One day you may start to notice the medial (side of your knee closest to midline) side of your knee hurts. Many people describe this as pain on the “inside” of their knee. As time passes it may hurt more and more especially with activities like squatting, running, or going up/down stairs. If you are not having any clicking or catching in your knee, read on for what is likely causing your medial knee pain.
Most medial knee pain is caused by hip weakness
You might think “But Daniela, I have strong legs!” I would respond with… do you? It’s possible. Hear me out here.
Sometimes when I test muscle strength in the clinic, a very athletic person will have strong quadriceps (these muscles straighten the knee) but weak hip abductors and extensors (muscles that bring the leg out to the side and behind you). The hip controls the position of the knee. If you stand up and point your knee towards and away from midline, this movement comes from your hip.
If the hip is not controlling the position of your knee, this can cause knee pain.
Take a look at these two pictures. In the first picture, the knees are over the feet. In the second picture, the knee is dipped in towards midline. This is called knee valgus. When a person moves with knee valgus, the transfer of the weight above the knee down to the foot puts excessive strain on the medial side of the knee.
In the photo above, the knees are aligned above the feet. Notice both shins are perpendicular to the gound.
In the photo above, there is right knee vaglus. Notice the knee is not above the foot, but slightly inside of it.
In the photo above, both knees demonstrate valgus. Notice how both knees slope in, and are inside of the foot instead of directly above it.
This is not just a strength issue. It’s also about motor control.
Think of it like this: strength is the ability to crush a can while motor control is the coordination of small, subtle movements to sign your name. Hip strength is a part of the picture here but without this control it’s not enough. If you have this problem, you need to perform exercises to not only strengthen your hips but also to train your hips to properly stabilize you. At first this may require a conscious effort but over time the goal is for it to become automatic.
Here are a few of my favorite exercises to reduce medial knee pain
This is by no means an exhaustive list, but these are a couple of my favorite exercises for this condition:
- Banded lateral stepping
- Monster walks
- Standing hip abduction
- Bosu squats
If you are wanting to try some of these exercises, I suggest taking a video of yourself performing them in slow motion. Analyze your movements. Is your trunk staying upright, or are you tilting to the side every time you stand on your affected leg? If you find yourself becoming crooked, this is a common compensation for hip weakness.
Do you look symmetrical on each side? Do your knees wobble side to side during the exercises? Are your knees dipping inside your feet at any time? These are all things that I look for when I’m analyzing my patients in the clinic.
As always, I recommend consulting a clinician before self diagnosing. It is always a good idea to rule out any underlying pathology or concerning conditions.
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