Knee Arthritis: Strengthen Your Hips to Save Your Knees

If you're dealing with knee osteoarthritis (OA), you're not alone. This condition affects millions worldwide. It can make everyday activities like walking or climbing stairs a challenge.

While it might sound counterintuitive, strengthening your hips could be the secret weapon for easing knee pain and improving mobility. Let’s dive into the how and why.

What's the Link Between Hips and Knees?

First, the basics: knee OA is a degenerative joint disease that commonly develops in the weight-bearing medial (inside) compartment of the knee. It can lead to pain, stiffness, and reduced function (Thomas et al., 2022​).

Knee OA involves three main changes:

• Breakdown of the cartilage. Cartilage is the smooth surface at the end of each bone that allows your knee to bend easily. The cartilage also cushions impact.
• Chemical changes to the joint fluid. Healthy and abundant joint fluid facilitates smooth movement of the knee.
• Damage of the bone. Specifically, the ends of the bones that come together at your knee tend to show damage.

Interestingly, research shows that weak hip muscles — especially the hip abductors — can make matters worse for your knees.  Your hip abductors are the muscles you use to lift your leg out to the side with your toes pointing forward, like you would if you were making a snow angel. 

Weak hip abductors can increase stress on your knee joints when you move. This extra load can speed up the changes to your knee cartilage if you have knee OA (Neelapala et al., 2020​). 

When your hip abductors are weak, the pelvis tends to drop on the opposite side when you're upright - during activities like walking. This forces your body’s center of gravity to shift, increasing pressure on the inside of your knee. Over time, this can contribute to pain and joint deterioration (Deasy et al., 2016​). A physiotherapist can analyse your hips while you walk, and tell you whether your pelvis drops to one side, suggesting weak hip abductors.

Another way to test if you have hip abductor weakness is by performing a forward lunge in front of a mirror. You can try this at home. If you notice your knee shifts inward, as seen in the first picture below, it can also be an indication of weak hip abductors, which can further contribute to knee OA. If your knee tracks straight forward, like in the second picture below, this suggests you have stronger abductors:

The Science Behind Hip Strengthening

Recent studies highlight the benefits of hip strengthening exercises for managing knee OA. Strengthening your hip muscles not only helps reduce pain, but it can improve your ability to move. For example, research has shown that hip abductor exercises can significantly lower your pain scores and enhance physical function (Thomas et al., 2022​).

A systematic review revealed that incorporating resistance exercises for hip muscles — using tools like elastic bands or ankle weights — can improve your overall quality of life. Research participants experienced better walking endurance, stair-climbing ability, and walking speed (Neelapala et al., 2020​).

Why Choose Hip Exercises?

Traditional knee-focused rehab often centers on strengthening the quadriceps. While this is effective, adding hip-focused exercises to your routine has unique advantages. Studies comparing hip-focused exercises to standard knee rehab found that targeting the hips provides added benefits, especially for reducing pain and improving walking mechanics (Thomas et al., 2022​).

Easy Exercises to Get Started

Ready to give hip strengthening a try? Here are some beginner-friendly exercises your physiotherapist may recommend you can do at home:

Side-Lying Leg Lifts:

• Lie on your side with your legs stacked.
• Lift your top leg upward, keeping it straight.
• Perform 3 sets of 10 reps on each side.

Standing Hip Abduction:

• Stand next to a wall or sturdy chair for balance.
• Slowly lift one leg out to the side and back down.
• Complete 3 sets of 10 reps on each leg.

Always consult with your physiotherapist before starting a new exercise regimen, especially if you’re managing a condition like knee OA.  Plus, if you haven't done these exercises before, it can be very helpful to have a movement expert (a physiotherapist) make sure you're doing them properly - you don't want to waste time or effort doing the wrong movement.

Final Thoughts

Don’t let knee OA hold you back. With your physiotherapist focusing on strengthening your hips as part of your treatment plan, you can reduce pain, improve mobility, and reclaim the activities you love. Think of it as building a strong foundation to support healthier knees, and a more active you.

Written by Dillon Hunter, in collaboration with River East Physiotherapy

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References

• Neelapala, Y. V. R., Bhagat, M., & Shah, P. (2020). Hip muscle strengthening for knee osteoarthritis: A systematic review of literature. Journal of Geriatric Physical Therapy, 43(2), 89-98.
• Deasy, M., Leahy, E., & Semciw, A. I. (2016). Hip strength deficits in people with symptomatic knee osteoarthritis: A systematic review and meta-analysis. Journal of Orthopaedic & Sports Physical Therapy, 46(8), 629-639.
• Thomas, D. T., Shruthi, R., Prabhakar, A. J., et al. (2022). Hip abductor strengthening in patients diagnosed with knee osteoarthritis: A systematic review and meta-analysis. BMC Musculoskeletal Disorders, 23(622).