In this blog, I’ve paired these two joints together as the biomechanics of both of these joints can drastically affect one another. And we could even take this article further and include the ankle joint too, but we'll save that for another time. The aim of this blog is to discuss some of the things we look at as physios and some of the treatments we offer to manage knee or hip pain. I will not be focusing on specific exercises as each patient treatment should be individualized and there are some exercises that may not be appropriate for certain conditions. No exercise is bad exercise but some can certainly flare-up symptoms.


The knee joint is a hinge joint that mainly allows flexion and extension with a degree of medial and lateral rotation. It's made up of the femur, tibia and patella; forming two joints, the tibiofemoral and the Patellofemoral joint. Within the knee, sits the meniscus. Two C shaped fibrocartilaginous structures that act to increase the depth of the surface and act as shock absorbers. There are four main ligaments to focus on. The collateral ligaments - medial collateral ligament (MCL) and lateral collateral ligament (LCL). The cruciate ligaments - the anterior cruciate ligament (ACL) and the posterior cruciate ligament (PCL).

The hip is a ball and socket joint connecting the femur to the pelvis. The acetabulum or socket is a cup-like depression in the pelvis where the rounded head of the femur sits. This socket is further deepened with a fibrocartilaginous structure called the labrum. The hip joint is an extremely strong joint that is reinforced by ligaments and musculature. In comparison to the shoulder, the hip joint is very stable. Movements available at the hip increase flexion, extension, abduction, adduction, medial and lateral rotation


Knee pain is the 2nd most common musculoskeletal injury reported. When it comes to knee pain, our patients present with a huge age range. Children/adolescents presenting with ‘growing pains’, the mid-20s presenting with traumatic sports injuries and 70-year-olds presenting with arthritic changes. The hip is a similar affair with a huge variety of conditions that greatly differ between children, adolescents and adults. Common knee injuries: Meniscus – both trauma and degenerative tears Ligament tears - ACL, PCL, MCL, LCL Anterior knee pain - Patellofemoral joint pain Osteoarthritis Common hip injuries: Femoral acetabular impingement Development hip dysplasia Groin strains Greater trochanteric pain syndrome Osteoarthritis


Biomechanics is the study of the structure, movement and function of living organisms. In physio and orthopaedics, we often see people with movement-related pain. This could be due to muscle weakness or people lifting things in the gym that are too heavy to perform correctly. Not every condition has to be related to structural damage such as a broken bone or a torn ligament. Therefore the first difference we need to look at is whether the altered movement is structural or mechanical. Structural means things like arthritis of a torn meniscus. Mechanical means things like muscle weakness or reduced mobility in a joint. We see different biomechanical presentations through different age ranges e.g. children with knee pain secondary to their hip structure vs the older adults with knee structural changes due to osteoarthritis causing differing biomechanics at the hip. These differ from the mechanical presentation we see e.g. weak gluteal muscles causing the hip ‘drop down’ when walking, leading to lateral hip pain. A great example of biomechanical pain is the knee, hip or lower back pain after a sprained ankle. In the first few days of severe, we limp causing changes to our normal gait patterns causing increased load to other structures

As with most areas of the body, physiotherapists almost always look at other joints and like to assess things from a more functional perspective. This is particularly relevant when we assess the lower limb. Simply looking at how much the knee bends or your hip extends may not be particularly useful. If you come to physio with knee or hip pain, most of the time, the physio will review your walking, squats, lunging and other tasks to see how things move functionally. And that assessment starts straight away in the waiting room. We'll be watching the way you get up from your chair, pick up your bag and walk into the clinic room. We will be comparing left with right, looking at ‘normal’ movement patterns and normal joint ranges. Now I'm not saying that an assessment specifically looking at the knee is worthless. Quite the opposite actually, particularly when it comes to ligament injuries and laxity at the knee. However, only a small percentage of our patient group come in with ligament rupture that requires surgical intervention.

Note, I say normal in quotation marks. This is because it's hard to define what normal movements are. With almost every patient, I'm sure we could find an altered movement or asymmetry in the bodies natural resting position. This, therefore, is not saying that every impaired or altered movement is abnormal. No one is perfect. We all move differently. Just because we notice the left shoulder moves differently to the right, doesn't mean that's the issue and that's what's causing your pain. However, what I will say is that if you are in with a physio, it's not for no reason therefore sometimes these altered movement patterns may be the issues. 'Flat feet' is probably a good example of this. Many people are 'flat footed' therefore we can describe this as a normal variant. If I see a 50-year-old with a new onset of knee pain and I see flat feet, I'm not putting all my eggs in one basket and blaming that. After all, they've probably had around 49 years of walking with no issues, so why are those feet an issue now. However, if I see a 35-year-old, with knee pain, and flat feet and they've recently started a half marathon training programme, then maybe this is something we need to look at. Along with probably overtraining, a footwear review and a lack of strengthening included in their programme.


Wear and tear equals pain - 'wear and tear' or age-appropriate changes are normal things we see as we age. Wear and tear on scans is like finding grey hair or a wrinkle. Most of the time this causes no issues. However with moderate to severe changes people can often have pain associated with the joint changes and the surrounding muscular weakness therefore the first line of treatment is normally physio. Orthopaedic input is always available if necessary

Running is bad for my knees - there is no evidence to support this. In fact, evidence shows that runners generally have better tissue quality than non-runners.

Clicking is bad - there are certainly a few incidences where clicking is bad. But most of the time clicking is normal and due to gases in the joint and soft tissues moving over structures

A scan WILL show the reason for my pain. Scans are great for showing structural changes. However, we need to focus on both the scan AND the clinical assessment. Common findings on MRIs include meniscus tears and impingement of the hip in both painful and pain-free people therefore we must clinically reason whether this structural change is the reason for pain.


Weight loss - One often overlooked aggravating factor for knee pain is body weight. Forces through the knee can be three times our body weight, therefore a drop in a few kilos equates to a significant amount of force reduction through the knees. There is a significant increase in knee arthritis risk in obese people. Therefore often some simple advice on weight loss, including nutrition advice and exercise advice can be a great place to start to aid your recovery.

Don't push stretches to the end of your range - Time and time again, we see stretching and stretching, and then stretching some more, despite the fact that this causes their hip pain.

Don't neglect the glutes in the gym and training. The gluteal muscles plan an important role in mechanical and lower limb movements. Functional exercises like Squats and step-ups are a great way to engage the glutes rather than the leg machines.

Review your habits - do you shift all your weight onto one leg when you're standing? Do you sit cross-legged when you'rE on the sofa?

Dynamic control - don’t solely focus on machine exercises in the gym. Incorporate balance exercises, twisting, turning and direct changes into your rehab and workouts.

Don't forget strengthening - this is aimed more at the runners. Strengthening throughout the lower limb is important for running. A good running programme should include a couple of strengthening sessions a week

Don't bias muscles or muscle groups. A good workout routine should cover all muscle groups. Functional training and push/pull workouts are great ways to avoid bias. Overtraining and undertraining muscle groups can cause mechanical pain due to altered movement patterns.

Are you facing issues with your knees or hip? Please feel free to contact us to make a booking here.