By Dana Santas, CNN
(CNN) — If your knees hurt, your first instinct is probably to blame them. But in many cases, knee pain isn’t about the knees at all — it’s about what’s happening above them.
Tight hips, especially when combined with weakness or poor control, can alter how your legs move, forcing your knees to compensate in ways they’re not designed to. Over time, this added stress leads to chronic discomfort and, in some cases, serious injury.
Understanding the hip-knee connection is the first step toward relieving that pain and moving better.
Why tight hips strain your knees
The hip is a ball-and-socket joint, built for mobility in multiple directions. The knee, on the other hand, is a hinge joint that primarily moves forward and back. When your hips don’t move as they should — whether due to stiffness, weakness or a lack of pelvic control — your knees pick up the slack during activities such as walking, running, squatting or climbing stairs.
For example, when the muscles on the outside of your hips aren’t keeping your hips aligned and providing lateral stability, your femur (thigh bone) can collapse inward, placing extra stress on the inside of your knee.
When your pelvis isn’t moving properly because it’s restricted or imbalanced, it affects how your thigh bone aligns with your shin. That type of pelvic problem causes the kneecap to shift off-center as it moves, rubbing against the cartilage beneath it.
The altered alignment resulting from these two issues causes significant stress and uneven wear and tear on the joint, contributing to conditions such as patellofemoral pain syndrome (pain around or under the kneecap ), also known as runner’s knee, and cartilage breakdown that can lead to osteoarthritis and other debilitating issues.
The role of lifestyle and movement habits
If you spend most of your day sitting, your hip flexors are likely tight, and your glutes may be underactive and weak. That imbalance can create a domino effect, leading to limited hip extension, poor pelvic alignment and less stability throughout your lower body.
Even athletes aren’t immune. Repetitive motions such as running, cycling or weight lifting without proper mobility work can reinforce asymmetries or restrictions in hip movement. And when your training lacks adequate attention to hip rotation, lateral movement or glute strength, your knees are the ones that suffer.
How to tell if your hips are contributing to your knee pain
If you experience any of the following issues, your hips may be part of the problem:
• Knee pain after sitting or going up stairs: Both situations involve restricted hip movement, forcing your knees to overcompensate.
• Tightness or pulling in the front of your hips or groin: These signs indicate hip flexor restriction, which limits hip extension and shifts stress to your knees.
• Knee pain during hip stretches like pigeon pose: This issue suggests poor joint mechanics or mobility imbalances that transfer strain to the knee.
• Poor balance or difficulty with single-leg movements: These challenges can stem from weak or unstable hip stabilizers that affect alignment and joint control.
• Knees caving inward when you squat or lunge: A classic sign that your hips — particularly the glutes and deep rotators — aren’t stabilizing properly.
A physical therapist or orthopedic specialist can help you assess your movement patterns more thoroughly, but the following exercises offer a great starting point for addressing hip-related knee pain.
Editor’s note: Check with your doctor before starting a new exercise program.
Strategies to relieve knee pain by improving hip mobility
Here are five targeted strategies you can take as part of your workouts and self-care to restore hip mobility and support better knee mechanics.
1. Release your hip flexors
Tight hip flexors limit your ability to extend your hips, which pulls your pelvis forward and increases strain on your knees. Releasing these muscles in multiple planes improves overall hip mobility, which is why my go-to exercise is the three-way hip flexor release.
2. Strengthen inner hip and leg muscles for better alignment
Weak adductors (inner thigh muscles) and glutes can lead to poor alignment of your femur and knee joint. Regularly practicing exercises that strengthen both sets of muscles can correct alignment and reduce lateral knee strain.
Try this variation of the glute bridge:
Lie on your back with knees bent and feet flat. Place a yoga block or rolled towel between your knees.
Ensure that your feet are pointed forward and aligned with your hips.
Exhale fully as you tuck your tailbone under and lift your hips a few inches.
Avoid lifting too high and arching your back.
Hold the lifted position for a few seconds, squeezing the block or towel strongly to engage your inner thighs and glutes, then lower slowly.
Inhale when you reach the floor.
Repeat 10 to 12 times for two to three sets.
3. Practice lateral lunges with control and balance
Most people train in the sagittal plane (forward and back) but neglect lateral movement (side to side), which is a key to functional hip mobility. Because your knees are hinge joints not designed to handle lateral forces, it’s important to build strength and control in side-to-side movement through exercises such as lateral lunges.
How to do a lateral lunge:
Inhale as you step to the side with your right foot, pushing your hips back and bending your right knee while keeping your left leg straight.
Keep your chest lifted and your core engaged.
Exhale as you push off the right foot to return to standing.
Perform two to three sets of 8 to 10 reps per side.
4. Use soft-tissue techniques to reduce hip tension
Foam rolling or using a massage gun can improve tissue quality and prepare muscles for stretching and mobility work. When hip muscles are extremely tight, jumping straight into mobility work can make it less effective and even aggravate the knees. Spend 30 to 60 seconds rolling or massaging each region in and around the hips — glutes, outer thighs, inner thighs, quads (front, top of leg) and hamstrings (back, top of leg) — before stretching or mobility exercises.
5. Stretch safely to restore full hip mobility
Extreme stretches like pigeon pose may feel good in the hips, but they often place excessive torque on the knees due to the angle and body weight pressing into the joint, especially when hip mobility is limited. Even if you feel flexible in a pose such as pigeon, it’s important to remember that the hip is a 360-degree joint. Overstretching in one direction without addressing other ranges of motion can lead to imbalances. Instead, focus on safe, well-balanced stretches that support functional mobility without putting unnecessary stress on the knees.
I recommend using gentle yet effective supported variations such as a seated figure-four stretch (from a chair, place one ankle on top of the opposite knee) or modified pigeon on a couch or chair (rest one shin on the cushion with your other leg behind you in a kneeling lunge). These options allow you to target hip mobility while protecting your knees.
The bottom line: Remember, the knees may be where you feel the pain, but the hips are often where the problem starts. By improving your hip mobility, strength and control, you give your knees the support they need to function as intended — pain-free and powerful.
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