APEX PWR | Physical Therapy Feature
Knee Pain When Squatting: The Hip Internal Rotation Connection
Key Takeaways
- Pain along the outside of the thigh or knee when squatting is often a hip mobility issue, not strictly a knee issue. Limited hip internal rotation (IR) is a common driver.
- During a squat, the femur needs to internally rotate relative to the pelvis while the tibia externally rotates. When hip IR is restricted, the body compensates and load can shift through the lateral thigh and knee.
- Dr. Jordan Prunty, DPT, shares a single-leg Romanian deadlift (RDL) with wall support to drive hip internal rotation and thoracic external rotation. Try 2 sets of 15 reps. Relief during the drill is a useful clue, not a diagnosis.
- APEX PWR is in network with most major health insurances, including Regence Blue Cross Blue Shield, Cigna, and more.
- Physical therapy at APEX PWR in Tigard, Oregon serves the Portland metro and helps people transition back into training, whether a high school athlete returning to sport or an adult returning to a favorite activity.
If the outside of your thigh or knee starts complaining the moment you drop into a squat, the knee is often not the real problem. The knee is where you feel it. The cause frequently sits one joint up, at the hip.
Dr. Jordan Prunty, DPT, one of our doctors of physical therapy at APEX PWR in Tigard, recently shared a short video breaking this down, along with a drill you can try at home. We reposted it so more people in the Portland metro dealing with this exact pattern can find it. Here is what he covers, why it works, and what to do if the pain keeps coming back.
What Dr. Prunty Sees in Athletes and Active Adults
"Experiencing pain along the outside of your thigh when squatting? It may be related to limited hip internal rotation (IR), a movement restriction I commonly see in athletes and active individuals."
Dr. Jordan Prunty, DPT | APEX PWR
This is one of the more common patterns a physical therapist sees, and it shows up across a wide range of people. The weekend lifter. The runner. The high school athlete in a single sport year round. The adult who just wants to get back to hiking or pickleball without their knee barking at them on every descent.
Why the Hip Drives Knee Pain in a Squat
A squat is not a simple up and down hinge. There is rotation happening at every joint in the chain, and the hip carries a large share of it.
"During a squat, the femur needs to internally rotate relative to the pelvis while the tibia externally rotates to allow efficient movement and reduce stress on surrounding tissues. When hip IR is limited, the body often compensates, which can increase load through the lateral thigh and knee."
Dr. Jordan Prunty, DPT | APEX PWR
That description lines up with what the research shows. Excessive or poorly controlled femoral internal rotation increases contact and stress at the lateral side of the patellofemoral joint, and limited hip internal rotation range of motion has been associated with altered knee mechanics in the literature. The hip and the knee are linked through the chain. When the hip cannot give the movement the squat is asking for, the knee tends to absorb the difference.
The practical takeaway is simple. Chasing the knee with ice and rest alone often misses the actual restriction. Restore the hip's ability to rotate, control it under load, and the knee frequently calms down.
The Drill: Single-Leg RDL With Wall Support
Here is the exercise Dr. Prunty demonstrates in the video. It targets the restriction directly by training hip internal rotation while you also reach into thoracic (upper back) external rotation, building both the mobility and the control to use it.
"Try this single-leg RDL with wall support, focusing on reaching into thoracic external rotation while driving hip internal rotation to improve hip mobility and control. Try 2 sets of 15 reps. If this provides relief, limited hip IR may be contributing to your symptoms."
Dr. Jordan Prunty, DPT | APEX PWR
Watch the full demonstration below so you can match the positioning and the cues.
Watch: The Single-Leg RDL for Knee Pain When Squatting
Dr. Jordan Prunty, DPT, walks through the setup, the cues, and the rep count.
If the drill gives you relief, that is a useful clue that limited hip internal rotation may be part of your picture. It is a starting point, not a diagnosis. A physical therapist can measure your hip IR directly and confirm what is actually driving the pain.
When to See a Physical Therapist
A single drill can help, and sometimes it is enough to get you moving better. But pain that keeps returning, sharp pain, or pain that limits what you want to do is worth a proper assessment. A physical therapy evaluation looks at the whole chain, hip, knee, ankle, and trunk, measures where your true restrictions are, and builds a plan to fix the cause rather than chase the symptom.
That is the difference in how our team works. We do not stop at making the pain quiet for a day. We get you back to the thing you actually want to do, and we build you stronger on the way out than you were on the way in.
From Rehab Back to Training and Sport
Getting out of pain is the first step. The goal is getting back to full activity with confidence. Our physical therapy team is built to bridge that gap, whether you are a high school athlete returning to sport after an injury or an adult returning to a favorite activity that your knee has been keeping you from.
Because we are a performance and rehab facility under one roof, the handoff from physical therapy into strength training is seamless. You are not discharged with a sheet of stretches and left to figure out the rest. We progress you from corrective work into real loading, so the squat that used to hurt becomes a squat you trust.
APEX PWR is in network with most major health insurances, including Regence Blue Cross Blue Shield, Cigna, and more. Coverage and visit limits vary by plan, so it is worth verifying your specific benefits. Reach out and our team can help you understand your options before you start.
Knee Pain That Will Not Quit?
Let our physical therapy team find the real driver and build you a plan to get back to squatting, training, and the activities you love. In network with most major insurances.
Get Started With Physical TherapyPhysical Therapy in Tigard, Serving the Portland Metro
APEX PWR is located at 11105 SW Greenburg Rd in Tigard, Oregon, central to the Westside Portland metro. We provide physical therapy for clients across Tigard, Portland, Beaverton, Lake Oswego, Tualatin, West Linn, and Hillsboro. Whether your knee pain shows up in the squat rack, on the trail, or on the field, the path forward starts with understanding why it is happening.
Frequently Asked Questions
Previous Blogs
How Consistent Strength Training Builds Confidence in Young Athletes | APEX PWR Portland
How Consistent Strength Training Builds Confidence in Young Athletes | APEX PWR Portland APEX PWR | Athlete Angle How Consistent Strength Training Builds Confidence in Young Athletes By The APEX Team | Tigard, Oregon | Serving Portland, Beaverton, Lake Oswego, Tualatin & the Westside Metro | June 2026 Key Takeaways Confidence in young athletes does
Physical Therapy for Throwers in Tigard, Beaverton & Tualatin Oregon | APEX PWR
Physical Therapy for Throwers in Tigard, Beaverton & Tualatin Oregon | APEX PWR APEX PWR | Physical Therapy Feature Physical Therapy for Throwers: Getting Javelin, Shot Put, and Discus Athletes Back to Competition By The APEX Team | Featuring Dr. Jon van den Boogaard, DPT, OCS, USATF Level 2 | Tigard, Oregon | Serving Beaverton,
Thorne Magnesium Promo Code: How to Get the Lowest Price | APEX PWR
Thorne Magnesium Promo Code: How to Get the Lowest Price | APEX PWR APEX PWR | Supplement Spotlight Thorne Magnesium Promo Code: How to Get the Lowest Price on Thorne Magnesium By The APEX Team | Tigard, Oregon | Serving Portland, Beaverton, Tualatin, Lake Oswego & the Pacific Northwest | June 2026 Key Takeaways There