The Knee-Hip Connection: Muscles and movement

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

Movements of the hip joint

Healthy hips are able to perform a diverse range of movements (see diagram right). All of these movements and their associated muscles have a direct impact on the knee.

If any of the hip muscles are weak, tight or both, they can affect the alignment of the knee joint at rest and in movement. The best approach for hip and knee health is a regimen that balances mobility with stability, or stretch with strength.

Front side – flexion

Whether working at your desk, driving your car, or watching your favorite show, every time you sit for an extended period your hip flexors get tight and your buttock muscles get weak. Both of these issues affect how your hips function and move.

Tight hip flexors, especially when combined with weak buttocks, can pull the pelvis forward into an anterior tilt. This can cause your thigh bones to internally rotate, leading to excess pressure on the inner knee. An anterior pelvic tilt also affects the biomechanics of walking, again leading extra pressure being loaded onto the knees.

Hip flexors

Weak hip flexors also present a problem when it comes to knee health. The two major hip flexors are the rectus femoris, the most superficial of the quadriceps muscles, and the iliopsoas, a deep muscle that connects from the thigh to the spine.

The deeper iliopsoas muscle is the hip flexor most likely to be weak on  people with knee pain. Because the illopsoas also acts as a secondary hip extensor, it helps prevent excessive inward rotation of the thigh and pronation of the foot. It also helps track the knee cap in place over the joint. The illiopsoas needs to be both long and strong if it’s going to support a healthy and durable knee joint.

The recuts femoris on the other hand is usually relatively stronger on most people. In fact, when it works overtime to make up for a weak illopsoas, it has the ability to overpower the knee and push the joint back into hyperextension.

Check here for yoga poses for strong, long hip flexors

Backside – extension

Standing up, sitting down, walking, running, all require strong hip extensors. The hip extonsor muscles are the gluteus maximus (the largest buttock muscle) and the hamstrings (the long back thigh muscles).

As mentioned above, the buttocks can become weak from prolonged sitting and begin to vacate their job of extending the leg back in space. When that happens the hamstrings end up picking up the extra workload and become tight in the process. Both of these issues affect your walking gait and exert extra pressure further down the kinetic chain at the knee joint.

When the gluteus muscles become tight they can pull the thigh bone into excessive external rotation and pull the knee along with it. This puts unnecessary stress on the knee, and of course, affects how you walk and run.

Outside – abduction

Adductors & abductors

The movement of the leg away from the midline is called abduction. The muscles responsible for this action, the gluteus medius, gluteus minimus and the deep gluteals, are located at the outer hips and in the deep buttocks. The abductors are important walking and balance muscles, which prevent the hips from swaying too far out to the sides as you walk.

Just like the gluteus maximus (see above) the abductors can get weak and tight from too much sitting.  This can lead to patellofemoral pain syndrome and iliotibial band syndrome, both painful knee conditions.

Inside – adduction

The hip adductors bring the leg back to the midline. The muscles responsible for this action, the adductors longus, brevis and magnus, and the pectineus and gracillis, are located at the inner thighs. Again, like all the other hip muscles, they should be long and strong so they support healthy knee functioning.

Of note, one of the adductor muscles, the gracillus, shares a tendon with the sartorius (a hip flexor) and the semitendinosus (an inner hamstring muscle). The tendon is called the pes anserinus and it attaches to the shin bone at the inner knee. Overuse of the three muscles (usually from bicycling or running) can cause the tendon become tender and inflamed resulting in pain at the inner knee. Stretching to reduce tightness of the three connected muscles can help.

Turning in – internal rotation

Internal or medial hip rotation is the action of turning the thigh towards the midline. This appears as a “knock kneed” look at the knee joint. Normal internal rotation is required for a healthy walking gait. However, when it’s caused by weak hip muscles, it can lead to pronation (a collapse at the inner foot) and excessive pressure at the inner knee.

