Your Knee Pain Can Be Coming From Your Hips - Total Performance Physical Therapy

Have you experienced knee pain while running or even during your daily activities? If so, you’re not alone. Knee pain is a common issue that 25% of adults in the United States face, often without realizing that the source of the problem may lie elsewhere. If you have and work with a physical therapist, you may have noticed that they use exercises focusing on your hips. Why is this?

Understanding the interconnectedness of your body is crucial. While there may be an issue with the knee, a good place to look for the cause of pain is in the hip region. One of the muscles on your hip is the gluteus medius, and it could be the main culprit of your knee pain. If the muscles surrounding your hips and pelvis are weak, there may be increased stress placed on your knee or other areas of your legs. This can result in increased pain and further injuries.

Addressing the strength and stability of your hips not only helps alleviate knee pain but also enhances your overall mobility and performance in various activities. Let’s look at why your gluteus medius is causing knee pain and how you can strengthen your hip muscles with specific exercises.

What Is the Gluteus Medius, and What Does It Have to Do With My Hip?

Several muscles are surrounding your pelvis and hips. Many of us have heard of the gluteus maximus muscle, also known as the buttocks muscle. This muscle is the strongest and largest muscle in the human body. It is responsible for the movement of the hip and thigh. You use this muscle to stand up from a chair, go up the stairs, stand up, and walk around. While this is the largest and most well-known buttocks muscle, two other gluteal muscles are very important to the hip region, especially while running — the gluteus medius and gluteus minimus.

The gluteus medius and minimus sit more on the side of each hip and start right underneath your gluteus maximus. They function to pull your thigh directly out to the side, also known as hip abduction. This is the motion of your leg while performing a jumping jack. It also functions to rotate the thigh inward.

The gluteus medius muscle is vital for your ability to walk around day-to-day and to run. During these activities, you are often standing on one leg as the other leg advances forward. For example, when you are standing on your right leg and holding the left leg up in the air, your right gluteus medius is active and functions to keep your hips level. If this muscle is weak, your hips will become uneven, and higher stress will be placed on certain parts of your legs. Over time, this can lead to injury.

Furthermore, the gluteus medius plays a critical role in maintaining lower body stability and balance. Its strength and coordination are essential for effective load distribution and shock absorption during movement, reducing the risk of injuries not only in the knees but also in the lower back and ankles. Factors that may contribute to the weakening of the gluteus medius include a sedentary lifestyle, which limits regular muscle engagement and strength building.

Muscle imbalances, often exacerbated by repetitive activities or poor posture, and previous hip or lower limb injuries, which may lead to compensatory movement patterns, also significantly affect the health of this muscle group.

Running Injuries from Gluteus Medius Weakness

Weakness of your gluteus medius muscle has been shown to contribute to many common running injuries. Some examples of injuries associated with this weakness are:

Knee pain on the inner or outer knee: When your gluteus medius is weak, you cannot properly control your thigh bone or femur. When this bone falls too far towards the midline of your body, it can cause stress on the knee in different areas. A weak gluteus medius causing knee pain can impede a runner’s ability to train. It can slow you down and may be all you can think about.

Low back pain: If your gluteus medius muscle is weak and not working correctly, more stress is placed on the muscles of your lower back to compensate for the weakness. This causes increased low back pain.

Iliotibial band syndrome: When there is a weakness of the gluteus medius, and there is more stress placed on the IT band that runs down the outside of your thigh. This causes increased inflammation of the IT band and increased pain as a result.

There are many other leg and foot injuries associated with weakness of the gluteus medius. Trigger points, or muscle knots, are also commonly formed throughout the leg muscles when the gluteus medius is weak. These can be treated with a foam roll program or manual therapy from a physical therapist.

How Can I Tell if My Gluteus Medius Is Weak?

There are many quick tests to tell if you have weak gluteus medius muscles.To accurately assess the strength and function of the gluteus medius, physical therapists may employ several tests.

The Trendelenburg Test, for example, is a quick and effective way to identify gluteal weakness. During this test, the patient is asked to stand on one leg for a short period. If the pelvis drops on the side of the lifted leg, it suggests weakness in the gluteus medius of the standing leg.
The Hip Abduction Strength Test involves the patient lying on their side while attempting to lift the upper leg against resistance; this test directly measures the strength of the hip abductors, including the gluteus medius.
Additionally, functional tests such as walking on toes/heels or performing a timed single-leg stance can provide insights into the practical impact of gluteus medius strength on balance and stability.

Visual aids such as images or videos demonstrating these tests can further help patients and therapists understand and analyze the muscle’s performance effectively.

