Knee Pain? Watch Those Hips

Patellofemoral pain is one of the most common issues that runners suffer from. It affects approximately 25 percent of the active running population.  Up until recently, knee pain was thought of as dysfunction with patellar tracking due to issues with the quadriceps. However, new MRI studies show that patellar movement dysfunction does not correlate with knee symptoms. Instead, issues with our femur and hip seem to be the key to weight-bearing knee pain. Three hip issues to address are hip flexor tightness, weak glute medius, and SI joint dysfunction. 

Lack of proper hip extension can have major implications when it comes to running and knee pain. It leads to early heel rise during gait, noticed in the running community as a “bop walk” where it looks like the person is bopping up and down as he or she is running or walking. This early heel rise can put excess stress on the structures surrounding the knee. What’s interesting is that it is not glute maximus strength that is the common issue, but rather the hip flexors. Eccentric load of these hip flexors are what causes proper hip extension during gait. This is why tight hip flexors can cause knee pain during running. 

In addition, glute medius weakness can be a significant cause of knee pain while running. Studies show that poor glute medius activation leads to excessive internal rotation of the femur, causing a large amount of stress on the medial meniscus, MCL, and ACL. This is due to the fact that we need our glute medius to keep our knee from crossing midline during running. A great way to see if you may have a weak glute medius is the the single leg squat test. If the affected knee caves in across the midline or you have to shift your pelvis excessively to perform the movement, warm-ups and exercises need to be implemented to strengthen the muscle. 

Lastly, sacroiliac (SI) joint dysfunction can play a huge role in knee pain while running. Good mobility at our SI joint allows proper movement in our pelvis and sacrum during the gait cycle. When our SI joint feels stuck, it can limit other hip movements and cause increased symptoms at the knee. Specifically, individuals with SI joint dysfunction have decreased activation of the hip extensors during gait. 

Have you had issues with knee pain while running? If so, give us a call! We at Indy Muscle and Joint can determine if the issue is the knee or coming from your hip to get you back to your best! 

Alec Domjan, D.C.

Works Cited

Devereaux M, Lachman S. Patellofemoral arthralgia in athletes attending a sports injury clinic. Br J Sports Med. 1984;18:18–21.

Dierks T, Manal K, Hamill J, Davis I. Proximal and distal influence on the hip and knee kinematics in runners with patellofemoral pain during a prolonged run. J Orthop Sports Phys Ther. 2008;38:448

Feeney DF, et. al. Individuals with sacroiliac joint dysfunction display asymmetrical gait and a depressed synergy between muscles providing sacroiliac joint force closure when walking. J Electromyogr Kinesiol. 2018 Dec;43:95-103.

Souza R, Draper C, Fredericson M, et al. Femur rotation and patellofemoral joint kinematics: a weight-bearing magnetic resonance imaging analysis. J Orthop Sports Phys Ther. 2010;40:277-285