Did you know that the source of your knee pain could be in your hip?

For many years, physicians and physical therapists thought that knee pain was caused by a weak quadriceps muscle and a poorly positioned kneecap.  They had some success but not enough because they were missing the bigger picture.

Through improved research, we now know that the kneecap position and the function of the quad is greatly influenced by the mobility and strength of the hip. 

Here are the three most important ways that the hip prevents and eliminates knee pain in the runner. 

  1. The hip keeps the knee in line. 

The knee joint is much happier when it is in line with the ankle and the hip. This allows the ground reaction force – the energy that the ground inflicts on us – to transfer into the muscle tissue where it can be absorbed & used for the next push off.  If the knee dives inward, and falls out of line of the ankle and hip, then the ground stress transfers through tissues other than muscle including joint (meniscus), ligaments (ACL) and fascia (iliotibial band). The hip muscles, specifically the muscles on the outside and back of the hip, prevent the knee from diving inward and thus limit the stress that goes into these other commonly injured tissues. 

  1.  Mobility in the hip helps to prevent compression of the kneecap. 

The kneecap has to be able to move freely to allow the leg to work efficiently. Knee pain in runners is often related to the kneecap pressing into its groove too tightly. Tightness in the front of the hip and down the front of the thigh can cause the kneecap to be too compressed. This tightness can be from the hip capsule itself, or mainly two hip muscles, including Iliopsoas and rectus femoris. If these tissues are found to be tight in a runner with knee pain, increasing their mobility has profound effects at eliminating their pain. 

  1.  The hip is the key link between the core muscles and the knee. 

We generate most of our power for limb movement from our core. If this system of transferring power and coordination from the core down the leg is interrupted by faulty mechanics or weakness in the hip, the victim is often the knee. The hip’s ability to transfer power from the core to the knee in all three planes of motion is critical for injury prevention and resolving current knee pain.

Self assessment of these three measurements is very difficult.  

All three factors can be assessed with a comprehensive running analysis. We look at the relationship of the hip and knee from all three planes of movement. We also have you do exercises to strengthen assessment moves, including the squat and a specific step down test to show us whether you are using your full hips potential to help protect the knee.  

In addition to a running specific video analysis, some runners need more hands-on care. We can help assess this need. If it is determined this is needed, we strongly advise you finding a healthcare clinician that specifically specializes in the runner. 

Dr. Eric Schweitzer, DPT

Founder at IdealRun
Doctor of Physical Therapy, author, professor, runner and triathlete – has practiced physical therapy for more than 15 years.He runs a successful physical therapy practice, Premier Physical Therapy, located in Clearwater, Florida and is the founder of IdealRun a personalized online running gait analysis.
Dr. Eric Schweitzer, DPT

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