Local Experts: How does your butt play a role in your knee pain?


By Dr. Chris Koutures, activekidmd.com

If you are a dancer with knee pain, you probably tend to blame only your knee. However, failing to blame your butt may be failure to fully help heal your knee pain. While some may chuckle at the mention of butt, poor buttock and hip muscle function is no laughing matter.

Gluteal muscles and iliotibial band- image courtesy of https://eorthopod.com/hip-arthroscopy/

When turning, landing, going into plie and jumping, the best knee position is right under the hip and above the second toe. Muscles in the buttock and back of the hip are key for controlling this leg alignment. Certain muscles such as gluteals (medius and maximus) and hip lateral (external) rotators are the knee’s best friend.

Hip external rotator muscles- image courtesy of https://lowbackpainprogram.com/hip-rotators-and-pain/

The gluteal muscles are known as hip “abductors” that help keep the pelvic stable. Gluteal muscle function keeps the knee and lower leg from collapsing inward (aka knee valgus). Appropriate function of the hip lateral rotators keeps the thigh from rotating inward. Inward thigh rotation and knee collapse can cause increased stress between the knee cap and thigh bone.

This abnormal kneecap position can not only cause immediate pain, but also increase risk of more significant knee injuries especially when jumping and landing.

There are a few relatively quick tests of the gluteal and hip external rotator muscles. One is the Trendelenberg Test where I’ll ask the patient to stand one one foot and raise up the other knee. If the gluteus medius is working, the pelvis should not drop on the raised knee side.

Trendelenberg sign on right side of pelvis due to weak gluteal/abductor muscles- image courtesy of http://epomedicine.com/clinical-medicine/trendelenburg-test-or-sign/

When it comes to dancers, I especially like to evaluate plie technique with turnout in second position. I’ll drop an imaginary line from the kneecap to the floor. If that line falls on top or inside of the big-toe, then there is concern about those hip and buttock muscles.

Plie in Second Position- solid line shows hip above kneecap, broken line shows kneecap above second toe.

Dancers can use mirrors and the barre to focus on this proper knee alignment-especially with the basic five ballet positions.


The iliotibial (IT) band is soft tissue band on the outside of the thigh that runs from the pelvis to the knee. Tight IT bands can cause pain on the outside of the hip and knee while also putting abnormal pressure on the kneecap. Many patients will report tightness of the IT Band and hope
that stretches will lead to less pain and stiffness. Often, a tight IT band is due to overload from weak gluteal muscles (especially that gluteus medius).

So while stretches may help reduce IT band tightness, a stronger gluteus medius will do more to reduce IT band pain.

Image courtesy of https://www.medicinenet.com/iliotibial_band_syndrome/article.htm

Ready to make your butt and hips work better to help your knee pain? I’ll share one of my favorite set of exercises for gluteal and hip external rotator strength. All you’ll need is a mat or soft surface and of course, your cell phone. Check out this video for more information.


You’ve started work on reducing knee pain by making your butt and hips work more effectively. One video set of exercises is a good start, but there is definitely more that you should do. Checking in with dance medicine specialist can help make sure nothing else is causing your knee pain. Besides weak butts and hips, injuries to inner parts of the the knee itself or even limited big toe motion can be problems.

A comprehensive dance medicine evaluation should give advice on proper techniques and additional exercises to build strength. Don’t continue to have your butt let you down. Your knees will be thankful to share the blame.

Dr. Chris Koutures is a dual board-certified pediatric and sports medicine specialist who practices at ActiveKidMD in Anaheim Hills, CA. He is a team physician for USA Volleyball (including participating in the 2008 Beijing Olympics), the U.S. Figure Skating Sports Medicine Network, Cal State Fullerton Intercollegiate Athletics, Chapman University Dance Department, and Orange Lutheran High School. He offers a comprehensive blend of general pediatric and sport medicine care with an individualized approach to each patient and family. Please visit activekidmd.com or follow him on twitter (@dockoutures).


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