APEX PWR  |  Physical Therapy Feature

Knee Pain When Squatting: The Hip Internal Rotation Connection

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

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.

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.

Watch the full demonstration below so you can match the positioning and the cues.

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.

Physical 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.

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