What Causes Hip and Knee Pain (and Why You Need to Treat Them Together)
Hip and knee pain are among the leading causes of mobility loss, chronic discomfort, and decreased quality of life.
Although often addressed separately, these two joints are deeply interconnected — sharing the femur bone and functioning together as part of a complex biomechanical chain. Dysfunction in one joint often destabilizes the other, making a combined approach essential for effective treatment and prevention.
“In my clinical experience, treating hip and knee pain separately often misses the underlying cause of chronic dysfunction,” says Rick Olderman, MSPT.
Olderman, an orthopedic physical therapist with more than two decades of experience, has specialized in identifying hidden movement patterns that drive persistent musculoskeletal pain. His work emphasizes restoring natural biomechanics to address pain at its root, rather than merely treating its symptoms.
Understanding how the hip and knee interact — and how imbalances can lead to breakdown — is a crucial step toward regaining mobility, reducing pain, and maintaining long-term joint health.
Quick Insights: What You Need to Know About
Hip and Knee Pain
- Hip and knee pain are closely linked through shared anatomy and movement patterns.
- Weak gluteal muscles and poor alignment increase joint stress and degeneration risks.
- Strengthening glutes and improving walking mechanics can significantly reduce joint pain.
- Ignoring conditions like Anterior Femoral Glide Syndrome (AFGS) can accelerate cartilage damage.
- Daily habits like avoiding locked knees and using targeted exercises protect joint health.
Why It Matters
Ignoring the interconnected nature of hip and knee mechanics can lead to progressive joint damage, reduced mobility, and a greater risk of osteoarthritis. Research from the American Academy of Orthopaedic Surgeons (AAOS) shows that addressing biomechanical factors early can significantly improve joint longevity and function. Understanding movement patterns — and correcting them — empowers individuals to move better, hurt less, and maintain independence longer.
How the Hip and Knee Joints Work
The Hip Joint
The pelvis is formed from two ilia and the sacrum. Each ilium houses a hip socket called the acetabulum, forming a ball-and-socket joint with the head of the femur (thigh bone). Surrounding the acetabulum is the labrum — a fibrocartilaginous ring that deepens the socket and stabilizes the femoral head through negative air pressure.
The gluteus maximus, the body’s largest muscle, is critical for maintaining hip stability and controlling movement forces through the joint.
The Knee Joint
At the opposite end of the femur, the knee joint forms where the femur meets the tibia (shin bone). The femoral end divides into two lobes, called condyles, which enable natural rotation during movement.
Key structures supporting the knee joint include:
- The meniscus, which cushions and stabilizes the joint.
- The anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL), which guide knee motion and prevent instability.
Common Causes of Hip and Knee Pain
Causes of Hip Pain
Hip pain often stems from a combination of joint dysfunction, muscular imbalances, and structural irregularities. A major contributor is Anterior Femoral Glide Syndrome (AFGS) — a condition where poor gluteal control allows the femoral head to migrate forward within the hip socket.
Olderman explains: “When the glutes don’t stabilize the femur correctly, the thigh bone behaves like a washing machine out of balance — creating friction, irritation, and eventual damage inside the hip joint.”
Common consequences of AFGS include:
- Groin pain (often diagnosed as femoral acetabular impingement [FAI])
- Hip bursitis, caused by bursal irritation
- Labral tears, due to shearing stresses on the labrum
- Piriformis syndrome, leading to sciatic nerve irritation
- Accelerated degeneration contributing to hip osteoarthritis
- Secondary lower back pain from pelvic instability
Causes of Knee Pain
Knee pain frequently develops when the thigh bone rotates inward excessively, increasing strain on the knee joint.
Contributing factors include:
- Habitually locking the knees while standing or walking, straining cartilage, ligaments, and the popliteus muscle
- Weak gluteal strength, failing to stabilize femur positioning
- Structural predispositions such as femoral anteversion (an inward twist of the thigh bone)
According to the Mayo Clinic, poor biomechanics — especially involving the hips and knees — is a leading contributor to premature joint deterioration.
How to Relieve Hip and Knee Pain
Strengthening the Gluteal Muscles
The gluteus maximus is not just a powerful muscle; it acts as the body’s steering system for the hips and knees. Without strong glutes, both joints are left vulnerable to abnormal forces.
As Olderman notes: “The glutes control not just strength, but alignment. When they weaken, the risk of breakdown accelerates.”
Recommended Exercise: The Butt Pump
- Position yourself on your elbows and knees (or lean against a counter).
- Lift one leg behind you until you feel the buttock muscles engage.
- Slightly rotate the lifted knee outward to enhance gluteal activation.
- Pump the lifted leg up and down about an inch, focusing solely on activating the glutes.
- Perform 2 sets of 30 repetitions, 1–2 times per day.
This exercise helps realign the femoral head, stabilize the pelvis, and reduce rotational stress at the knee.
Addressing Knee Joint Compression
Tension in the popliteus muscle, located behind the knee, can lead to joint compression and stiffness, particularly when the knees are habitually locked.
Steps to relieve popliteus strain:
- Stay mindful to avoid locking your knees when standing or walking.
- Incorporate regular massage therapy targeting the popliteus muscle to release tension and improve knee mobility.
Walking: Friend or Foe?
Walking can either support healing or contribute to joint strain, depending on gait mechanics.
- Supportive walking: Activating the glutes stabilizes the hips and knees and promotes healthier movement patterns.
- Strainful walking: Over-striding, poor posture, or locked knees increase stress and dysfunction in both joints.
Monitoring posture, stride, and muscle engagement while walking can turn this everyday activity into a powerful tool for joint health.
Further Reading: Understanding Pain Patterns
Hip and knee pain rarely exists in isolation. They are often symptoms of broader movement dysfunctions involving the back, pelvis, and lower limbs. For a deeper exploration of how seemingly separate pains are linked, readers can refer to Rick Olderman’s book, Pain Patterns: Why You Are in Pain and How to Stop It.
The book offers insights into movement-based solutions for chronic musculoskeletal problems. You can also visit his website, rickolderman.com for free access to a masterclass video on pain patterns.
Author Note
Rick Olderman, MSPT, is an orthopedic physical therapist, author, and clinical expert specializing in the movement-based treatment of chronic musculoskeletal pain. His work bridges the gap between traditional therapy and long-term pain resolution by focusing on biomechanical correction.
Disclaimer: This article is for educational purposes only and is not a substitute for professional medical advice. Please consult a qualified healthcare provider for evaluation and treatment of persistent pain.
