It's All in the Hips: The Key to a Pain-Free Life

On a daily basis, I see it all: knee pain, ankle and foot pain, back pain, and general difficulty moving. You know what all those issues have in common—your hips. If you walk into my office, I guarantee that any lower body or core issue you complain of will require us to take a look at your hips. "But it's not my hips that hurt, it's my knee!" I hear constantly. How could dysfunction of your hips cause that nagging knee pain that just won't quit during your 5Ks, marathon training, or even that dreaded 1-mile run on the treadmill after a long day sitting behind your desk?  

The answer is simpler than you think. When we run, walk, or even stand, our hips are constantly engaged to stabilize our entire leg. The pressure of our heel and foot hitting the ground is known as a ground reaction force. This force travels up through our foot, ankle, calf, knee, thigh, and finally to the hip. As this force ascends the leg, it forces our entire leg to stabilize itself, particularly by rotating the leg. Most of our leg muscles primarily propel us forward and backward. However, our foot and ankle muscles can only control minimal rotation. Our calves generally only push off the ground or clear our feet to prevent toe dragging. Our quadriceps and hamstrings can only flex or extend our leg and cannot control rotation. So, that leaves us with one last resort—our hips.

The force generated during heel strike induces rotation that travels all the way up to our often-neglected hips. Our hip internal and external rotators are tasked with controlling this rotation and stabilizing the femur, the long bone of the thigh. They prevent excessive rotation from overloading our knee and causing conditions like patellofemoral syndrome, quad tendonitis, or patellar tendinitis. Excessive femur rotation can also significantly increase the risk of ACL and meniscal tears, as well as hamstring and quadriceps strains.

But what about our ankles and feet? With excessive femur and knee rotation comes increased stress on structures like the gastrocnemius, soleus (the two main calf muscles), and the Achilles tendon. Forced to compensate for the altered mechanics, these muscles strain and work harder to prevent excessive movement. Additionally, plantar fasciitis can be a debilitating consequence of weak hips when our foot and ankle are forced into poor mechanical positions.

Runners, in particular, engage in repetitive forward and backward movements, leading to weakness in their hip rotators and glutes. Without proper cross-training to strengthen these muscles, injuries can lurk, ready to strike at any moment. The problem is that even consistent runners who frequent the gym often neglect these muscles. Can you name a single machine in the gym that directly targets hip rotator strengthening? As a physical therapist and a biomechanics enthusiast, I teach people how to dynamically strengthen these muscles daily. It's crucial for people of all ages and athletic abilities to learn these basic and dynamic exercises to maintain a strong core and lower body. Whether you're a 15-year-old soccer player, a 30-year-old runner, or a 70-year-old striving to stay healthy and fit... it's all in the hips.

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<span class="fineprint"Kyle Branday, MSPT, CAP, is a Physical Therapist and partner at Amity Physical Therapy with locations in Woodbridge, Hamden, Milford, Wallingford and Branford.  He is certified in dry needling, acupuncture, and has 19 years of experience treating a broad spectrum of orthopedic and neurological conditions. Kyle can be reached at 203-389-4593 or visit amitypt.com.</span>