A few months ago, I started working with a gentleman (let’s call him Hippie) whose right knee and hip had been bugging the crap out of him. While lying in bed, his hip would ache like an irritating alarm and keep him up at night. While walking around, he’d get aching in his hip or — even worse and more debilitating — pain in his knee. The pain had been bugging him for a year, and nothing had helped to date.
The first thing I do with anyone who tells me about knee, hip, or foot pain is take a look at how their hip muscles are developed. Some common movement assessments that pretty much all good trainers use to determine how functional the hips are are the overhead squat assessment and the single leg squat assessment. But one that few use is really simple and straightforward. You put my hands on the greater trochanters.
The greater trochanter is a bony protuberance that sticks off the femur (your thigh bone), and serves as the attachment point for such important muscles as the gluteus minimus, gluteus medius, gluteus maximus, obturator internus, obturator externus, and piriformis. All of these muscles are crucial for getting stability and smooth movement in the hip joint. Unfortunately, for most people the biggies, the glute max and glute med, get suffocated in daily life. Over the course of years and decades of sitting, the daily suffocation makes it hard to get these muscles to fire with appropriate levels of coordination (read: cooperation) with the other smaller guys. As these biggie muscles wither from disuse, they shrink.
When you put your hands around someone’s greater trochanter, you get a quick snapshot of how well developed the muscles of the hip are. When we’re feeling around the greater trochanter, we want to palpate around the back edge to see how much padding (read: muscle) is there to stop our hands from actually touching the bone. On the lateral aspect of the greater trochanter, you’re going to feel lots of bony-ness, but as you move posteriorly, ideally you won’t.
As you move posteriorly on the greater trochanter, what you want to feel is some firm padding keeping you from being able to cup the greater trochanter in your palm. This tells you that glute medius and maximus are fairly well developed and are apparently getting some stimulus in daily life. When they are working well, they help keep the femur and the pelvis articulating well with each other.
When these muscles aren’t working well, all manner of irritating symptoms may ensue (e.g. knee pain, hip aching, foot pain, back pain, etc.). The greater trochanter will feel extremely bony, because it is a bone and because all the padding that should be there has gradually died off. I have felt very bony greater trochanters on otherwise very muscular and athletic people (and they either were actively complaining about knee issues or had a history of knee pain or ligamentous injuries).
If you find a bony greater trochanter, then you probably have a list of deceiving, nonspecific issues at hand. Knees hurt. Feet ache. Hips spasm. The back spasms. This is, I believe, where a lot of people get extremely frustrated. The pain moves around. The issue seems to be coming from nowhere and everywhere as different muscle groups spasm in compensation!
Welcome to troubleshooting hips!
I cannot count the number of people who have come to me complaining about feeling really tight in the piriformis/butt asking me to use a little Rolfing to help knock it out, only to find that there is basically no muscle tissue back there besides the spasmed out little hip muscles like piriformis and the obturators crying out for help (from here on referred to as deep hip rotators).
Often, a few weeks of progressively more difficult gluteal retraining knocks the issue right out and provides an easy, cost-effective, repeatable way to get rid of what ails the client.
However, it doesn’t always go without a hitch because of those spasm-prone deep hip rotators. It seems that for many people, when the glutes aren’t firing well, the deep hip rotators tend to throw a spasm party (I theorize due to synergistic dominance), and it can result in an unexpected bout of knee pain (abnormal activation of the quads, hams, and IT are pretty likely if your deep rotators are trying to twist the femur laterally all the time). I have personally experienced this after doing barbell squats and barbell glute bridges, and I’ve seen countless clients with knee pain experience this exact same phenomenon. Hippie, the guy I mentioned at the beginning of this post, was a classic case.
On his second visit, his right knee was bugging him a lot. His extremely weak right hip was getting stronger, but the knee was starting to hurt more. So rather than have him hop on the table and wollop his hip myself, I handed him a lacrosse ball and had him roll it all around the posterior aspect of his greater trochanter.
Result: knee pain was instantly relieved. Any time over the next week that the knee started to irritate him at all, a ball in the deep hip rotators instantly knocked the pain out. How’s that for a convenient knee pain reliever? It works quicker than a few hundred milligrams of Advil. It also tends to be quite helpful for sciatica type pain. How’s that for a simple solution? And a lacrosse ball $3 at a sporting goods store!
This post actually got a bit longer than I expected, but the actual point came across, hopefully. Poorly developed hip muscles can get your knees feeling pretty crappy. Try to relieve the hot spots in your deep hip rotators and see if that helps your knees. Once you’ve knocked that problem out, start training your glutes to fire properly.
The knee you save could be yours!