The muscles involved in internal hip rotation are the gluteus medius and minimus (both buttocks muscles), and the semitendinosus and semimembranosus (both inner hamstring muscles).

Turning out – external rotation

External or lateral hip rotation is the action of turning the the thigh away from the midline. Normal external rotation is also required for a healthy walking gait. However, when it’s caused by tight hip muscles it can lead to supination of the foot, which puts too much pressure on the outer foot. This twists the knee out from the midline and again can cause an imbalance of pressure in the knees.

The muscles responsible for external hip rotation are the biceps femoris, gluteus maximus, and the deep gluteals

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Hip Flexor Muscles Anatomy | American Hip Institute

Posted in: | Tags: | Posted on: 23-Nov-2022

Hip flexors are a group of muscles responsible for flexing the hip and raising the legs. These muscles are essential in movement as you use this muscle group every time you stand or take a step; they also help maintain your stability and posture. 

It is essential to keep hip flexor muscles strong, given their importance in a person’s balance and mobility. If you want to know more about the hip flexor muscles anatomy and how to keep them healthy, then keep reading.

What Are the Hip Flexor Muscles

If you are wondering, “what are the hip flexor muscles,” the first step is understanding its makeup. Hip flexor muscles anatomy is composed of five different muscles, namely:

• Psoas major: A deep muscle that connects the legs to the spine. It runs from the lower back to the pelvis and passes to the front of the hip, where it attaches to the top of the femur (thigh bone).
• Iliacus: This muscle rests deep within the pelvis and attaches to the femur. It is responsible for flexing and rotating the thigh.
• Rectus femoris: This muscle is a part of the quadriceps group, which attaches the pelvis to the knee. Its function, along with the other quadriceps muscles, is to facilitate knee extension.
• Pectineus: Also referred to as the groin muscle, the pectineus rests at the top of the inner thigh.
• Sartorius: This is the longest muscle in the body which spans the hip and knee joints. It is responsible for flexing and moving the knee and leg.

Just like with any other muscle in the body, the hip flexor muscles require regular conditioning to be strong; however, this muscle group is often neglected.

Consequences of Weak Hip Flexor Muscles

Individuals who live a sedentary lifestyle are at a high risk of developing short and tight hip flexors. This is because the muscle group is only activated when standing or moving. Therefore, weak flexor muscles are common in people who sit for extended periods, like those who work in an office. 

When you have weak hip flexors, you may experience pain in your lower back, hip and knee due to the overworked joints that compensate for the deficient muscles. You may also experience changes in your posture and gait. 

In addition, weak hip flexor muscles are more prone to strain. Once you sustain an injury to your flexors, it can significantly affect your movement and comfort. 

Hip Strain Symptoms

The main symptom of a stained or torn hip flexor muscle is a pain in front of the hip where it meets the thigh. The pain level depends on the injury’s severity but most often includes swelling, bruising, cramping and muscle spasms.

Hip strain injuries are classified into the following categories:

• Grade 1: Injuries that are mildly painful with minor swelling and tenderness. You can continue your regular activities but with slight discomfort.
• Grade 2: Injuries that involve a more significant tear in the muscle and come with a moderate amount of pain. You can expect a slight loss of function in your legs and knees.
• Grade 3: Injuries involving a complete muscle tear causing severe swelling and pain. Putting weight on the affected leg is impossible, making walking very difficult. With this grade of injury, you can expect to lose more than 50 percent of muscle function in your lower extremities. 

Doctors often recommend complete restraint from physical activities following a hip flexor muscle tear to avoid re-injury. It may take two to six months to return to your routine.

Experiencing hip flexor strain and injuries is genuinely troublesome. The good news is that you can avoid them by strengthening your flexor muscles through regular movement and muscle conditioning.

