What Is It?
The most common presentations include patellofemoral pain syndrome (PFPS) — lateral or anterior knee pain related to altered patella tracking — gluteal tendinopathy (deep lateral hip pain worsened by sitting, stairs, and walking), hip flexor-related anterior hip and groin pain from prolonged sitting, and osteoarthritic joint pain in both regions.
Many knee pain presentations originate proximally: a runner with patellofemoral pain is frequently dealing with insufficient gluteus medius strength causing excessive hip adduction and internal rotation during the stance phase, increasing compressive load on the patellofemoral joint. Treating the knee alone without the hip produces short-lived outcomes.
Common Causes
- Gluteus medius weakness causing excessive hip adduction and internal tibial rotation
- Tight hip flexors from prolonged sitting reducing hip extension and altering gait mechanics
- VMO (vastus medialis oblique) inhibition relative to lateral quadriceps pull on the patella
- Rapid increases in training load without adequate adaptation time
- Previous ligament or meniscal injury with incomplete neuromuscular rehabilitation
- Leg length discrepancy or foot pronation affecting lower limb alignment
- Osteoarthritis — cartilage degradation with subchondral bone changes, synovial inflammation
How Myotherapy Can Help
- Soft tissue therapy — quadriceps, iliotibial band, TFL, hip flexors, and gluteals to restore normal muscle length and reduce compressive forces at the knee and hip
- Dry needling — trigger points in VMO, glute med, and TFL for pain modulation and neuromuscular inhibition
- Exercise rehabilitation — single-leg strength, gluteus medius activation, hip hinge patterning; evidence-based programmes for PFPS and gluteal tendinopathy
- Biomechanical assessment — gait and movement screening to identify the proximal and distal contributors to loading patterns
- Load management education — adjusting training to allow tissue adaptation without aggravation
Expected Outcomes
PFPS has strong evidence for exercise therapy, with significant improvement in pain and function expected within 6–8 weeks of a targeted programme. Gluteal tendinopathy responds to progressive loading (the LEAP trial demonstrated superiority of exercise over corticosteroid injection at 12 months). Pain on stairs and during activity is typically the first to improve, followed by sustained sitting tolerance and running capacity.
Likely Symptom Changes
Early: reduced resting hip and knee pain, improved muscle flexibility. Weeks 2–4: improved pain with stairs and walking. Weeks 4–8: progressive strength improvements allowing return to sport or exercise at increased load. Flares may occur if loading is progressed too rapidly — this is managed by adjusting volume and intensity rather than ceasing exercise entirely.
References
- Crossley, K. M., et al. (2016). 2016 Patellofemoral pain consensus statement from the 4th International Patellofemoral Pain Research Retreat. British Journal of Sports Medicine, 50(14), 839–843.
- Mellor, R., et al. (2018). Education plus exercise versus corticosteroid injection use versus a wait and see approach on global outcome and pain from gluteal tendinopathy (LEAP trial). BMJ, 361, k1662.
- Rathleff, M. S., et al. (2015). Hip strength training for patellofemoral pain: A 12-month prospective study. American Journal of Sports Medicine, 43(6), 1426–1432.
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