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Pain in Your Knees? You May Need to Look No Further than Your Hips.

If you’re suffering from knee pain, you may be surprised to learn it’s your hips that are to blame. How’s that? Several research studies over the last decade have shown a link between weak hip muscles and athletic injury, including tendinitis and knee cap pain.  More recently, a link between knee pain from osteoarthritis (“wear and tear” of the joints leading to pain and stiffness) and weak hip muscles has also been established.

Traditional medical treatment for arthritis pain consists of NSAIDs (non-steroidal anti-inflammatory drugs, like Tylenol or Motrin), accompanied by stretching and low-impact activity (walking, biking, etc). While those remain useful approaches to reducing the discomfort of arthritis in the knees, they do little to strengthen the hip muscles most closely associated with knee pain and as a result may be less likely to create long-term improvement. New research shows that a program of clinician-supervised exercises targeting these hip muscles, especially the hip abductors (muscles on the side of the hip that move the hip away from the body and control pelvic alignment), can play a significant role in improving the pain and physical function of people with knee pain.  The main hip muscle you want to strengthen – the gluteus medius.                                                                                               

So how do weak hip abductors, the gluteus medius in particular, lead to the development of pain, tendonitis or arthritis in the knee? Further research is needed but the evidence suggests that over time weak hip abductors lead to changes in the alignment of the pelvis, shifting a person’s center of gravity and putting unusual and uneven pressure on the knee joint. Remember that “wear and tear” we mentioned above? This is one of the ways it happens and pain, joint inflammation, tendonitis and ultimately arthritis can too often be the result.

So, what’s the bottom line? Chances are, if you have pain in your knees, weak hip muscles are making it worse or contributing to the problem.  And an exercise program addressing only the muscles around the knee, may not be effective in resolving the symptoms.   But there’s a silver lining buried in this cloud of weakness. The research also shows you can significantly strengthen your hip muscles and chances are good that the pain and discomfort will go away. 

So, how do you strengthen your gluteus medius?  Let us count the ways.  Quickly googling “exercise to strengthen gluteus medius” will give you enough ideas to make your head spin and your hip muscles panic.   Some of these exercises may help, others may aggravate your problem.  So proceed with caution.  But far be it from us to discourage you from trying a few.  A couple hip abduction exercises that are least likely to aggravate the knee would include:   


              Side-lying Hip Abduction                                                                 The Clam                                                                   


For both exercises it’s important to stabilize your back by tensing your stomach muscles and, at the same time, avoid holding your breath.  For the side-lying hip abduction, it’s best to lift your leg up and back or you’ll strengthen hip muscles other than the gluteus medius.  There’s no magic formula for how much is enough.  In general start with enough repetitions to feel tired but don’t overdo it and make yourself so sore you can’t walk.  You can gradually increase repetitions and then add some resistance through ankle weights or bands if the un-resisted versions seem too easy after a few days.  There are some standing exercises that may be even more effective for strengthening the gluteus medius but those are best done under the supervision of a physical therapist.

Another consideration is that any time one joint in the leg -  be it hip, knee or ankle -  have a problem there are ripple effects above and below the painful joint.  These effects can be a result of or a contributor to the main problem.  It gets complicated quickly.  So if you have knee pain and have tried some things on your own that have not been as effective as you like, your ErgoScience physical therapist can develop a personalized, comprehensive exercise program to strengthen weak muscles and address any biomechanical factors,  putting you on the road to reduced pain, improved mobility and a better quality of life.

Call Shannon at (205) 278-2250 to schedule a specialized evaluation today. And remember, you don’t need a physician’s prescription for your first visit.

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