How To Strengthen My Hip Flexors

A strong hip flexor is essential to avoid injury and ensure your overall muscle and postural health. To strengthen this muscle group, you can start with the following stretches and exercises:

Bridge Pose

The bridge pose is famous in yoga because it stretches many parts of the legs, back, and hips while lying down. To perform this, you should lay flat on the ground with your arms on either side of you. Then pull your feet towards the buttocks while keeping the soles of your feet and arms on the floor. Next, lift the buttocks into the air to form a straight line from the knees and shoulders. Hold for 30 seconds, lower and repeat the process.

Lunges

Lunges are one of the most effective exercises to strengthen hip muscles. You can perform this exercise in various ways, but the most common routine is the forward lunge. To execute this, you stand straight with your legs slightly apart. Then, place your hands on the hips and take a big step forward. The heel should make contact with the floor first. Next, bend your knee forward until your thigh is parallel to the floor. Finally, step back into the standing position and repeat with the other leg.

Mountain Climbers

Another great exercise to strengthen the muscles of the hip and legs is mountain climbers. Start in a plank and pull your knee up to your chest. Then quickly alternate between legs until the set is complete. Keep your hands firmly planted on the ground while making these moves.

If you are recovering from a hip flexor injury, it is best to ask a doctor for recommended routines that are safe for your condition. 

Consult with the Experts at American Hip Institute

The American Hip Institute is a destination clinic for advanced hip remedies. We have developed unique techniques in Robotic Hip Replacement and stem cell therapies to restore the hip’s movement and strength. Contact us today to learn more about how we can help you.

Why do legs hurt more than a knee?

Why do my legs hurt above the knees? Usually, pain, numbness, burning sensation in the muscles is a common symptom of diseases of the spine, femur and surrounding muscles.

Doctors of the Clinic of Dr. Dolinsky (m. Brovary , Kiev region) will help to find out the causes of pain in the thigh muscles, using advanced methods of complex diagnostics, prescribe the most effective treatment to return the joy of movement without pain and discomfort.

Pain in the legs above the knees: causes and typical symptoms

What causes pain in the hip? Similar symptoms may indicate various pathological processes and diseases:

• complicated by intervertebral hernia, osteochondrosis – causes characteristic pain, burning and numbness;
• in diseases of the hip joint, pain is localized only in the thigh, usually when walking and during exercise;
• with different lengths of the lower extremities, the muscles of the leg above the knee hurt, lameness is observed, the torso may be skewed;
• iliopsoas muscle syndrome – pain in the leg above the knees in front when walking.

Pain in the legs also occurs:

• with injuries – bruises, sprains and ruptures of tendons or muscles. In addition to pain, swelling and hematoma are noticeable;
• myositis of the muscles of the thigh – an inflammatory process that may result from unusual or excessive stress on the muscles of the legs;
• quadriceps tendonitis occurs in active people over 40 years of age, manifested by aching pain in the lower part of the front of the thigh;
• pains that are localized in the outer side of the thigh, arising from aseptic arthritis of the hip joint;
• infectious lesions of bones and soft tissues.

In addition, pain in the legs above the knees may indicate neurological problems and oncological processes.

Diagnosis and treatment

Why do the muscles of the leg above the knee hurt?

If a symptom tends to recur under certain conditions, it is worth contacting qualified specialists without delay.

If a symptom tends to recur under certain conditions, it is worthwhile, rather than putting it off for the future, to contact qualified specialists. traumatologist – orthopedist or neurologist – in Brovary you can undergo the necessary diagnostics and treatment at the Clinic of Dr. Dolinsky.

The doctor determines the nature of the symptoms, performs an examination and prescribes additional diagnostic tests:

• bone radiography;
• CT brush;
• CT or ultrasonography of soft tissues;
• Laboratory tests.

Note that our modern multidisciplinary medical facility will allow you to undergo all the necessary examinations – for this you no longer need to go to Kyiv.

