It’s All in the Hips: Anatomy of a Knee Injury

After two visits to the Physical Therapist, I’m a couple steps closer to running again!

On Tuesday, I went to the PT office for a 15-minute chat with the doctor to give her the background on my achy knee. In case you haven’t read it, here’s what’s going on.

Then, I had an hour-long exam on Wednesday (thank you, last-minute scheduling gods) to really dive in and discover what’s going on. The physical therapist tested the range of motion in my knees, legs, and hips; she even measured my feet and arches! She poked at my limbs for painful spots along the hips and knees, but as I’ve had no pain unless I’m actually running, I felt quite unhelpful telling her that, nope, there was no pain anywhere. Then she has me perform several exercises, like squats, single-leg squats, and running around the room, so she could see how my form looked.

Finally, my doctor told me what I half-suspected was the root of the knee issue…

Problem #1: Weak hip adductors.
My hips were tight and relatively weak. In fact, they were laughably weak. To test the strength of my different leg muscles, the doctor pushed or pulled against them slightly and I’d have to keep my leg from moving. It was no problem when she put resistance against my quads, hamstrings, [thunder] thighs or shins. But as soon as she had me lay on my side and barely pushed down against my hip muscle, it was like my leg had a 50-pound weight on it and it couldn’t stay up, no matter how hard I tried to keep it level. I was in disbelief!

Problem #2: Tight piriformis.
Piri-what? I’ve heard of the muscle before from other runners who’ve had tightness or pain, but I never knew what it actually was. It’s located in the upper butt/lower back area, behind the hip joint:

piriformis muscle injury

So, I have a tight piriformis muscle. Well, THAT makes sense, because for the last few weeks, I’ve been having a lot of pain in that area. I thought it was just my lower back being crappy, as it’s always had a tendency to ache due to misfortunes in snowboarding forays in junior high school… I figured it was completely unrelated to all these other issues. But of course, everything in the body is connected and affects everything else. Basically, because of the tightness in my hips and piriformis, it’s no wonder my knee is hurting.

So, how to reconcile these issues?

The ironic thing was, I had already been working on strengthening my hip adductors. Knowing that weak hips often cause issues for runners, and having had knee pain/ITBS issues in the past on my right leg, I was doing my own PT exercises at home (on both legs) and foam rolling the crap outta my right leg.

The doctor asked me to show her the exercises I was doing at home. She said, Great! All good exercises to do for your hips.

IF you do them CORRECTLY.

…Which I wasn’t.

She showed me how my form was incorrect for most of the hip exercises I was doing. I wasn’t isolating the hip adductors correctly, so instead of working those muscles, I was letting my hips fall back and my stronger muscles around them (like the hip flexor or quadriceps) take over. Turns out the hip exercises that I was usually rushing through at night and thought were pretty easy, well… After she showed me the proper way to do them, I realized just how hard they can be when you do them right!

At the end of the appointment, the physical therapist gave me several stretches and exercises to add to my normal routine of stretching & strengthening.

In case you too are battling tight or weak hips, these links to videos below are similar to what my doc gave me to try out. Remember, all of these stretches and exercises are tailored to my specific needs or weaknesses, so if you’re really hurtin’ or have a goal race in mind, go see a professional! There’s a reason we pay them the big bucks.*

Exercises for the hip adductor:
• Side Lying Hip Abduction (10x, 1 set)
• Clam Shells (10x, 1 set)
(I am doing this without a band, as shown in the video. Also, I’m only able to open my knees about half the distance this woman is, she must have hip adductors of steel!)
• Lumbar Quadruped Alternating Leg Lifts (hold for 3 seconds, 10x, 1 set)

• Piriformis Stretch (hold for 30 seconds, 2x a day)
(note: I don’t come close to being as flexible as the woman in this video, only stretch as far as feels good for you!)
• Hip Flexor Stretch (hold for 30 seconds, 2x a day)
• IT Band Stretch (hold for 30 seconds, 2x a day)

I go back to the physical therapist tomorrow for another hour-long session. She mentioned at the last appointment that she’ll start trying to work out some of the knots at the top of my hip adductor and around my piriformis. I can already tell it will be one of those things that will hurt so good—just like my friend, the foam roller.

Here’s hoping I’ll start to getting stronger, and get the go-ahead to try running a few miles on Saturday!

Have you ever had knee pain, hip or piriformis issues? What kind of exercises or stretches do you normally do to help them out? 

*Don’t let the big bucks thing scare you away. My doc wants me to come in 3 times a week, but it’s $50 a visit, so their office worked it out so I only have to pay $35 a visit instead. They said it’s more important to them for me to get better, than to miss an appointment due to money! Very thankful for that.


5 thoughts on “It’s All in the Hips: Anatomy of a Knee Injury

  1. We say the hips are bad neighbors in PT. Many back and knee issues are actually non-painful hip issues that push the pain up or down to the next motion segment. Isolated hip exercises are where you start and make sure your form is right as you mentioned. Then your therapist should evaluate your single leg stance to see if the muscles are working together in a functional way. Good luck.

  2. This is a great read, because I have had ITBS/hip issues for a few years. There are time when I think I must be the only person on earth who has felt the way I have at times.

    Question… I was wondering if you thought a chiropractor or an orthopedic might be able to help with my issue/s?

    • Hey Jared! Thanks for reading! Actually, I have thought of seeing a chiropractor to see what they could do. I’ve heard they can fix many an issue, and have runner friends who swear by their chiros. I haven’t tried it yet, since I was already seeing a physical therapist for a few weeks there. The best help I have had with my hip issues is just making them stronger with exercises, and foam rolling like it’s my job!

      • Thanks Amanda!! I appreciate your reply. I have a foam roller that I use a lot, but sounds like I need to use it more. I am sure I need to do exercises but there is something out of whack. I think a good chrio is worth all the money in the bank. I think that is the route I’ll go.

        Thanks again for your time!

      • And your welcome. I enjoyed the post, but wish you didn’t have the issue/pain in your knee/hip.

        That is the great thing about the blogging world. You can go and talk to “real” people about things that you having issues with. Plus, people are for the most part friendly and open to your comments/questions.

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