How Hip and Foot Strength Affect Knee Pain by Sydney Dixon PT, DPT, ATC
June 9, 2023
Have you ever wondered why a physical therapist gives a patient with knee pain exercises for their hip and foot? Many people live with knee pain that affects their daily activities and quality of life. There are many conditions that can cause knee pain. Patellofemoral pain syndrome is one of the most common diagnoses of knee pain that we see in our clinic every day and accounts for 25-40% of all knee pain cases. If you do a quick Google search for “best exercises for front knee pain,” you will get many exercises that strengthen your quad (thigh muscle) and stretches for various muscles around your knee. While not wrong, the exercises provided are usually very general and do not address deficits above and below the area of the pain. Sometimes your knee hurts, but the source of your pain is actually in your hip or your ankle. Recent advances in research have shown how weakness in the gluteus medius muscle (muscle on the outside of your hip) and/or over-pronation caused by weakness in the small muscles of the foot increase malalignment at the knee during walking, running, stair climbing, squatting, and other daily activities. This malalignment can cause an increase in stress on the ligaments around the knee and possibly improper tracking of the patella (knee cap). These deficits can cause pain and popping, symptoms many people who have patellofemoral pain syndrome report. Research has shown a significant reduction in knee pain and improvement in quality of life with the addition of gluteus medius and foot strengthening.
So, what hip and foot exercises can I do to reduce my knee pain? Below are some exercises that will strengthen your hip and foot to reduce the stress on your knee.
Resisted Side Steps (for glute med strengthening)
Sidelying Hip Abduction (for glute med strengthening)
Clamshells with Resistance bands (for glute med strengthening)
Various Single Leg Balance Exercises (for prorpioception)
Foot doming (for foot intrinsics)
Toe Yoga (for foot intrinsics)
Towel Crunches (for foot intrinsics)
If you try these exercises and are not seeing relief from your symptoms, we recommend that you seek further evaluation and treatment from your trusted healthcare provider. At Physiolete Therapy and Performance we provide complimentary screens to help you with further steps in the care of your pain.
Kısacık, P., Tunay, V. B., Bek, N., Atay, Ö. A., Selfe, J., & Karaduman, A. A. (2021). Short foot exercises have additional effects on knee pain, foot biomechanics, and lower extremity muscle strength in patients with patellofemoral pain. Journal of Back and Musculoskeletal Rehabilitation, 1–12. doi:10.3233/bmr-200255
Nakagawa, T. H.; Muniz, T. B.; Baldon, R. d. M.; Dias Maciel, C.; de Menezes Reiff, R. B.; Serrao, F. V. (2008). The effect of additional strengthening of hip abductor and lateral rotator muscles in patellofemoral pain syndrome: a randomized controlled pilot study. Clinical Rehabilitation, 22(12), 1051–1060. doi:10.1177/0269215508095357
Payne, Karlie; Payne, Justin; Larkin, Theresa A. (2019). Patellofemoral pain syndrome and pain severity is associated with asymmetry of gluteus medius muscle activation measured via ultrasound. American Journal of Physical Medicine & Rehabilitation, (), 1–. doi:10.1097/PHM.0000000000001367