Hip Weakness May Contribute to Knee Pain

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If you have knee pain or other knee problems, your physical therapist may pay close attention to your hips and the strength of your hip muscles. Why? Because your hip muscles, like the gluteus medius, control the position of your knees when you are walking, running, or jumping.

Woman running with hip muscle illustration shown
Henning Dalhoff / Getty Images

Knee pain is a common problem that can be caused by many things including arthritis, trauma, repetitive strain, or running, and it may limit your ability to walk, run, or climb stairs.

Anatomy of the Hip

The movement and stability of your hips and knees work together and share several muscles. The hip is a ball and socket joint and is a major weight-bearing joint in the body. There are many ligamentous attachments that add to the stability of your hip.

There are also many muscular attachments around the hips that help control the motion of your hip joint and your leg.

The gluteus medius, a muscle group around your hips, can have an effect on knee pain.

The gluteus medius muscle helps to:

  • Abduct your hip and thigh—pulls your leg out to your side
  • Rotate your thigh outward when you are sitting
  • Work with other muscles to rotate your thigh inward when you are standing
  • Keep your pelvis level when you are standing and walking

Weakness in the Hip

Weakness in your gluteus medius muscle may be caused by injury or it can develop due to a lack of exercise. Weakness in your hip flexor muscles in the front of your hip may lead to weakness in your gluteus medius muscles in the back and side of your hip. This is sometimes referred to as dormant butt syndrome.

How Hip Weakness Affects the Knees

When your gluteus medius muscle becomes weak, it allows your thigh to rotate and pull inwards abnormally. This is called a "collapsing kinetic chain." This abnormal position of your thigh can put excessive stress and strain around your knee joint and kneecap (patella).

A collapsing kinetic chain is often an indirect cause of an anterior cruciate ligament (ACL) injury. This can happen when the knee collapses in (possibly due to weak glutes) while running or jumping, and the knee buckles in, tearing the ACL.

Common knee injuries and problems that may occur as a result of hip weakness include:

If you are experiencing knee pain, you should visit your healthcare provider or physical therapist. They can evaluate your condition to determine the cause of your pain.

A thorough evaluation and assessment of your gait, lower extremity strength (including hip strength), flexibility, and range of motion can help your physical therapist provide the proper treatment for your condition.

Strengthening Your Hips

If you have weakness in your gluteus medius and your thigh turns inwards abnormally during walking and running, then you may be prescribed a strengthening program to target specific hip muscles.

Basic hip-strengthening exercises may help, or you may need more advanced hip-strengthening exercises to help strengthen your gluteus medius.

Other exercises, like the pelvic drop exercise, can also be effective in strengthening your gluteus medius. Since weakness in your hips can affect the position of your leg and your knee, balance and proprioception exercises are beneficial for restoring normal control and position of your thigh.

The use of a BAPS board may help to work on muscular control of your leg and thigh. This can help strengthen your entire lower extremity, placing your leg in an optimum position and taking stress off of your knee.

By working on improving your hip strength and overall balance, you may be able to keep your knees in the correct position and, ultimately, relieve your knee pain.

Be sure to check with your healthcare provider or physical therapist before starting any exercise program to ensure that it is right for you.

A Word From Verywell

If you have knee pain, you may need exercises and therapy to strengthen your hip muscles. In fact, knee pain could be a sign that you are at risk of eventually having an injury to your knee or other parts of your leg. By working closely with your physical therapist, you may be able to strengthen your hips, take the stress off of your knee, and return to your normal activity level quickly and safely.

3 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Brund RBK, Rasmussen S, Nielsen RO, Kersting UG, Laessoe U, Voigt M. The association between eccentric hip abduction strength and hip and knee angular movements in recreational male runners: An explorative study. Scand J Med Sci Sports. 2018;28(2):473-478. doi:10.1111/sms.1292

  2. Santos TR, Oliveira BA, Ocarino JM, Holt KG, Fonseca ST. Effectiveness of hip muscle strengthening in patellofemoral pain syndrome patients: a systematic review. Braz J Phys Ther. 2015;19(3):167-76. doi:10.1590/bjpt-rbf.2014.0089

  3. Ohio State University Wexner Medical Center. Dormant butt syndrome may be to blame for knee, hip and back pain.

By Brett Sears, PT
Brett Sears, PT, MDT, is a physical therapist with over 20 years of experience in orthopedic and hospital-based therapy.