What Do I Do if My Gluteus Medius Is Weak?

Because weak hips cause knee pain, you’ll want to focus on your gluteus medius during your strength training. Many exercises can be performed to target this essential muscle of your hip. First, you should see a physical therapist to have the strength of your gluteus medius and other gluteal muscles assessed. Next, you should begin a hip and core strengthening program to target these muscles in order to treat or prevent hip, knee, and other lower extremity injuries.

Common gluteus medius exercises for knee pain include-

#1 – Pistol (Or One-Legged) Squat:

This type of squat targets your hip structure and helps you regain strength in these muscles.

Stand on one leg with the other leg extended forward at hip level. Lower into a squat on the standing leg, keeping the extended leg straight. Return to the starting position.
Sets/Reps: 3 sets of 8-10 reps.
Progressions: Use a chair for balance or lower the range of motion initially.
Regressions: Perform assisted pistol squats using a suspension physical therapist or by holding onto a stable surface.
Proper Form: Keep the spine neutral and the squatting knee pointed straight ahead to avoid inward collapse.

#2 – Pelvic Drop Exercise:

This exercise strengthens your weak gluteus medius.

Stand on a step with one foot, letting the other hang off the side. Lower the hanging leg by dropping the hip and then raise it back to level.
Sets/Reps: 3 sets of 10-12 reps.
Progressions: Increase the height of the step or add ankle weights for more difficulty.
Regressions: Perform the exercise with a lower step or a reduced range of motion.
Proper Form: Keep your shoulders and hips squared and aligned during the movement.

#3 – Lateral Hip Raises:

With an exercise band around your ankles, perform these raises while lying on your side to target your hips.

Lie on your side with an exercise band around your ankles. Lift the upper leg towards the ceiling while keeping your hips stacked and the leg straight, then lower back down.
Sets/Reps: 3 sets of 15-20 reps.
Progressions: Increase band resistance or add a weight on your thigh.
Regressions: Perform without the band or with a lighter band.
Proper Form: Avoid hip rotation; keep the movement strictly in the lateral plane.

#4 – Gait Retraining:

Often, weak hip muscles can cause your gait to be thrown off, which may cause knee pain. A physical therapist can run through exercises with you to improve your gait.

Warm up, then walk on a treadmill or a path while a therapist assesses and corrects your walking pattern using verbal cues and mirrors.

Sets/Reps: Perform 3-5 sets of walking intervals, each lasting 2-5 minutes, with rests in between as needed.

Progressions: Gradually increase walking intervals, incorporate obstacles, vary speeds, add slopes, or use resistance bands to enhance strength and coordination.

Regressions: Reduce interval lengths, use support like handrails or walkers for stability, or engage in aquatic therapy to lessen weight-bearing stress.

Proper Form: Maintain an upright head and torso, engage core, ensure natural arm swing, and use a heel-to-toe foot motion with natural step lengths to promote efficient walking patterns.

#5 – Clamshells

Clamshells target the hip abductors, specifically the gluteus medius, essential for stabilizing the pelvis and preventing knee and hip injuries. This exercise helps improve hip stability and supports a better gait pattern.

Lie on your side with knees bent at a 90-degree angle, and feet together. Raise the top knee while keeping your feet together. Lower the knee back down.
Sets/Reps: 3 sets of 15-20 reps.
Proper Form: Keep hips stacked and do not roll backward.

#6 – Glute Bridges:

Glute bridges focus on strengthening the gluteus maximus, which supports the lower back and enhances core stability. Strong glutes improve posture and performance in sports, while also mitigating lower back pain.

Lie on your back with your knees bent and your feet flat on the floor. Lift your hips up to create a straight line from your knees to your shoulders, then lower back down.
Sets/Reps: 3 sets of 12-15 reps.
Proper Form: Keep your core engaged and avoid arching your lower back.

How Do I Avoid Putting Stress on My Knees and Hips?

If you’re recovering from an injury because of your weak hips, be sure to follow the strengthening exercises your physical therapist gave you. You may feel like you want to immediately get back up to exercising the way you were before the injury, but give your knees and hips time to heal. Exercise lightly on a regular basis with floor exercises, hand weights, gentle yoga, or swimming.

Are My Weak Hips Causing My Knee Pain?

Continual knee pain is not a good sign, especially for runners still wanting to train and improve their skills. If you’re struggling with painful knees, a physical therapist can perform an assessment of your hip mobility and strength to determine if your gluteus medius muscle is weak. They’ll be able to relieve the stress on your knees by strengthening your hips.

For more information on physical therapy services or gluteus medius testing, contact us today!