Patellofemoral pain is often discussed as a knee problem, yet many contributing factors originate higher in the kinetic chain. Increasingly, clinicians recognise the influence of the hip and gluteal muscles in controlling lower limb alignment and load distribution through the knee.

For manual therapy practitioners, understanding this relationship helps explain why anterior knee pain frequently improves when treatment targets the hip rather than the knee alone.

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• Patellofemoral Pain: Why Anterior Knee Pain Is Often Misunderstood in Clinical Practice

How the Gluteal Muscles Influence Knee Alignment

The gluteus medius and gluteus maximus play an important role in controlling femoral position during weight-bearing activities. These muscles contribute to pelvic stability and help regulate hip internal rotation and adduction.

When gluteal function is reduced, the femur may move into greater internal rotation and adduction during tasks such as squatting, running, or stair descent. This altered alignment can influence the mechanics of the patellofemoral joint.

Dynamic Valgus and Patellofemoral Loading

One commonly discussed movement pattern in patellofemoral pain is dynamic valgus. This describes a combined movement of hip adduction, femoral internal rotation, and knee valgus during weight-bearing activities.

Dynamic valgus can increase lateral forces on the patella and alter patellofemoral contact mechanics. While it is not the sole cause of anterior knee pain, it is frequently observed in individuals experiencing patellofemoral symptoms.

Understanding this pattern allows clinicians to look beyond the knee joint and assess how proximal control influences patellofemoral loading.

Femoral Internal Rotation and Patellar Tracking

Excessive femoral internal rotation can affect how the patella interacts with the femoral trochlea during movement. Rather than viewing patellar tracking as purely a local issue, clinicians increasingly consider the role of proximal hip control in influencing patellofemoral joint mechanics.

This perspective supports a broader assessment of movement rather than focusing exclusively on the knee.

Why Hip Strengthening Can Reduce Knee Pain

Strengthening the gluteal muscles can improve control of hip position during functional tasks. Improved hip stability may reduce excessive femoral internal rotation and adduction, which in turn can decrease stress on the patellofemoral joint.

For many clients with patellofemoral pain, addressing hip strength forms an important component of a comprehensive management strategy.

If you regularly treat clients with anterior knee pain, our professional development course “Patellofemoral Pain: Understanding and Managing Anterior Knee Pain in Clinical Practice (2026 Edition)” explores assessment and management strategies for this presentation in greater depth.https://www.thetherapyweb.com/cpdcourses/patellofemoral-pain%3A-why-anterior-knee-pain-is-often-misunderstood-in-clinical-practice