Knee Pain

I constantly find myself telling people, “Knee pain is almost never coming from the knee.”  What do I mean by this?  Let me explain. 

There is a common saying in the physical therapy world: “Pain is like smoke, you need to find where the fire is to put it out.”  This means that we have to look at the patient as a WHOLE and assess the patient biomechanically to see what’s happening. When someone comes in with insidious knee pain and doesn’t know how it happened, it’s often stemming from elsewhere.  Now, if someone came in and told me they were in a soccer game and had someone slide-tackle them and their knee bent backward, then yes, it’s most likely coming from the knee. But if it’s NOT coming from the knee, then were is it coming from?

Now, depending on the person and what exactly is happening, there are lots of places it can be stemming from.  Poor ankle mobility, poor arch strength, poor pelvic mobility, heck a tight shoulder could even lead to knee pain… but for the purpose of THIS blog post, I’m going to talk about WEAK HIPS. 

Hip weakness is a big indicator of possible knee pain or future trauma.  The big ones that should be strengthened are the  extensors (kicking behind you), the Abductors (kicking away from you to the side) and the external rotators (turning your foot outward).  Research has shown that if these muscle groups are strengthened, it will most likely reduce the risk of injury (Crowell, K. R., Nokes, R. D., & Cosby, N. L. (2021). Weak Hip Strength Increases Dynamic Knee Valgus in Single-Leg Tasks of Collegiate Female Athletes, Journal of Sport Rehabilitation30(8), 1220-1223. Retrieved Jan 16, 2023, from

So how do you know if you are weak in the hips?  Well, you could see a physical therapist for an injury risk assessment, or you can do some quick functional tests.  Genu Valgus, also know as knock-kneed, is a big indicator of hip weakness.  Now, some people are just genetically knock-kneed.  But if you’re not, and when you do a squat, your knees dive inward, that’s a good sign you are weak in those muscles.  If you aren’t really sure because your knees might SLIGHTLY dive in, then jump off a small box onto the floor in front of a mirror.  If your knees dive in, you could be in trouble for a future knee injury.  You should have the strength to do a squat and have your knees perfectly in line with your ankle.  

Now, one other tid-bit of information regarding squats.  Turn to the side in front of your mirror.  When you do your squat, your knees should never cross over your toes.  If they do, your are doing the squat improperly and could hurt your knees a DIFFERENT way.  You need to get your BUTT BACK like you are sitting in a chair.  If you feel that your are going to fall backward, then place a chair behind you.  If you fall, you SIT and wha-la.  You just stand back up again. 

If you need help understanding exactly what exercises you need to do to strengthen your hips, then reach out to your local physical therapist and they will be happy to help you.