In case of traumatic injuries, they provide rest to the limb. For bruises and sprains apply cold. Painkillers are used if necessary. The severity of the symptoms of tendinitis or myositis is reduced using anti-inflammatory drugs. As directed by a physician, therapy may include physiotherapy, massage, and exercise therapy.

Do you often have pain in your legs above the knees?

Do not put off a visit to the doctor, because early diagnosis of any pathology will allow the specialist to quickly prescribe the most effective therapy and return you to the pleasure of free movement without pain.

Book an appointment

15 exercises for knee joints that will protect against pain

December 3, 2022

Likbez

Sports and fitness

Do them regularly and you will forget about pain and stiffness.

Iya Zorina

Author of Lifehacker, athlete, CCM

How exercises can support the health of the knee joints

First of all, exercises are aimed at strengthening the muscles that surround and support the knee joint. Most recommended movements involve the quadriceps femoris (quadriceps), the three muscles at the back of the thigh, and the gluteus maximus and medius.

Exercise also plays an important role in maintaining the volume of articular cartilage, the thinning of which is associated with a disease such as osteoarthritis. Scientists suggest that cartilage can grow in response to the mechanical stress created during exercise.

This may be why knee exercises that improve muscle strength, coordination and balance help people with osteoarthritis relieve pain and improve quality of life.

In addition to knee health (and osteoarthritis pain relief), it is often recommended to do not only strength movements, but also stretching exercises for the muscles of the thighs and lower legs. It can be assumed that such movements increase the mobility of the hip and ankle joints, which will improve the biomechanics of movements in sports and everyday life and take some of the load off the knee joints.

What exercises for the knee joints will help strengthen the muscles

These movements are suitable for any level of training. Some of them are advised to perform even with pre-existing joint problems, such as osteoarthritis. However, in the latter case, you should be careful – carefully monitor the sensations and, if pain occurs, stop the workout and consult your doctor.

1. Wall Leg Curl

Stand one foot away from a wall with your feet hip-width apart and point your toes out. Slowly bend your knees as you slide your back against the wall. Don’t let your knees go past your toes. Make sure they point in the same direction as your feet.

You can also place an exercise ball between the wall and your back to make it slide up and down more smoothly.

Do 3 sets of 10 reps.

If this is too easy for you, use the static version. Lower yourself into a squat and hold the position for 30 seconds.

You can also add resistance with a fitness band – put it on your hips and squat your knees apart, overcoming the resistance of the expander.

2. Seated knee extension

Sit on a chair with your back straight. Slowly straighten your right knee until it is fully extended, pointing your toe slightly to the side. Squeeze the muscles on the right thigh with all your might and hold this position for 15 seconds.

Do not relax the muscles until the end of the interval. Do 3 sets of 15 seconds on each leg.

3. Straight leg raise

Sit on the edge of a chair with a straight back and fully extend your left knee so that the entire leg is parallel to the floor and the foot is slightly turned outward. Tighten your left hip and move it up and down in a small range. Perform 10 raises and lowers without relaxing the leg and without placing it on the floor until the end of the set.

Do 3 sets of 10 reps on each leg. If this is too easy, add resistance by putting weights on your working leg.

4. Squats

Place your feet shoulder-width apart, toes slightly outward. You can freely lower your arms to the sides, put them on your belt or stretch them out in front of you for better balance.

Squat down to a right angle at the knees, or as low as you feel comfortable, and rise back up. Keep your back straight and keep your heels off the floor. If it’s too easy, add resistance with a fitness band or use dumbbells.

Do 3 sets of 10 reps.

5. Single Leg Squat

Place your feet hip-width apart with your toes pointing straight ahead. Raise your left leg and balance on your right. Bend your right leg and slowly lower yourself into a squat. Make sure that the knee does not go far forward and does not turn inward. Straighten up and repeat.

Do 3 sets of 5 reps on each leg.

6. Lunges

Step forward with your right foot and leave your left foot in place. Bend your knees and lower into a lunge to a right angle at the knee of your front leg. Straighten up and repeat.

