This article is part of a series discussing the biomechanical connections
between the feet, ankles, knees and hips and how they all impact knee health.
The knee-hip connection
The hip joint is a large ball and socket joint with a diverse range of motion. It can flex forward, extend backward, adduct to the midline, abduct out to the side, and internally and externally rotate in the socket. The knee joint on the other hand is relatively small and mainly designed to flex bent and extend straight.
Because the hip is a larger and more central joint, it has the potential to assert far more force on the knee than either the foot or the ankle. The downward pressure of gravity also plays a part in the hip to knee loading dynamic.
Weak hips sink ships
Weak hip muscles, especially at gluteus maximus (GM), can reflect negatively down into the knee. The GM is the largest muscle in the body. One of its primary functions is to help the thigh bone externally rotate out. If the GM is weak the thigh bone can end up overly turning in, which causes pressure to descend into the inner knee.
Excessive internal rotation of the thigh bone, coupled with excessive pronation at the inner foot can be a recipe for mayhem at the inner knee. This is compounded when the inner thigh muscles aren’t strong, a common occurrence in many people, especially women due to their hip/knee width ratio.
Tight hips are not friendly neighbors
Tight hips can be equally as bothersome for the knee. When the large hip muscles are tight they restrict the hip’s varied and necessary range of motion. The movement instead gets shunted along the kinetic line, sometimes up to the vertebral joints in lower back, sometimes down in the knee, and sometimes in both directions! The knee and lower back joints are much smaller
than the hip and not well designed to share the load. The knee in particular doesn’t like being moved too far out of its usual
flexion/extension range of motion.
Other possibilities: referred & radiated pain
Referred pain is the phenomena where pain that’s caused in one area of the body can refer to another area because they share some of the same nerve wiring. So an issue that’s happening at the hip can potentially refer pain into the knee.
For example, someone with hip arthritis may feel referred pain in their knee. The knee pain might intensify because of irritating movement happening at the hip, not because of any strain in the knee. If the source of knee pain is in the hip, then the hip should be treated rather than the knee.
Referred pain differs from radiated pain because it travels down unexpected nerve pathways.
Radiating pain happens when pain from a herniated spinal disc travels down known nerve pathways from the spine to the knee. You can often feel and trace the pathway of the pain from its origin to its destination.
For example, sciatic pain originating in the lumbar spine can often be felt from the spine through the buttock, down the leg into the knee, and sometimes into the foot. The treatment solution is the same as in refereed pain – the source of the pain should be treated. If the knee pain is caused by a herniated disc, then the herniation should be treated to relieve the knee pain.
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