Why Hips and Ankles Matter for Knee Health
Knee pain is one of the most common complaints in both active individuals and general populations – but the knee is often not the cause of the problem.
How the Hips Influence Knee Pain
Studies show that individuals with knee pain often demonstrate weak hip abductors and external rotators, poor neuromuscular control of the glutes, and increased hip internal rotation and adduction during movement (Rowe et al., 2007). These movements can cause abnormal movement of the knees and therefore causing pain. By strengthening the quads, they can absorb more shock creating less impact on the knee (Harvard Health Publishing, 2012).
Stretching and mobility are equally as important for the hips and helping with knee pain. If your hamstrings are too tight, they can prevent the quads from moving through the full range of motion. Therefore, mobility and stretching the hips are important for knee health (Harvard Health Publishing, 2012).
How the Ankles Influence Knee Pain
While hips control movement from above, the ankles influence the knee from below. Limited ankle mobility can lead to early heel rise during squats or walking, increased foot rotation, and compensatory knee movement leading to knee stress. Studies indicate that improving ankle function alongside hip and knee strengthening can further reduce pain and improve stability (Harvard Health Publishing, 2012).
With all that being said, if the ankle can’t move well, the knee absorbs the extra stress.
What This Means for Training and Rehab
If you’re dealing with knee pain, the solution isn’t just resting. Evidence supports a more comprehensive approach:
1. Strengthening the hips – focus on the glutes and hip external rotators as well as prioritizing single-leg stability and control (Harvard Health Publishing, 2012; Rowe et al., 2007).
2. Improve ankle mobility – address foot control and mobility (Harvard Health Publishing, 2012).
3. Retrain movement patterns – squat, run, and land with proper alignment (Harvard Health Publishing, 2012).
Final Thoughts
Knee pain is rarely just about the knee.
The research consistently shows that both hips and ankles play a major role in knee mechanics, pain, and recovery. Addressing these areas not only reduces pain, but improves overall movement efficiency and resilience.
If you want long-term results, you have to treat the system – not just the symptom.
References
Harvard Health Publishing (2012, June 12). Exercise for stronger knees and hips. https://www.health.harvard.edu/healthbeat/exercise-for-stronger-knees-and-hips
Rowe, J., Shafer, L., Kelley, K., West, N., Dunning, T., Smith, R., & Mattson, D. J. (2007). Hip strength and knee pain in females. National American Journal of Sports Physical Therapy, 2(3), 164-169. https://pmc.ncbi.nlm.nih.gov/articles/PMC2953297/#:~:text=The%20gluteus%20maximus%20posteriorly%20rotates,possibly%20affect%20the%20knee%20joint
