Your knee hurts. It’s been annoying you for a few weeks or months now, but you’ve been too busy to get it checked out. Finally, you schedule an appointment with an orthopedist who gives you a knee-related diagnosis and writes you a prescription for physical therapy. Or, you were aware that you could skip this step and you venture directly into an orthopaedic Physical Therapy clinic. You tell your PT that something is wrong with your knee including when it started and what you were doing when it started. After a thorough examination, the PT tells you that your hip muscles are weak and your hip and ankle mobility are limited. Apparently, the PT did not understand that it’s your knee that hurts. Time for a second opinion? Probably not.
We often experience pain in a location that’s actually not the problem, while the true problem spot hides its devious self. In the physical therapy world this is called Regional Interdependence, where one dysfunctional region is responsible for pain in another region. The knee and hip relationship is no exception to this and provides a great example.
The knee is a joint that works in three planes of motion and is not limited to simply bending and straightening. In fact, it rotates when you bend and straighten your leg and when you pivot. This rotation is not a lot, but it’s significant enough so that you don’t walk around like a robot. The hip on the other hand is a ball and socket joint that specializes in rotation. But what happens if the hip, for one reason or another, loses some rotational mobility? Well, if you were to pivot, squat, or perform an activity that requires rotation of the hip it’s not going to be there. Something else, such as the knee, has to pick up the slack. So now the knee is responsible for more rotation than it’s used to and it begins to let you know. Again, that pain is like your car’s check engine light and you need to bring your car into the shop (or more appropriately, a physical therapy clinic) before things get worse. You may have heard this: “It’s all connected.” Truly, the knee and hip are connected. The femur (thigh bone) is the same bone that makes up the hip and knee joints. That means that hip muscles function for the knee, helping to promote and control our movements including rotation.
Please recognize that this is only an example before you Google to find hip exercises, stretches, and mobility techniques for your knee pain. The problem spot may be beyond your hips and involve your foot, ankle, pelvis, spine, and possibly more. The problem may also be right at your knee, requiring treatment to where it actually hurts. Only a thorough examination will tell.
Dr. John De Noyelles, PT, OCS, CSCS
