If you run, then it’s likely that at one point or another, you’ve suffered from an overuse injury to your lower limb. The knee is the most common site for overuse, accounting for up to half of all injuries! The most common complaint is patellafemoral pain syndrome or PFPS for short, followed by Iliotibial Band Syndrome. So why are us runners getting knee pain? It’s more than likely coming from your hips. Your hips operate as stabilisers of your knees during the running gait and so with poor muscle strength and overactive muscles, we end up imbalanced and unstable.
The glute medius is often referred to when discussing hip stability as its role in the stance phase of gait is to eccentrically control hip adduction and medial rotation, therefore preventing valgus stress on the knee joint. Delayed glute medius activation has been reported in female runners with PFPS (Wilson et al 2011).
The lateral rotators ie Piriformis are also vital for hip stabilisation as they also eccentrically control medial rotation during the stance phase of gait.
Studies have looked at the strength of hip abductors and external rotators and the incidence of knee pain and have found that females with PFPS had 26% less hip abductor strength and 36% less external rotation strength (Ireland et al 2003). In addition, runners with ITBS had significantly weaker hip abductors on the effected limb when compared to the non-injured limb (Federicson, 2000).
So it seems that painful knees can be contributed to weak hips – particularly the hip abductors and hip external rotators. Incorporating hip strengthening exercises into a rehabilitation programme for knee pain will help to reduce symptoms and correct the subsequent postural mal-alignment. There is a myriad of exercises to perform in order to strengthen the required muscles, but which ones are the best?
Side lying hip abduction with resistance is a great open chain exercise which generally is performed during early rehabilitation, promoting neuromuscular gains that occur fairly quickly and helps to support more functional exercises later practiced. During side lying hip abduction, the glute medius muscle is most active and therefore is an appropriate exercise to begin with. Be wary of ‘Clam’ exercises prescribed for glute medius strengthening, as these will also activate your TFL and Anterior hip flexor muscles with very little activation of the glute medius.
Once glute medius strength has begun, more functional, weight bearing exercises can be introduced. Here are some examples:
Single leg squats with resistance band
Lateral Monster Walks
In order to maintain Range of movement around the hip, try this great stretch!
Adductor/hip stretch – the Lizard!