is only the first step. The most important thing is to follow an organized and progressive exercise routine.
If you are looking for a structured program to start with, you can check out this exercise routine focused on strengthening and physical conditioning:
What can we conclude?
Current science shows that people with patellofemoral pain often have lower hip muscle strength. However, it is not yet entirely clear whether this weakness is the cause of the pain or an adaptation resulting from it.
What we do know is that exercises that strengthen the hip, especially the glutes, can reduce pain and improve function when they are part of a well-structured rehabilitation program.
Therefore, when treating knee pain, it is worthwhile to look beyond the painful joint and consider the entire lower limb as an integrated system.
References
Rathleff MS, Rathleff CR, Crossley KM, Barton CJ. Is hip strength a risk factor for patellofemoral pain? A systematic review and meta-analysis. Br J Sports Med. 2014.
Nascimento LR, Teixeira-Salmela LF, Souza RB, Resende RA. Hip and Knee Strengthening Is More Effective Than Knee Strengthening Alone for Reducing Pain and Improving Activity in Individuals With Patellofemoral Pain. J Orthop Sports Phys Ther. 2018.
Barton CJ, Lack S, Malliaras P, Morrissey D. Gluteal muscle activity and patellofemoral pain syndrome: a systematic review. Br J Sports Med. 2013.
Rogan S et al. Effects of Hip Abductor Muscles Exercises on Pain and Function in Patients With Patellofemoral Pain: A Systematic Review and Meta-Analysis. J Strength Cond Res. 2019.
Alammari A et al. Effect of hip abductors and lateral rotators’ muscle strengthening on pain and functional outcome in adult patients with patellofemoral pain: A systematic review and meta-analysis. 2023.