Do your knees ache when you walk or climb stairs? If you have knee pain, the problem may actually come from your hips. Hip weakness is a common cause of knee pain and weak hips can lead to other orthopedic injuries by changing gait biomechanics The hip is one of the most mobile joints in your body. It’s made up of a ball-and-socket joint that gives it greater mobility. Being more complex, the hip joint needs a variety of muscles to move the hip in so many directions and strong muscles and ligaments to provide stability. The muscles that surround the hip are divided into groups: an anterior and posterior group and the abductor group and adductor group.
How can hip weakness lead to knee pain? Remember, muscles and joints don’t work in isolation. The hips and knees are part of a kinetic chain, a concept that movement of one joint or muscle group impacts the movement of other muscles and joints along the kinetic chain. If your hips are weak, it throws off the position of your knees and how your knees move. We can better balance our strength training if we acknowledge that all the joints and muscles in the body are interconnected and impact each other. If one is weak, it alters the position and function of another.
We often focus our training on the gluteus maximus, the largest muscle that extends the hip. Weak glutes can cause orthopedic issues, including knee pain. Many people have weak gluteus maximus muscles because they sit so much on the job. But, there’s a small muscle in the glute region that causes muscle weakness and it doesn’t get the attention it deserves. This muscle is the gluteus medius.
Gluteus Medius and Hip Function
The gluteus medius is a smaller muscle that connects the top of the pelvis to the upper outer part of the leg. It runs along the outside of the hip and has an important function. The gluteus medius is the muscle that abducts your hip or lifts your leg to the side. It also rotates the hip and leg inward when your hip is flexed. If your hip is extended, it rotates your leg outward. It also gets help from a smaller muscle called the gluteus minimus. Just as important is the role the gluteus medius and minimus play in hip stabilization. Strong gluteus medius muscles keep your legs from collapsing inward. Strong gluteus medius muscles are also important for maintaining balance.
Healthy, strong gluteus medius muscles are especially important for runners. When you run and your feet strike the ground, the gluteus medius muscles absorb some of the force as your feet hit the ground. If these muscles are weak, the force will be borne by other structures, such as the knees. Weakness of these muscles also places added stress on the iliotibial band and can lead to iliotibial band syndrome, a common cause of knee pain in runners
Research also shows that weak gluteus medius muscles contribute to back pain. If you watch someone walk from behind and their hips swing when they walk, they likely have weak gluteus medius muscles. Hip swinging takes it toll, over time, on the lower back. In habitual hip swingers, because of weak gluteus medius muscles, the hip drops down with every step. The repetitive “pulling” on the lower back can cause lower back pain.
In fact, a study published in the European Spine Journal found that gluteus medius weakness was more common in people with chronic lower back pain than in a control group without lower back pain. To prevent lower back pain, you need all the muscles in your buttocks to be strong, not just the “head honcho” muscle, the gluteus maximus. In some back pain sufferers, the gluteus medius is the weak link. All the muscles in your glutes need to be strong to absorb shock and maintain the health of the entire kinetic chain. Sitting too much is the biggest cause of these muscles being weak. Over time, this can lead to back and knee problems.
How to Strengthen Weak Hips
Two of the best exercises for strengthening the gluteus medius are fire hydrants and monster walks. Let’s see how to do each one to strengthen your gluteus medius muscles.
To do the fire hydrant exercise, get on to all fours on a mat. Place your hands in front of you so your back forms a tabletop and your face is facing the floor. In this position, lift one leg up to the side with your knee bent at a 90-degree angle. Stop when your leg is parallel to the floor. Pause for a second and slowly bring it back down to the starting position. Do ten repetitions and repeat on the other side.
Monster Walks is a dynamic move that helps strengthen the gluteus medius. To do this exercise, place a resistance band around your ankles. The band should feel tight when you place your feet shoulder width apart. Get into a squat position. While maintaining the squat, take two or three small steps forward as you alternate your feet. Then walk backward in the same way, back to the starting position. If the exercise is too challenging, use a lighter band or place the band higher on your legs.
The Bottom Line
Make sure the workout you do is balanced. The big muscle in the glutes, the gluteus maximus, must be strong, but so must the smaller, but still important, gluteus medius. Have someone assess your gait. If you swing your hips when you walk, weak gluteus medius muscles may be the reason. Work on strengthening these often neglected muscles to avoid future knee or back pain.
On Fitness. January/February 2013. “All Hype or Key Player in Lower Extremity Injury”
Journal of Electromyography and Kinesiology, 30, 98-110 (2016)
American Council on Exercise. “6 Exercises to Target the Gluteus Medius”
WebMD.com. “What is Iliotibial Band Syndrome?
Eur Spine J. 2016 Apr;25(4):1258-65. doi: 10.1007/s00586-015-4027-6. Epub 2015 May 26.