The Relationship of the Hip, the Low Back, and Knee

The hip is a very unique joint. The depth of the socket, the strength of the muscles and ligaments surrounding it, and the way it functions in weight bearing activities
is unlike any other joint in the body. The focus this month is on the relationship between the hip and the rest of the body.

The hip joint is a synovial joint, meaning it moves freely. It is a ball-and-socket joint that is made up of the femoral head (the “ball”) and the acetabulum (the “socket”). The ball is largely contained within the cup or socket, though there are genetic and cultural differences with regards to the depth and shape of the hip joint in any one individual.

The relationship between the hip and the surrounding joints is intimate in that each joint affects the next. For instance, ankle pronation—or the inward rolling of the foot and ankle—results in a knocked knee, which can then shift the hip outwards. The pelvis then drops down on that side, the tailbone or sacrum becomes unleveled or sloped, and the lower spine curves to compensate with the ultimate goal of keeping your eyes level. Hence, when your hip hurts, your doctor of chiropractic will examine and treat the ENTIRE lower kinetic chain—the foot, ankle, knee, hip, pelvis, and spine—as ALL are so closely related to each other. 

When it comes to managing you and your hip pain, be prepared for management of any of the following:
  • Ankle pronation: This is the inward rolling of the ankle often associated with a flat foot. When viewing someone with ankle pronation from behind, the angle from the Achilles tendon to the ground will lean inward when it normally should be perpendicular. A valgus correction in a “rear foot post”—a heel wedge thicker on the inside—of a foot orthotic (customized arch support) is needed to correct this.
  • Knocked-knees: Ankle pronation can result in “knocked-knees” (genu valgus) which overloads or jams the outer knee joint, over-stretching the inner knee joint and ligaments. The knee cap (patella) then rides excessively hard on the outer surface of the femoral groove in which it glides as one bends and straightens their knee, causing knee cap pain.
  • Hip inward angulation (or coxa vera): As the knee shifts inward or knocks, the head of the femur moves outward, leaving the joint less stable. Leg length deficiency (LLD)—or a short leg—occurs when the pelvis drops on that side further destabilizing the lower kinetic chain.
Once ankle pronation is properly corrected with a rear foot post and the hind foot is repositioned back to neutral (if LLD persists) a heel lift can be placed under the foot orthotic to corrective this imbalance. ONLY then will the pelvis become level and stable so it can properly serve as a strong foundation for the spine the rest of the body to rest on!
There are many studies that report low back and hip arthritis often occur together, and differentiating between the two can sometimes be a challenge. For example, pain can radiate from the hip to the knee, which many doctors will diagnose as “sciatic nerve.” But hip pain can present exactly the same, making it hard to determine if it’s low back-generated pain or hip-generated pain.

This is why it’s SO IMPORTANT that your doctor of chiropractic conduct a careful history and examination. There are specific tests that he or she will perform that help determine which of the two is causing the pain. There are times when they may find BOTH problems co-existing together, making it necessary to manage two problems, rather than just one.

There are many mobilization, manipulation, soft tissue therapies, modalities, and exercises available to patients with both hip and low back pain. So if you’re not sure what is bothering you and you don’t know what to do, visit your doctor of chiropractic and he or she will help you through this.

We haven’t touched the subject of muscle imbalance, strengthening of commonly weak hip extensor muscles, or stretching of overly tight hip flexors and adductor muscles—topics for another day! The good news—doctors of chiropractic can help you with this common problem!
 by 
Call today and schedule an appointment 321-783-1960

Dr. Steve Alukonis is the only Diplomate of the American Board of Chiropractic Orthopedists in the Cocoa Beach, Cape Canaveral area and one of very few in the county. He has been in practice for over 25+ years right here in Cocoa Beach, Florida.



Please visit our website to learn more about what we do at Space Coast Advanced Health

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