When your knee hurts, your first instinct is probably to focus on the knee.

Maybe you stretch it. Maybe you strengthen your quadriceps. Maybe you ice it after activity. Maybe you avoid stairs, squatting, golf, tennis, or pickleball because those activities seem to aggravate it.

But there is another area that deserves attention: your hips.

The hip and knee do not function independently. Every time you walk, climb stairs, squat, get out of a chair, play pickleball, swing a golf club, or move across a tennis court, your hip muscles help control the position of your pelvis and thigh.

That control can influence what happens farther down the leg — including at the knee.

Research supports this connection. Hip muscle weakness is commonly identified in people with knee osteoarthritis, and systematic reviews have found that hip-strengthening programs can improve knee pain and physical function.^1,2 For people with patellofemoral pain, clinical practice guidelines specifically recommend combining hip- and knee-targeted strengthening exercises rather than focusing only on the knee.³

So if your knee keeps hurting despite repeatedly treating the knee itself, it may be time to ask:

How well are your hips doing their job?

What Do Your Hips Have to Do With Knee Pain?

Your hip is a ball-and-socket joint surrounded by some of the largest and most powerful muscles in your body. These include the:

• Gluteus maximus
• Gluteus medius
• Gluteus minimus
• Hip rotators
• Hip flexors
• Adductors

Together, these muscles help control your pelvis and thigh while you move.

This becomes particularly important when you are standing on one leg — and you spend more time on one leg than you might realize.

Every step you take involves a period when one leg supports your body. So does:

• Going upstairs
• Going downstairs
• Stepping onto a curb
• Golfing
• Lunging for a pickleball
• Moving laterally during tennis
• Hiking
• Getting into and out of a car

When the muscles around the hip are strong enough to control these movements, they help maintain stability throughout the lower extremity. When they are weak or poorly coordinated, movement may change elsewhere — and that can include the knee.

Think of Your Leg as a Chain

One of the most important concepts in understanding knee pain is that the knee sits in the middle of a larger system.

Above it is the hip. Below it is the ankle and foot. So rather than thinking about your knee as an isolated joint, think about the entire chain:

Trunk → Pelvis → Hip → Knee → Ankle → Foot

If one part of that chain is not moving or controlling force effectively, another part may have to compensate. For example:

• If your hip cannot control your thigh well during a step-down, your femur may move differently relative to your pelvis and knee.
• If your ankle is stiff, your knee or hip may have to compensate during a squat or lunge.
• If your quadriceps are weak, you may alter how you climb stairs.

That is why successful treatment for knee pain often involves more than simply asking, “Where does it hurt?” We also need to ask, “How is the entire leg functioning?”

What Are the Hip Abductors — and Why Do They Matter?

One group of muscles deserves particular attention: the hip abductors. The gluteus medius is one of the primary muscles in this group.

Your hip abductors help stabilize your pelvis when you stand on one leg. Imagine taking a step: as one foot leaves the ground, the opposite leg must support your body, and the hip muscles on that stance leg help keep your pelvis controlled.

Research has found that people with knee osteoarthritis commonly demonstrate hip abductor weakness. Hip abductor strength is associated with balance, lower-extremity force generation, and control during weight-bearing activities.¹

A systematic review and meta-analysis examining hip abductor strengthening in people with knee osteoarthritis found significant improvements in both pain and functional outcomes following hip-strengthening interventions.¹

That does not mean hip weakness is the cause of every case of knee pain. It means the hips can be an important part of the rehabilitation picture.

Strong Hips Can Help You Control Your Thigh

One reason hip strength matters is that your hip muscles help control the femur — the large thigh bone above your knee. This is particularly important during movements such as:

• Squatting
• Lunging
• Stepping down
• Running
• Landing
• Changing direction
• Balancing on one leg

When you perform these movements, the knee is influenced by what happens above it. The muscles around your hip help control pelvic position, femoral movement, rotation, and balance — and that can influence how your knee moves during activity.

However, there is an important nuance. It is tempting to oversimplify this relationship and say, “Weak hips cause your knee to collapse inward.” The research is more complicated than that.

A 2024 systematic review found that hip strength alone did not consistently correlate with hip and knee biomechanics during single-leg tasks.⁴

That means we should not assume every movement problem is simply caused by weak glutes. Strength is one piece of a larger system that also includes:

• Mobility
• Coordination
• Balance
• Motor control
• Pain
• Fatigue
• Task demands

This is why an individualized assessment is important.

