Why Gluteal Strength Matters for Knee, Hip and Ankle Pain
The muscles around your hip do far more than power a squat. They control how the whole leg lines up when you walk, run, climb stairs and land — which is why gluteal strength keeps coming up in the management of knee and hip pain.
The gluteal group — gluteus maximus, medius and minimus — steadies the pelvis and controls rotation and inward collapse of the thigh. When these muscles work well, load is shared sensibly through the hip, knee and foot. When they’re weak or poorly controlled, the knee tends to fall inward and other tissues take more strain. That’s the link between the hip and pain felt lower down the leg.
The knee connection
People with patellofemoral pain (pain around the front of the knee, common with stairs, squatting, running and prolonged sitting) are, on average, measurably weaker in hip strength than people without it. A well-known randomised trial found that strengthening the hip abductors and external rotators improved pain and function in people with patellofemoral pain. Hip-focused exercise is now a standard part of managing this condition, usually combined with knee strengthening for the best result.
It’s worth being realistic: hip strengthening reliably helps in the short term, but it doesn’t always produce big changes in knee movement patterns, and long-term results depend on continuing to load the muscles. Strength is a process, not a one-off fix.
The hip connection
Pain on the outside of the hip — often diagnosed as greater trochanteric pain syndrome — is now understood to be mostly a gluteal tendinopathy, an overload problem of the gluteal tendons where they attach to the hip. Management centres on settling irritation (including avoiding positions that compress the tendon, like crossing the legs or leaning onto one hip) and then progressive loading of the gluteal muscles, rather than rest or repeated injections.
Down to the ankle and foot
Because the glutes influence how the whole limb lines up, hip control also affects loading further down at the knee, ankle and foot. That’s why we rarely assess a lower-limb problem in isolation — how the hip behaves changes what the foot and ankle have to absorb.
Key points
- The glutes control pelvic stability and stop the knee collapsing inward.
- Hip strengthening helps patellofemoral knee pain, best combined with knee work.
- Lateral hip pain is usually gluteal tendinopathy — managed with load, not rest alone.
- Strength gains need to be built and maintained over time.
At Flow Clinic we assess strength and control from the hip through to the foot, then build a progressive programme targeted at where your control is breaking down — not a generic set of exercises.
Evidence & sources
Khayambashi K, et al. Short-Term Effects of Hip Abductors and Lateral Rotators Strengthening in Females With Patellofemoral Pain Syndrome: A Randomized Controlled Clinical Trial. Journal of Orthopaedic & Sports Physical Therapy. jospt.org/doi/10.2519/jospt.2010.3246
Grimaldi A, Fearon A. Gluteal Tendinopathy: Integrating Pathomechanics and Clinical Features in Its Management. Journal of Orthopaedic & Sports Physical Therapy. 2015. jospt.org/doi/10.2519/jospt.2015.5829
This article is general information, not a substitute for individual assessment. See a qualified health professional for advice specific to you.
Knee or hip pain that keeps coming back?
Book an assessment at Flow Clinic in Wairau Valley for a targeted strength and control plan.