Keep your back straight during the lunge, and the knee of the front leg does not go beyond the toe.

Do 3 sets of 5 reps on each leg.

7. Side Thigh Raise

Lie on your left side, put your feet on top of each other and bend your knees. Without separating the foot, take the right thigh to the side and direct the knee to the ceiling. Hold this position for 10 seconds, return to the starting position and repeat. Do 10 times on each side (the video shows the option without fixation).

If this is too easy for you, add resistance. Buy a small fitness band and put it on your hips just below your knees.

8. Straight Leg Raise

Lie on your left side, straighten your legs and rest your head on a bent arm or pillow. Point your toes forward. Raise your right leg, hold for 10 seconds and lower back. Repeat the movement 4-5 times with each leg.

As with the previous movement, if this is too easy for you, add resistance with a fitness band.

9. Elevated steps

Find a stable bench about 25-30 cm high. You can use the stairs.

Step forward and return to the floor. Keep your back straight, avoid sudden movements and jerks from the floor, and make sure that the knee of the working leg does not wrap inward during the lift. Do 3 sets of 10 reps on each leg.

You can gradually increase the height of the support up to 45-50 cm and use additional resistance like dumbbells.

10. Glute bridge on one or two legs

Lie on the floor, place your arms along your body, bend your legs and place your feet on the floor. Squeeze your buttocks and lift your pelvis as high as you can. Hold for a second, return to the starting position and repeat again.

You can also do a single-leg glute bridge with your supporting foot on your heel and knee bent at a right angle.

Perform 3 sets of 10 glute bridges. If you perform on one leg – 10 on each.

What kind of exercises for the knee joints will help stretch the muscles

When performing movements to stretch the muscles, watch your sensations and take your time. You should only experience mild discomfort, not pain. Do not try to increase the range of motion in jerks – this can result in injury.

1. Hamstring Stretch

Sit on the edge of a chair with your right leg bent and your left leg straight and on your heel. Slightly turn the left sock to the side. Keeping your back straight and your left thigh tense, tilt your torso forward.

Feel the stretch in the back of the thigh with the leg extended. Hold this position for 15 seconds and then repeat with the other leg. Do 3 sets for each leg.

2. Iliotibial Tract (TIT) Stretch

To stretch the right side of the tibial tract, cross the right leg behind the left and tilt the body to the left, pushing the right thigh to the side. Lean to the side, not forward, and don’t push your butt back. You should feel the stretch on the outside of your right thigh.

Hold in position for 15 seconds and repeat on the other side. Do 3 sets for each leg.

3. Standing Anterior Thigh Stretch

During this movement, you can hold onto the back of a chair with one hand to keep your balance. Bend one leg, grasp the ankle with your hand and pull the heel to the buttock. Feel the stretch in the front of your thigh.

To increase the stretch, tilt your pelvis back—imagine pulling your pubic bone toward your navel. Hold the position for 5-10 seconds, then return the foot to the floor. Perform 5 times with each leg.

4. Buttock Stretch

Lie on your back, lift one knee and pull it closer to your chest, wrapping your arms around it. Point the knee towards the opposite shoulder, stretching the gluteal muscles well.

Hold the position for 30 seconds, then lower the leg and repeat on the other side. Do 5 times with each leg.

5. Standing Calf Stretch

Stand close to a wall, step back and bend your front leg and keep the other leg straight. Tilt your body forward, leaning against the wall. Feel the stretch in your calf muscles. Hold the position for 30 seconds, then switch legs and repeat the same. Do 5 times on each side.

How often to do knee exercises

Do this little workout every day. As a rule, the first positive changes occur after two weeks of regular implementation of the complex.

If you run or do other cardio activities, you can use strength exercises as a warm-up and stretch after your run.

Those who do strength training with weights will not benefit from these movements, as they will not sufficiently load the already pumped leg muscles.