It’s Not Your Knees, Babe! Blame Your Hips (or Your Big Toe)

by Breathe. Physical Therapy & Wellness Staff | Jun 23, 2025 | Pelvic Pain and Dysfunction | 0 comments

You’re out for a walk or maybe finishing a workout, and your knees start to ache. Your first instinct? “My knees must be the problem.” But here’s the thing…your knees are often just the victim, not the culprit. When it comes to pain in the knees, especially in active women or postpartum individuals, we often have to zoom out and look at what’s going on above and below.

Your Whole Body Is Connected

In physical therapy, when one area of the body is hurting, the cause may actually stem from a neighboring joint or system. The knee is a hinge joint; it likes stability and has very little wiggle room to deviate from its main job (bending and straightening). It takes direction from the hip above and the foot and ankle below which are much more mobile. So when those areas aren’t doing their job, guess who suffers? That’s right – your knees.

How Your Hips Can Impact Knee Pain

Let’s talk about your hips first. Weak glutes and poor hip control are some of the most common findings I see in clients with knee pain. This shows up often during squats, running, walking, or even getting up off the floor. If your glute med (aka the glute muscles on the side of your hip/but) isn’t activating well, your upper leg can roll inward, causing extra stress on the kneecap and surrounding tissues. Over time, that creates pain in the front of the knee (what we call in the PT world “patellofemoral pain”) which is a super common issue in women due to our natural pelvic structure and hormone-related ligament laxity.

A Common Culprit to Knee Pain, Your Big Toe

Now for the underrated MVP: your big toe. That tiny little joint plays a huge role in your walking mechanics. If your big toe can’t extend well (because of stiffness, past injury, or bunions), your entire gait pattern changes. That might mean rolling off the outside of your foot, shifting weight in strange places, or shortening your stride. All of those changes ripple upward, affecting your ankle, knee, and even hips/low back over time. So, what can you do?

4 Ways To Help Your Knee Pain

Strengthen your hips. Different exercises including glute bridges, clamshells, side steps with bands, and controlled single-leg exercises can help to activate the glutes.
Mobilize your big toe. Gentle stretching and mobility work can make a big difference. Your big toe needs to get at least 60 degrees of movement from neutral into extension (Your PT can show you how!)
Check your movement patterns. Working with a PT who understands the whole kinetic chain can help identify where the breakdown is happening. They can help to identify if you have differences side-to-side that can be impacting the pain in your knees.
Support your feet. Footwear matters. Appropriate arch support, wide toe box for your toes to move, and alignment make a difference.

Next time your knees are nagging, don’t just ice them and hope for the best. Let’s dig deeper, get curious, and start looking at the whole picture. Because your body is brilliantly connected, your knees deserve some backup from the rest of the team above and below the joint!

Get Rid of Your Knee Pain With Breathe. Physical Therapy & Wellness

Need help figuring out what your hips and feet are up to? Book a session! We’ll get to the bottom of it together. Our physical therapists in North Liberty and Des Moines are highly educated and experienced. Let our team help you figure out the steps you need to take to live a life of relief.