Could Stronger Hips Be the Secret to Reducing Knee Pain? New Research Says Yes
Written by Dr Julian Simpson — Chiropractor with 15+ years of experience, Board Member of the Chiropractic Australia Research Foundation, and author/reviewer of 800+ health articles.
Could Stronger Hips Be the Secret to Reducing Knee Pain? New Research Says Yes
If your knees hurt every time you climb stairs, squat or go for a walk, your hips could be part of the problem.
If you've ever experienced pain around the front of your knee, you're certainly not alone.
Whether you're commuting along the Calder Freeway from Sunbury, travelling the Western Highway from Melton, chasing the kids around the local sporting fields, or simply trying to stay active, knee pain can make everyday life frustrating.
One of the most common causes of persistent front-of-knee pain is Patellofemoral Pain Syndrome (PFPS)—often called runner's knee. Despite its name, you don't have to be a runner to develop it.
Exciting new research has found that strengthening specific muscles around the hips and thighs may actually improve the alignment of the knee, helping reduce one of the underlying mechanical factors associated with patellofemoral pain.
Let's look at what the latest research discovered.
What is Patellofemoral Pain Syndrome?
Patellofemoral Pain Syndrome occurs when pain develops around or behind the kneecap (patella).
It is one of the most common knee conditions seen by healthcare professionals.
Research estimates it affects:
15–45% of athletic populations
22–30% of young adult women
Pain is usually aggravated by activities such as:
Walking downstairs
Climbing stairs
Running
Squatting
Lunging
Prolonged sitting
Getting up after sitting for long periods
Many people describe it as a dull ache at the front of the knee that gradually becomes more noticeable over time.
Why Does It Happen?
There isn't one single cause.
Instead, Patellofemoral Pain Syndrome usually develops because several factors combine together, including:
Weak hip muscles
Weak quadriceps
Poor neuromuscular control
Reduced pelvic stability
Poor movement patterns
Increased knee valgus ("knock-knee" position)
Poor tracking of the kneecap
When your hip muscles don't stabilise your leg properly, your knee can drift inward during walking, running or squatting.
Over time this places extra stress on the kneecap.
What Did This New Study Investigate?
Researchers in Brazil wanted to answer an important question:
Can strengthening the hip and thigh muscles actually improve knee alignment?
Twenty-nine university students with Patellofemoral Pain Syndrome initially entered the study.
Because this was an intensive supervised programme, only 10 participants completed all 36 exercise sessions, making this a pilot study.
Although the final sample was small, the researchers used highly accurate 3D CT scans before and after the programme to measure changes in knee alignment—something rarely done in rehabilitation studies.
The 12-Week Exercise Programme
Unlike many studies that simply ask participants to "exercise", this research used a carefully structured strengthening programme.
Participants attended:
3 supervised sessions each week
12 weeks
36 sessions in total
Each session included:
Warm-up
5 minutes of stretching
15 minutes of treadmill walking at 4–5 km/h
Strengthening Exercises
The programme targeted three key muscle groups:
Quadriceps
Hip abductors
Hip external rotators
Exercises included:
Hip abduction against a wall
Leg extensions
Hip abduction machine
Squats with resistance bands
Clamshell-style hip abduction with external rotation
Single-leg bridges
Quadruped hip strengthening
Hip abduction with ankle weights
Lateral band walks
Seated hip external rotation
Hip bridges with resistance bands
Standing cable hip abduction with external rotation
Most strengthening exercises were completed using:
3 sets
Progressive resistance
20, 15 and 10 repetitions
Loads based on 60–70% of each participant's one-repetition maximum (1RM)
Rest periods of 2–3 minutes were provided between larger exercises to optimise strength gains.
What Did the Researchers Find?
After completing the 12-week programme, several important improvements were observed.
Improved Knee Alignment
Researchers measured something called the Q angle, which reflects how the hip, kneecap and shin align.
After training:
Knee valgus reduced significantly (p = 0.0091)
Average Q angle reduced by 1.14 degrees
Although this sounds like a small change, the researchers used highly precise 3D CT imaging capable of detecting subtle improvements in alignment.
Improved Patellar Tracking
Another important measurement was the Tibial Tubercle–Trochlear Groove (TT–TG) distance.
This measures how well the kneecap aligns with the thigh bone.
Following the strengthening programme:
TT–TG distance improved by an average of 1.51 mm
This improvement was highly statistically significant (p = 0.0001)
Better alignment may reduce stress placed on the kneecap during everyday movement.
What Didn't Change?
Interestingly, not everything improved.
