Knee Pain? Check in With Your Hips

Nagging knee pain can be a damper to anyone's regular fitness routine. What you may not realize is that a hip imbalance may be the cause of your knee pain. The solution to healthier, better feeling knees can often be found by restoring balance in the hips.

Consider these questions: 1)Do you sit on a regular basis?, 2) Do you have back pain?, 3) Does your exercise routine contain repetitive motions?, 4) Do you intentionally do exercises to maintain balance around your hip joints? If you answered yes to 1, 2, or 3 and no to 4, then it’s a good idea to investigate ways to restore or maintain balance in your hips. Yoga postures can offer many opportunities to do this when approached with awareness.

The hip is a load-bearing ball and socket joint that bears much of the weight and impact of the body with movement. This impact from the hip is transferred down through the knee and ankle. Repetitive imbalanced movements can create imbalanced tensional integrity in the soft tissues surrounding the hip, relaying dysfunction down through the knee and ankle. This can be from something like a misaligned running gait/technique or imbalanced cycling position and pedal stroke. Think of how many steps you take on your daily walk/run or how many pedal strokes you take in a 30-minute bike ride. That's a lot of repetition and plenty of time for the imbalanced soft tissue patterns to get wired into your brain and body. This also applies to repetitive motions with yoga, weight training, HIIT exercise, and any other fitness format.

“The imbalance doesn’t just exist in your tissues, but also in your nervous system that initiates and coordinates all of your actions.”

There are several muscles that cross the hip and the knee joint. These are the Hamstring, Rectus Femoris, Sartorius, Gracilis, and the Tensor Fasciae Latae. To get a better understanding of these muscles and the overall anatomy of the hip and knee, consider my book, Embodied Posture: Your Unique Body and Yoga. Imbalance in any of these muscles at the hip will have an effect on how the knee functions and feels. The typical pattern that creates imbalance is a muscle or group of muscles get “sleepy” or forgotten, and another muscle or group of muscles over-work to pick up slack. This will cause over-tightening or excess rigidity in one area with simultaneous laxity or lack of firing in another. The imbalance doesn’t just exist in your tissues, but also in your nervous system that initiates and coordinates all of your actions. The skeletal structure also tends to get pulled off center with the force from the imbalanced soft tissues. In the knee joint, excess force and imbalanced weight bearing will typically land in one of the supporting ligaments or meniscus. The patella or kneecap can also get “off track” when there is imbalance in the hip and thigh muscles. If we don’t consider overall body balance, we can find ourselves caught in a cycle of chasing and ‘fixing” symptoms rather than getting to the root cause.

Awareness of how you are moving is key. When you are exercising, pay attention to the symmetry at your hip joint. Are certain muscles firing more than others? Is your knee or thigh constantly going toward the midline of your body when you step, jump, or pedal? Where is the weight landing in your feet? Aim for balanced weight bearing. Re-patterning your movement will require your willingness to slow down, tune-in, and feel. Remember that you need to give your brain time to register the new movement patterns so that your nervous system can also rebalance. There are many great resources out there for proper running gait and cycling technique. Do your research and then let your movement be your laboratory for figuring out what works best for you. And when it comes to yoga, remember that this practice is just as likely as other fitness formats to be the impetus to body imbalance. Yoga is know for its repetitive movements and it is imperative that you slow down and take responsibility for finding proper alignment. An instructor that has a strong understanding of the body will know and teach the importance of variable, functional movement, but ultimately it is up to you—the practitioner.

In addition to being more aware of your repetitive motions, a routine to increase awareness of symmetry at the hip joint will be helpful. Here are some ideas for approaching your yoga practice with hip and knee wellness in mind.

In all standing yoga poses where the hip is extended, engage the gluteus max. Here in Warrior 1 Pose, the back-leg hip is extended. Common tendency is for the gluteus max to get a little sleepy—especially if you sit for any portion of the day. Find times to use it!

In standing poses where the hip is abducted (moving away from the mid-line of the body), you can engage the gluteus medius and other hip abductor muscles that we tend to dismiss and under-use. This will feel like squeezing your outer, upper hip. In Tree, the top leg is abducted. In Half Moon, the standing leg is abducted.

In back bending postures like Bridge, hip extension is a vital component. The gluteus max is the primary worker in hip extension, so here is another opportunity to fire it up. Aim to fire the gluteus max more than the hamstring.

Take a multifaceted approach to hip-releasing. Consider that you have 3 hip compartments: inner, outer, and front. Pigeon pose will target the outer, Yogi Squat or will target the inner, while Low Lunge will target the front. Overall awareness of the how, why, and what of your movement is key. Tune-in, learn to feel what your body is telling you and always--keep on moving!