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What’s knee pain all about?

Usually the problem is actually coming from the hips or feet

After seeing an older woman in the clinic a few weeks into her post-knee replacement rehabilitation, her daughter approached me saying she knew she was headed in the same direction as her mom as she was already having knee and hip pain. She wanted to know if there was anything she could do to prevent the process, or if it was just inevitable that she would eventually have to replace a joint or two.

I assured her that just because there is a family history of something does not mean it can’t be prevented or corrected, especially when it comes to movement health.

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When it comes to the knees — generally the actual problem is coming from the hips and/or feet. The knee is a bridge joint, designed to improve efficiency of transit, absorb and transfer force. If the lines of force get messed with (you lack stability in the joints above and below), then the efficiency of that joint and its movement is affected.

Stress builds up and that leads to warning signs (pain), inflammation, stiffening, and eventually degeneration of the structures within the joint. This can present via tendonopathies, osteoarthritis, runner’s knee/jumper’s knee (both tendonopathies), patellofemoral syndrome or patellar chondromalacia, and increase the risk of structural damage to the knee.

Barring external trauma (but yes postural dysfunction can even contribute to the risk of this), pain and issues in the knee generally are coming from above or below.

So it’s a good idea for those who do much repetitive movement to get their gait screened by a professional. Catching dysfunction early and prescribing appropriate corrective movements is key in preventing problems down the chain.

Here are three “simple” exercises I prescribe routinely to clients experiencing knee/hip/back pain or rehabbing a joint replacement.


Designed to activate the lateral stabilizers in the hip, you should feel the burn on the top side of your hip as that is where the activation should come from. Laying on your side with knees bent to approximately 90 degrees, hips and ankles stacked — clamshell the knee open lifting from the hip. Do not let your hips fall backwards; they should remain stacked and level throughout the movement. Hold the clam at the top range of motion (wherever you can raise to without your hip sliding back) for 10 seconds. Slowly return back to the start position.

Repeat three sets of 10 to 15 routinely in your day. The more you activate the muscles properly, the more the brain makes it automatic.

Gait activation

Laying on your stomach, tuck your chin to lift your head (nose should remain pointed down to the ground), and squeeze your butt cheeks together. Holding and maintaining this position, press opposite arm and leg to the ground while lifting the other opposite limbs off the floor. Hold for four seconds, switch and repeat process.

This activates deep postural muscles and connects the brain to a proper gait transfer pattern.

Repeat three to five rounds of 20 a day.

Side bridges

On your side, supported by your elbow, shoulder, and core activation, pivoting from the knees, use glutes to actively push hips up and forward through a hinge motion. Hold at the top for five to 10 seconds, then sit back and down through the hip hinge.

Common mistakes here: slouching into the shoulder (push up through the ground/elbow and squeeze shoulder blades together), lack of core activation/bracing allowing for the spine to hinge instead of the hips (think of a squat motion at the hips), lifting up then forward. Try and make this simultaneous, as if your hips are moving up and down a ramp.

Repeat six to 12 times for rounds of three to five.

About the author


Kathlyn Hossack runs a clinical practice, Integrative Movement in Winnipeg, Manitoba and consults clients throughout Alberta on a regular basis. For questions or consultations email her at [email protected].

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