Why Strong Hips Matter for Pain Around the Kneecap

If your pain is around or behind the kneecap, you may have heard the term patellofemoral pain. This type of knee pain can become more noticeable with activities such as:

• Squatting
• Going up or down stairs
• Running
• Lunging
• Jumping
• Prolonged sitting

For this type of knee pain, the evidence supporting hip strengthening is particularly strong. Clinical practice guidelines from the Academy of Orthopaedic Physical Therapy recommend combined hip- and knee-targeted exercise therapy to reduce pain and improve function in people with patellofemoral pain.³

The guidelines specifically recommend targeting the posterolateral hip musculature along with the muscles around the knee.³

In other words: if the front of your knee hurts, strengthening only the front of your thigh may not be enough.

Why Strong Hips Matter When You Have Knee Arthritis

Hip strength also deserves attention when knee osteoarthritis is present. People with knee osteoarthritis frequently experience weakness beyond the knee itself.

A systematic review examining hip strengthening for knee osteoarthritis found benefits in knee pain, physical function, and hip strength.²

Another systematic review and meta-analysis specifically examining the hip abductors found that strengthening these muscles significantly reduced pain and improved functional outcomes in people with knee osteoarthritis.¹

This is important because arthritis is sometimes viewed exclusively as a structural problem. Someone sees an X-ray showing arthritis and concludes, “The joint is worn out. There isn’t much I can do.”

But physical function is influenced by far more than what appears on an X-ray. Strength matters. Mobility matters. Balance matters. Activity tolerance matters. And the muscles surrounding both the knee and the hip can be trained.

Why Your Hips Matter When You Walk

Walking is essentially a repeated series of controlled single-leg positions. Every time one foot leaves the ground, the opposite leg must support your body, stabilize your pelvis, control your thigh, absorb force, and propel you forward.

Your hip abductors play an important role in this process. Weakness in these muscles may affect pelvic control and lower-extremity force generation during weight-bearing activity.¹

This becomes increasingly important if you want to walk farther, walk faster, walk hills, hike, travel, or walk a golf course.

If knee pain starts appearing after longer walks, simply focusing on the knee may miss part of the reason your leg is fatiguing.

Why Your Hips Matter Going Up and Down Stairs

Stairs require considerably more lower-extremity strength than level walking. Going upstairs requires your hip and knee extensors to help lift your body. Going downstairs requires your muscles to control your body as gravity pulls you downward.

If your hips are weak, your body may compensate by changing trunk position, pelvic position, step width, knee position, or speed.

This is one reason knee pain on stairs should prompt us to look at both hip and knee strength.

Why Your Hips Matter When You Squat

A squat requires coordinated movement through the hips, knees, and ankles. If you lack hip strength, hip mobility, or ankle mobility, your body may alter how it performs the movement.

For someone with knee pain, the goal should not necessarily be to avoid squatting forever. Squatting is part of everyday life. You squat when you:

• Sit in a chair
• Stand from a chair
• Use the toilet
• Pick something up
• Garden
• Get into a low car
• Play sports

The better strategy is often to determine why the movement is difficult and progressively build the capacity required to perform it.

Strong Hips Matter Even More for Golf, Tennis, and Pickleball

For active adults over 50, hip strength becomes especially important during recreational sports.

Golf

During the golf swing, your hips help rotate, transfer weight, stabilize your pelvis, generate force, and control the lead leg. If your hip mobility or strength is limited, your body may compensate through the knee, foot, or lower back.

For a golfer with knee pain, simply strengthening the quadriceps without assessing hip function may therefore miss an important part of the problem.

Pickleball

Pickleball repeatedly requires lunging, lateral movement, deceleration, balance, and rapid direction changes. Your gluteal muscles help control the pelvis and thigh during these movements.

When you lunge toward the kitchen line, your hip and knee need to work together to absorb and control force.

Tennis

Tennis adds even greater court coverage and repeated lateral movement. Every time you chase a wide forehand, your hip muscles help you accelerate, stabilize, decelerate, change direction, and push off again.

For active adults who want to continue playing sports, hip strengthening should therefore be considered part of whole-body preparation, not simply a treatment for hip problems.

What Are Signs That Your Hips May Need More Strength?

Hip weakness cannot be diagnosed from one symptom alone. But you may notice difficulty with tasks such as:

• Standing on one leg
• Climbing stairs
• Getting out of a low chair
• Performing a controlled step-down
• Lunging
• Walking uphill
• Moving laterally
• Balancing while dressing
• Controlling a single-leg squat
• Maintaining stability late in a round or match

You may also notice that one side feels significantly weaker than the other.

A physical therapist can assess these movements along with specific measures of hip and knee strength. For patellofemoral pain, clinical practice guidelines specifically recommend assessing functional tasks such as squatting, step-downs, and single-leg squats, together with measures of hip and thigh strength.³

Five Exercises That Can Help Build Stronger Hips

There is no single “best” hip exercise for every person with knee pain. The appropriate exercise depends on your strength, symptoms, mobility, medical history, and goals. But several categories of exercise can be useful.

