The hip is the largest joint close to our center of gravity. The powerful muscles that make up the buttocks - the gluteals - are responsible for hoisting us out of chairs, lifting us up stairs and holding us upright while we stand in line at the grocery store. Without good strength in our butts and flexibility in our hips, our whole body suffers.

As important as they are, our butts are not really on our minds much. Other than worrying about their size, we mostly use them for a cushion for our sitting bones. Without daily maintenance, our butts get weak, our hips get tight and, over time, the poor condition of our hips dictates the poor condition of our low backs and knees.

How can your butt affect your knees, you ask? Remember, the hip is made up of the femur (the large upper leg bone) joining with the pelvis. At the other end of your femur is your knee. Now does it make sense? As your hip goes, so goes your knee.

If your butt is weak and unable to adequately control your hip, the femur will likely rotate in when you face challenges like getting out of a chair or stepping over a curb. As the femur rotates inward, the knee drifts inward as well. This inward stress on the knee causes the kneecap to grind on the front of the femur. Whether you are complaining of pain in the medial aspect of your knee (your inner thigh and down toward the inside of the calf) or whether you are complaining of knee pain in the front of your knee and around your knee cap, the hip is a likely source of your trouble.

Folks who spend all their time in chairs -sitting at a desk, watching TV or driving -are likely to have tight hip flexors to go along with that weak butt. Hip flexors are the muscles which are responsible for lifting your leg when you go to put your foot up on a curb. When the hip flexors get tight, the pelvis is pulled forward causing you to lean slightly forward like you do when you do dishes. With your hips tilted forward like this, your back must arch backward in order to raise your shoulders and head up so you can see where you are going.
You can imagine that if you walked around with your back arched all day, you would start to have a number of aches and pains. As we get older, we can develop stenosis in our backs. Stenosis is a narrowing of the bony canals that the nerves run through. Folks with stenosis complain of increased pain when they arch their backs. You can imagine then that if you have stenosis, walking around with your back arched might be doubly painful.

How can you tell if your hips are responsible for your pain? That's where you need a physical therapist. It is a rare person, though, that couldn't use a little extra exercise to improve their hip flexibility and strength. While you are considering whether you need to get physical therapy or not, try these things to improve your hip health.

First, lie on your tummy (prone). Lying prone stretches your hip flexors. Lying on the floor will give you the best stretch, but use your bed if you must. If you have a large belly, you may need to put a pillow under your thighs in order to feel a gentle stretch in the front of your legs. If your back is very stiff, you may need a pillow under your belly until you get more accustomed to this position.

Lie quietly for three or four minutes until you feel the stretch in the front of your thighs ease up. Move your legs out to the side, bend your knees then bring your heels together. Gently squeeze your heels together as you try to lift your knees off the floor. In the beginning, you may not be able to lift your knees at all. Keep trying. Even the effort is good exercise. Be careful when you are doing this exercise that you are using your butt muscles and arching your back. Repeat this exercise five times at first, but build up to where you can lift your knees 20 times.

Now bring your legs closer together again. With your knees still bent, let your feet fall out to the sides. Let the muscles stretch a few seconds before you raise your feet back up to the middle. Repeat this exercise slowly 10 times.

Lastly, and still on your tummy, bring one knee slightly up and out to the side. We call this position the "low crawl" position. Try to rest your foot on the back of the other leg. You may not be able to bring your knee very far up in the beginning. Try to rest in this position for two or three minutes while you concentrate on relaxing all the tight things you feel stretching. Repeat on the other side.

The suggestions you read in a little article like this are no substitute for expert advice. Ask your physician for a referral to your physical therapist for instruction in an exercise program designed specifically for your needs.

ABOUT THE WRITER: Jackie Randa is a physical therapist who owns Back on Track in Barstow. She can be contacted at