I'm an orthopaedic surgeon and this is the reason your crippling knee pain isn't going away... and the simple fix that can banish your agony for good
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If your knees ache when you walk, climb the stairs or even rest, it's easy to assume the joint itself is to blame.
But, according to a leading orthopaedic surgeon, the real problem often lies much higher up the leg.
Mr Mazin Ibrahim, who works at The Princess Grace Hospital in London, says many people who come to him with painful knees actually have nothing wrong with them at all – their hips are the culprit.
'I joke that some of my patients walk into my office with knee pain and leave needing a hip replacement,' he told the Daily Mail.
'They laugh, but it's true. Their knees are absolutely fine – but when I examine their hips, I find they're full of arthritis. After a hip replacement, the knee pain disappears.'
This surprising connection is due to what's known as referred pain – when the brain misinterprets nerve signals and feels pain in a different place from where it actually originates.
Because of the way our nervous system is wired, Mr Ibrahim explains, the hip can cause pain in the knee – but the knee can't send pain to the hip.
'You get pain in the knee because of the hip, not the other way around,' he says.
Mr Mazin Ibrahim says many people who come to him with painful knees actually have nothing wrong with them at all – their hips are the culprit
The most common reason for this is arthritis of the hip. The condition affects millions worldwide and is one of the leading causes of disability.
In the UK, around 10 million people live with osteoarthritis, the wear-and-tear form of the disease, with 3.2 million affected in the hip and 5.4 million in the knee.
One in five adults over 45 has knee osteoarthritis, and one in nine has hip osteoarthritis.
Osteoarthritis occurs when the cartilage that cushions bones wears away, leaving the joint stiff, painful and inflamed. Women are more likely to develop it than men, and the risk increases with age, obesity and previous joint injury.
Each year, more than 120,000 knee replacements and 110,000 hip replacements are carried out on the NHS, mostly for end-stage arthritis.
Over 90 per cent of operations successfully restore mobility and relieve pain, and artificial joints typically last 15 to 20 years.
Early treatment focuses on lifestyle changes such as weight loss and low-impact exercise, alongside pain-relief medication and physiotherapy.
'Exercise is very good for general health and for keeping muscle strength and integrity,' says Mr Ibrahim. 'It prevents many of these problems from starting.'
Because of the way our nervous system is wired, Mr Ibrahim explains, the hip can cause pain in the knee – but the knee can't send pain to the hip
However, hip arthritis isn't the only hidden cause of knee pain. Weakness in the abductor muscles – the group that includes the gluteus maximus, medius and minimus – can also make knees hurt even when they're structurally sound.
'They're very important for the stability of the leg and pelvis,' Mr Ibrahim explains.
'If you have weakness in these muscles, it affects how your leg moves and rotates. Often when people complain that their knee is buckling, what's actually happening is that the knee itself is fine, but it's rotating inwards because the hip abductors are so weak.'
Sedentary lifestyles are largely to blame. Many of us sit for hours at desks or on sofas, take lifts instead of stairs, and rarely challenge our lower-body muscles.
Even if we reach the recommended 7,000 steps a day, Mr Ibrahim says, 'they're often not spent power-walking up an incline but meandering around – which doesn't do much for strength.'
Weak abductors are particularly common among older adults. 'I see it more in the elderly population, especially in women with osteoarthritis,' he says. 'They have stiff hips, they don't move much, and then they develop abductor weakness.'
Another cause of so-called knee pain is Greater Trochanteric Pain Syndrome (GTPS)—inflammation of the muscles and tendons on the outer side of the hip. 'It can cause excruciating pain that radiates down the leg,' Mr Ibrahim says.
First-line treatment for GTPS and abductor weakness is physiotherapy to strengthen the gluteal muscles, combined with anti-inflammatory medication such as ibuprofen, diclofenac or naproxen.
Sedentary lifestyles are largely to blame to hip issues. Many of us sit for hours at desks or on sofas, take lifts instead of stairs, and rarely challenge our lower-body muscles
'In some cases, a steroid injection is also necessary,' he adds.
For severe hip or knee arthritis, surgical options may eventually be required. Hip and knee replacements are among the most common and successful procedures performed in the UK, with around 230,000 operations carried out annually.
The lifetime risk of needing one is about 10 per cent for men and 12 per cent for women, and demand is expected to rise by nearly 40 per cent by 2060.
Another major cause of joint pain is rheumatoid arthritis, an autoimmune disease that affects around 450,000 Britons.
In this condition, the immune system attacks the lining of joints, causing inflammation that makes them swollen, stiff and painful. It can affect the hips, knees, wrists and fingers, and may also trigger fatigue and fever.
Treatment usually involves immune-suppressing medication and physiotherapy to protect joint function.
As life expectancy increases – with UK men now living to about 78 and women to 82 on average – maintaining joint health has become crucial.
'It's never been more important to start planning for a healthy, happy old age,' says Mr Ibrahim.
Thankfully, preventing hip and knee problems doesn't require hours in the gym. Simple, regular movement makes a huge difference.
'Swimming is excellent because it works every muscle in the body without putting pressure on the joints,' he says. 'Cycling is also very good for the hips and knees, particularly the gluteal and quadriceps muscles.'
For anyone prone to weakness in the hip area, Mr Ibrahim recommends a simple home exercise known as clamshells.
'Lie on your side with your heels together and knees bent,' he explains. 'Raise the top knee while keeping your feet touching, pause at the top, then lower and repeat. Adding a resistance band around your thighs makes it more effective.'
The move can also be done sitting down – ideal, he says, for multitasking while working at a desk or watching TV. 'The most important thing is to keep active and move the joints,' he adds.
'Strengthening the hips doesn't just protect them – it can stop knee pain before it even starts.'
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