Researchers found no significant changes in:
Femoral neck anteversion
Tibial external torsion
These are structural features of the bones themselves.
This tells us something important:
Exercise won't change your bone structure—but it can improve how your muscles control your movement.
That's excellent news because muscle function is something we can actively improve.
Why Are Hip Muscles So Important?
Many people assume knee pain should be treated only at the knee.
Modern research tells a different story.
The hip muscles help control:
Pelvic stability
Femur position
Knee alignment
Balance
Walking mechanics
Running technique
When these muscles become weak, the knee often collapses inward.
Over thousands of steps every day, this increases pressure on the kneecap.
Improving hip strength helps the entire lower limb work more efficiently.
What This Means for You
If you're living with persistent knee pain, simply resting isn't usually enough.
An evidence-based rehabilitation programme that targets the hips and thighs may help improve:
Knee alignment
Muscle control
Joint stability
Movement efficiency
Confidence during activity
While every person is different, research increasingly shows that strengthening the hip muscles should be a central part of managing Patellofemoral Pain Syndrome.
Why a Holistic Approach Works Best Exercise is one of the most effective tools for managing patellofemoral pain, but it works best when combined with a comprehensive treatment plan. At Health Wise Chiropractic, we assess how your spine, pelvis, hips, knees and feet work together. Where clinically appropriate, we combine manual therapy, personalised strengthening programmes, movement retraining, education and lifestyle advice to optimise your recovery and help reduce the likelihood of symptoms returning.
What Are the Study's Limitations?
As encouraging as these findings are, it's important to understand the limitations.
Only 10 participants completed the entire programme, making this a relatively small pilot study.
The researchers also measured alignment, rather than directly measuring long-term pain relief or return to sport.
Larger randomised controlled trials are still needed to confirm these findings.
However, the study adds to a growing body of evidence showing that strengthening the hip and thigh muscles can positively influence the way the knee functions.
How Chiropractic Care Can Help
At Health Wise Chiropractic, we know that knee pain often starts somewhere else.
Rather than looking only at the painful knee, we assess your entire movement system, including:
Hip mobility
Pelvic stability
Muscle strength
Walking and squatting mechanics
Balance
Lower back function
Depending on your individual assessment, your care may include:
Chiropractic adjustments where clinically appropriate
Soft tissue therapy
Individualised strengthening exercises
Glute and quadriceps rehabilitation
Movement retraining
Postural advice
Return-to-sport or activity planning
While this study did not investigate chiropractic care or spinal manipulative therapy directly, it supports the importance of targeted exercise and comprehensive conservative management as part of an evidence-informed rehabilitation programme.
Simple Tips to Support Healthier Knees
If you're looking after your knees, these strategies can help:
Strengthen your hip muscles as well as your quadriceps.
Focus on good technique rather than lifting heavier weights too soon.
Progress your exercises gradually under professional guidance.
Stay active—complete rest is rarely the best long-term solution.
Address pain early before movement patterns become more difficult to change.
Seek an assessment if knee pain has persisted for more than a few weeks or is limiting your daily activities.
How Chiropractic Care May Help
At Health Wise Chiropractic, we take a comprehensive approach to posture-related care.
Treatment may include:
We focus on addressing both the symptoms and the underlying biomechanical stress contributing to neck dysfunction.
About the Author
Dr Julian Simpson is an Australian chiropractor with over 15 years of experience in musculoskeletal healthcare and rehabilitation.
He is a Board Member of the Chiropractic Australia Research Foundation and has reviewed and written more than 800 evidence-based health articles focused on spinal health, rehabilitation, sports injuries and conservative care approaches.
His treatment focus includes:
Chiropractic adjustments
Sports chiropractic
Massage therapy
Shockwave therapy
Laser therapy
Non-surgical spinal decompression
Dr Simpson provides patient care through Healthwise Chiropractic, serving communities including Sunbury, Melton, Diggers Rest and surrounding regions.
Reference
Carvalho RAG, Pizzolato BB, Souza GPA, Minussi Filho E, Calixto GFL, Galdeano EA, Madureira MMS, Rodrigues WM, da Cunha MR, Machado EG, Cunha FB, Buchaim RL, Munhoz MAS. The Strengthening of Quadriceps, Abductors, and External Rotator Muscles of the Hip to Alter Axial Alignment of the Lower Limbs in University Students with Patellofemoral Pain Syndrome: A Prospective Cohort Study. J Funct Morphol Kinesiol. 2026 Jun 1;11(2):225. doi: 10.3390/jfmk11020225. PMID: 42346754; PMCID: PMC13302242.
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