1. Bridge

Bridges can help strengthen the gluteal muscles while placing relatively low demands on balance.

Basic progression: two-leg bridge → marching bridge → single-leg bridge.

Focus on using your hips rather than excessively arching your lower back.

2. Side-Lying Hip Abduction

This exercise targets muscles on the outside of the hip. Lie on your side with the top leg straight and lift it upward under control. Avoid rolling your pelvis backward. As strength improves, resistance can be added.

3. Sit-to-Stand

One of the most useful functional exercises is simply standing up from a chair. This trains both the hips and knees.

Progressions can include: higher chair → lower chair → added resistance → slower lowering.

This is also a good example of why knee rehabilitation often should not separate hip and knee strengthening. Real-life movements require them to work together.

4. Step-Ups

Step-ups can help develop hip strength, quadriceps strength, balance, and single-leg control. They also transfer well to real-life activities such as stairs, curbs, hiking, and golf-course terrain.

Begin with an appropriate step height and gradually progress.

5. Lateral Step or Band Walk

Lateral exercises challenge the muscles on the outside of the hips. These can be particularly useful for people returning to activities involving side-to-side movement, including tennis, pickleball, golf, and hiking.

Progress from controlled movement to more challenging resistance and eventually to sport-specific lateral tasks when appropriate.

Don’t Make the Mistake of Strengthening Only Your Hips

This is important. If hip strengthening is helpful for knee pain, should you stop doing knee exercises? Usually, no.

The strongest evidence — particularly for patellofemoral pain — supports combined hip- and knee-targeted strengthening rather than choosing one or the other.³

Think of your lower extremity as a team. Your hips, quadriceps, hamstrings, calves, ankles, and feet all contribute to movement. A comprehensive program should address the specific deficits that matter for you.

Strength Is Only Part of the Solution

You can have strong hip muscles and still experience knee pain. Why? Because movement requires more than strength. You may also need:

• Mobility — Can your hips and ankles move through the range required for the activity?
• Balance — Can you control your body over one leg?
• Coordination — Can your muscles work together at the right time?
• Endurance — Can you maintain control when you become tired?
• Deceleration — Can you absorb force when stopping?
• Sport-specific capacity — Can your body tolerate the actual demands of golf, tennis, pickleball, hiking, or another activity?

This is why simply prescribing three “glute exercises” may not solve every knee problem. The goal is to identify what is actually limiting your movement.

What If Hip Exercises Make My Knee Hurt?

Exercise should be appropriately matched to your current ability. If a particular exercise significantly increases knee symptoms, you may need to modify resistance, depth, repetitions, range of motion, exercise selection, or frequency.

For example, someone who cannot tolerate a deep squat may initially work with a higher chair. Someone who struggles with a deep lunge may begin with a smaller range.

The objective is not to force painful movements. It is to find an appropriate starting point and progressively build capacity.

How Long Does It Take to Strengthen Your Hips?

Strength does not change overnight. Meaningful improvements generally require consistent progressive resistance training over weeks and months.

The exact timeline varies depending on starting strength, age, training history, exercise intensity, frequency, nutrition, recovery, medical conditions, and consistency.

The important point is that your program should progress. If you have been performing the same easy exercise with the same resistance for months, your muscles may no longer be receiving enough challenge to continue adapting.

Do You Need Stronger Hips After 50?

Maintaining hip strength becomes increasingly important as we age — not simply because of knee pain.

Strong hips contribute to your ability to walk, climb stairs, get out of chairs, balance, travel, hike, golf, play tennis, play pickleball, and get up and down from the floor.

For active adults, strength is not just about lifting heavier weights. It is about maintaining the physical reserve needed to continue participating in life.

When Should Knee Pain Be Evaluated?

Seek appropriate medical evaluation if knee pain follows a significant injury or if you experience:

• Significant swelling
• Inability to bear weight
• True locking of the knee
• Repeated giving way
• Significant loss of motion
• Redness or warmth
• Fever or systemic symptoms
• Persistent or progressively worsening symptoms

You should also consider an evaluation when knee pain repeatedly limits walking, stairs, exercise, golf, tennis, pickleball, or other activities despite reasonable modifications.

What Should a Comprehensive Knee Pain Evaluation Include?

If you have persistent knee pain, the evaluation should look beyond the painful area. Depending on your symptoms and goals, it may include:

• Knee mobility — Can your knee fully bend and straighten?
• Knee strength — How strong are your quadriceps and hamstrings?
• Hip strength — How well can your gluteal muscles generate and control force?
• Hip mobility — Do you have enough rotation and extension for your activities?
• Ankle mobility — Is restricted ankle motion influencing how you move?
• Balance — Can you control your body on one leg?
• Functional movement — How do you squat, step down, lunge, walk, and climb stairs?
• Sport-specific movement — If your goal is returning to golf, tennis, or pickleball, the evaluation should eventually examine the movements required for that sport.

