Fix Your Hips, Save Your Knees: The Forgotten Link in Lower Body Pain

Introduction

When people complain about knee pain, they often focus squarely on the knee joint itself — but what if the root cause lies upstream? The hip joint and surrounding musculature play a pivotal role in knee biomechanics. In this post we’ll unpack how poor hip mobility or strength can negatively impact knees, what the research shows, and how to proactively protect and build your hips (and knees) for long‑term health and performance.

The hip–knee relationship

• Research shows that motion impairments at the hip may predispose to knee injuries such as ACL tears, iliotibial band syndrome (ITBS), and patellofemoral pain. JOSPT+1

• Weak hip musculature is associated with knee pain. For instance, a study found individuals with knee pain had weak hip muscles. PMC

• A systematic review concluded hip‑ and knee‑strengthening combined is superior to knee‑only strengthening for patellofemoral pain. JOSPT+1

• From a mobility perspective: tight hip flexors may tilt the pelvis forward, increase knee joint stress (e.g., on the patellofemoral joint) and contribute to dysfunction. Nebraska Medicine+1
  In short: hips matter — often more than you realise when it comes to knee health.

Key mechanisms

• Kinetic chain compensation: If the hip can’t extend/rotate properly, the knee or ankle may take on extra work or be placed in less favourable geometry (valgus collapse, increased shear).

• Muscle imbalance: Weak glute med/max or hip external rotators lead to excessive internal rotation or adduction of the femur — this changes knee loading. PMC+1

• Mobility restrictions upstream: If hip extension or rotation is limited (e.g., from tight flexors or poor control), then knee mechanics suffer — more strain, less efficient movement.

• Injury & degenerative pathways: Over time, faulty hip‑knee mechanics contribute to overload on knee cartilage (e.g., in OA) or soft tissue structures leading to pain and degeneration. Journal of Rheumatology

What you can do: a dual focus on hips & knees

1. Mobility & Control

• Hip hinge drills, lunge with T‑reach, 90/90 internal/external rotation holds.

• Ankle dorsiflexion work and thoracic spine extension — all link into hip/knee chain.

• Use controlled reach/rotate movements rather than “just stretch”.

2. Strengthen the Hip Complex

• Glute bridges, single‑leg Romanian deadlifts, clamshells, lateral band walks (hip abduction/external rotation focus).

• Combine hip strengthening with knee and lower‑leg work (quad/hamstring balance) — research shows better outcomes when hips are included. JOSPT

3. Movement Pattern Reinforcement

• Focus on proper form in squats, lunges, hinges. Cue: “ knees track over 2nd/3rd toe, hip drives back, torso tall”.

• Use unilateral work to identify asymmetries (single‑leg squat/lunge).

• Progress to athletic/trip‑wire drills: e.g., single‑leg hop to land softly—focus on knee alignment, hip control.

4. Prehab and Active Recovery

• Include hip mobility and glute activation in warm‑ups.

• For knee‑pain clients, address hip strength: systematic review found strong evidence recommending hip strengthening in knee osteoarthritis. PubMed

• Don’t ignore the hips just because the pain is the knee — treat the system.

Sample routine: “Hip‑to‑Knee Bulletproofing” (beginner/intermediate)

• 3×10 Glute bridges with 2‑s hold at top

• 3×8‑10 Single‑leg Romanian deadlift each side

• 2×20 Lateral band walks (10 steps each direction)

• 3×8 Single‑leg squat/lunge (bodyweight or light load)

• 2×30 s Hip flexor stretch (dynamic + hold)

• 2×10 Hip internal rotation/90‑90 drill each side
  Perform 2‑3× per week. Combine with your regular strength/conditioning work.

Final thoughts

If you’re chasing knee health, performance, longevity or simply want to feel better during everyday movement, don’t treat the knee in isolation. The hips set the stage. Your ability to generate, control and transfer force from the ground up (“hip to knee to foot”) often dictates how your knees behave. By proactively mobilising, strengthening and engaging your hips, you’re not just protecting your knees — you’re unlocking better movement, better performance and fewer setbacks.