I can’t tell you how many times I’ve heard somebody tell me that they have “bad knees.” Well, your knees may bother you, but I’m here to say that your knees are probably not the problem. In actuality, your knees are most likely doing everything right, but you have bad hips (or ankles).

I should make clear that there are exceptions, and I will not be talking about any knee issues that may have developed from a contact injury (like having someone headbutt your knee, shattering your ACL). But, everyone needs to realize that the pain is NOT the problem - it’s merely the signal of a larger problem.

Before you point at your bum knee and tell me that you fundamentally disagree with what I just said, I want to start by mentioning two of the biggest messages from Dr. Shirley Sahrmann. To say that she’s one of the most well-known physical therapists would probably be an understatement, and anytime I want to feel like a nerd, I pull out one of her textbooks and feast on information. Anyway, she’s often said that whenever something is injured to immediately look at the surrounding parts, and that every “non-contact injury” could have been avoided.

Whenever I want to "up my nerd game," I turn to this beast of a book.

With that said, this study on knee pain (patellofemoral pain, to be exact) looked at 15 young women and found some serious problems with their hips. To be exact, those with knee pain had 26% less hip abduction strength than their counterparts, and 36% less strength during hip external rotation.

Now, before we proceed with the scientific mumbo jumbo (and hopefully I haven’t lost you yet), one easy way to think about how the body is all connected is through the joint by joint theory of the human body. The joint by joint theory is a special way of saying that your body is composed of mobile levers on stable segments. While that probably sounds a bit complicated, let’s break it down to only the lower body.

First off, you need a mobile ankle in order to walk and function in everyday life. And what happens if you don’t have a mobile ankle? You’re probably more prone to sprains and rolling your ankle.

Next, we need a stable knee. Now, we’re not talking about stability in the traditional, static, “I hope my coffee table doesn’t collapse when I dance on top of it” kind of way. Instead, think about what happens when your knee caves inward or outward. In fact, my eyes bleed whenever I see people’s knees caving in. True story.

This is a valgus collapse.  Yes, it looks as bad as it sounds. — This is a valgus collapse. Yes, it looks as bad as it sounds.

Higher up the chain, we then need to have a mobile hip joint so that we can run, and move in multiple directions. As you can see, the joints in the lower body go mobile-stable-mobile.

In a perfect world, these three parts work together. But, as we all know, nothing is ever perfect. If you’ve lost mobility in either the ankle or the hip, you knee is going to have to make up for it, and a stable joint will become unstable. Often times, these changes are ever so slight, but it can develop into some serious knee pain that would have you choose to get stabbed in the face with a fork, rather than embarking for a 2 mile run. (Those that have had knee problems will know what I’m talking about.)

Now, let’s look at this study, which focuses the problem on the kneecap. The authors took MRIs of knees when they were flexed and extended. What they found is that the kneecap doesn’t move or “track” in a certain direction. Instead, its your knee cap that moves around your femur and tibia (the two big bones in your leg). Suddenly, you can see how decreased rotation and movement (or too much of either) can throw off this entire mechanism.

Now, if you’ve made it this far in my blog post, I must congratulate you. This information is some pretty heavy stuff, and if you’ve managed to pick up some of what I just threw down, give yourself a pat on the back! If nothing else, just remember that if you have knee pain, strengthen those glutes and abductors.

Remember: you can ice your knee all you want, but you’re probably just mopping up a wet floor…when it’s the ceiling that’s leaking.