Pesky Knee Pain? It Might Not Be Your Knees.
Understanding the Role of Hips and Ankles in Knee Pain for an Athlete.
Let’s talk about knee pain. If you’ve been training in a gym long enough, chances are you or someone you know has experienced that nagging ache around the kneecap, a sharp pinch during squats, or a lingering discomfort after running or jumping.
But here’s the truth a lot of athletes (and even some clinicians) miss:
Knee pain often isn’t a knee problem—it’s a symptom of what’s happening above or below the knee.
As a physical therapist working inside of a CrossFit gym, I see this time and time again. Athletes come in worried they’ve “wrecked their knees,” but after a movement assessment, it’s clear the root cause is usually at the ankles or the hips.
Let’s break it down.
🔁 The Body is a Kinetic Chain
Your body doesn’t move in isolated pieces—it moves as a unit. The knee is sandwiched between the ankle and the hip, which means it often ends up being the victim of limitations or dysfunctions elsewhere.
Think of the knee as the middle child in the family: it takes the heat when the siblings (hip and ankle) don’t pull their weight.
🦶 Ankle Mobility: The Unsung Hero of Squat Depth
Let’s start at the bottom of the chain.
Limited ankle dorsiflexion (your ability to bring your knee forward past your toes) is one of the most common culprits behind poor squat mechanics. If your ankles can’t move well, your body compensates by driving the knees in odd directions or collapsing the arch, which increases pressure at the knee joint, and also issues at the lower back (stay tuned for another blog on that).
Common signs during squatting:
Heels come off the floor
Knees cave in, or foot collapsing inward
You feel pressure or pinching in the front of the knee
Difficulty to keep chest tall
Quick test:
Try the knee-to-wall test. While kneeling on one side, can you touch your other knee to the wall while keeping your heel down, about 4 inches away? If not, you likely have some restrictions to work on.
🏋️ Hip Stability and Strength: The Control Center
Now let’s look up the chain.
Weak or underactive glutes—especially the glute medius—lead to poor control of femur positioning. This can cause your knees to dive inward (valgus collapse), which is a common movement fault in squats, box jumps, and even running.
Why it matters:
When the hip can’t control the position of the femur, the knee is forced into angles it doesn’t tolerate well, especially under load. This can increase the risk of patellofemoral pain, tendonitis, or even ACL strain over time.
Red flags:
Your knees cave inwards during squats
You struggle to balance on one leg
You feel more quad than glute activation during lifts
✅ What You Can Start Doing Today
Here are three things you can work on right now to bulletproof your knees:
Daily ankle mobility
2–3 minutes of banded distraction work or weighted dorsiflexion pulses
Glute activation drills
Banded side steps and single-leg bridges pre workout
Assess your squat
Practice tempo squats and video your movement to assess knee tracking
💬 Final Thoughts
If you’re treating knee pain in isolation, you’re likely missing the big picture. By zooming out and addressing ankle mobility and hip control, you might not only relieve pain—you can move better and lift stronger.
If you’re dealing with persistent knee pain that isn’t responding to the usual fixes, it might be time for a more in-depth movement assessment. That’s exactly what I do here at the gym—identify the weak links in your chain so you can get back to training pain-free.
Need help figuring it out? Let’s chat.
Shoot me a text: 248-821-1494
Message me on IG: @debashphysicaltherapy