This is consistent with clinical guidelines that recommend evaluating both hip and thigh strength and functional lower-extremity movement in people with patellofemoral pain.³

Frequently Asked Questions About Hip Strength and Knee Pain

Can weak hips cause knee pain?

Hip weakness may contribute to knee symptoms in some people, but it is rarely as simple as saying weak hips directly “cause” all knee pain. Hip strength influences lower-extremity function, and hip strengthening has been shown to improve pain and function in conditions including knee osteoarthritis and patellofemoral pain.^1,2,3

Which hip muscles are most important for knee pain?

The gluteal muscles — particularly the posterolateral hip musculature — are frequently targeted. For patellofemoral pain, clinical guidelines specifically recommend hip exercises targeting the posterolateral hip combined with knee strengthening.³

Will strengthening my glutes fix my knee pain?

Not necessarily by itself. Knee pain can have many contributing factors. Hip strengthening may be useful, but your program may also need to address knee strength, ankle mobility, balance, activity volume, movement control, and sport-specific demands.

Are squats good for knee pain?

Squats can be an effective way to strengthen both the hips and knees when appropriately prescribed. Clinical guidelines for patellofemoral pain include resisted squatting as one form of knee-targeted exercise.³ Exercise depth and resistance should be matched to your symptoms and current capacity.

Why do my knees move inward when I squat?

Several factors can influence knee position during a squat, including hip and ankle mobility, strength, coordination, anatomy, task demands, and technique. It should not automatically be assumed that weak glutes are the only cause.⁴

Should I strengthen my hips if I have knee arthritis?

Hip strengthening can be useful as part of a comprehensive exercise program. Systematic reviews have found improvements in knee pain and physical function following hip strengthening in people with knee osteoarthritis.^1,2

What exercises strengthen the hips without hurting the knees?

Exercises such as bridges, side-lying hip abduction, and appropriately selected resistance exercises may initially place less demand on the knee. The right starting point depends on why your knee hurts and what movements you can comfortably tolerate.

Stop Thinking About Your Knee in Isolation

If there is one takeaway from this article, it is this: your knee is part of a system.

When your knee hurts, it is certainly important to evaluate the knee. But we should also ask:

• How strong are your hips?
• How well do your hips move?
• How strong are your quadriceps?
• How well do your ankles move?
• How is your balance?
• How do you walk?
• How do you squat?
• How do you lunge?

And most importantly: what are you trying to get back to doing?

If your goal is walking around the house, your physical requirements are relatively modest. If your goal is walking 18 holes of golf, playing 90 minutes of tennis, competing in several pickleball games, hiking on vacation, or keeping up with your grandchildren, your body needs considerably more capacity.

At Kriz Mobility and Vitality in Bonita Springs, Florida, we work with active adults who want to understand not only where they hurt, but why their body is having difficulty with the activities they want to perform.

That means looking beyond the knee and assessing the entire movement system — including the hips, ankles, strength, balance, mobility, and activity-specific demands.

Because the goal isn’t simply to make your knee hurt less. The goal is to help you build a body capable of doing the things that matter to you.

Move better. Live better. Stay Active for Life.

References

1. Thomas DT, Shruthi R, Prabhakar AJ, Dineshbhai PV, Eapen C. Hip abductor strengthening in patients diagnosed with knee osteoarthritis—a systematic review and meta-analysis. BMC Musculoskelet Disord. 2022;23:622. doi:10.1186/s12891-022-05557-6.

2. Neelapala YVR, Bhagat M, Shah P. Hip muscle strengthening for knee osteoarthritis: a systematic review of literature. J Geriatr Phys Ther. 2020;43(2):89–98. doi:10.1519/JPT.0000000000000214.

3. Willy RW, Hoglund LT, Barton CJ, et al. Patellofemoral pain: clinical practice guidelines linked to the International Classification of Functioning, Disability and Health from the Academy of Orthopaedic Physical Therapy of the American Physical Therapy Association. J Orthop Sports Phys Ther. 2019;49(9):CPG1–CPG95. doi:10.2519/jospt.2019.0302.

4. Garcia MC, Waiteman MC, Taylor-Haas JA, Bazett-Jones DM. Hip strength does not correlate with hip and knee biomechanics during single-leg tasks: a systematic review with meta-analysis and evidence gap map. J Sports Sci. 2024;42(19):1831–1846. doi:10.1080/02640414.2024.2415219.