Why Glute Exercises Are Important for Knee Health

The gluteal muscles are worth training not because they somehow directly "support the knee," but because they control the position of the pelvis and femur during walking, squats, stair climbing, running, and single-leg movements. When the foot is on the ground, hip movement inevitably changes the mechanics of the entire lower limb, including the knee joint. Therefore, adequate gluteal strength and the ability to activate them at the right time help distribute the load between the hip joint, knee, and other parts of the leg. [1]

But the popular explanation "weak glutes → knees collapse inward → knee pain is inevitable" is too straightforward. The latest data show that in healthy individuals, measured hip abductor and external rotator strength is a poor predictor of dynamic knee valgus. In other words, a strong hip abductor and external rotator cuff does not guarantee proper coordination, and "collapsing knees" do not prove weak glutes. [2]

The most compelling clinical evidence relates to patellofemoral pain—pain around or behind the kneecap. Current best practice guidelines recommend knee-focused therapeutic exercises, supplemented with hip exercises if necessary, rather than opposing the gluteal and quadriceps muscles. For knee osteoarthritis, therapeutic physical activity and muscle strengthening are also basic treatment, but there is no evidence that gluteal muscle training specifically prevents cartilage deterioration or is essential for everyone. [3]

How are the gluteal muscles connected to the knees when they are located much higher?

The knee joint doesn't work in isolation. During most everyday movements, it's part of a kinematic chain that includes the pelvis, hip, femur, lower leg, ankle, and foot. Therefore, a change in motion in one joint can alter the position and load in another.

The gluteus maximus is one of the primary hip extensors and is actively involved, for example, when a person rises from a chair, climbs stairs, or comes out of a deep squat. The gluteus medius and minimus are primarily involved in hip abduction and pelvic stabilization, especially when body weight is transferred to one leg. [4]

Let's imagine walking down a flight of stairs. At this point, the muscles need more than just straightening the knee. They also need to simultaneously support the pelvis, control the position of the femur, and maintain balance. The gluteal muscles are part of this control system.

Therefore, their training is especially logical in situations where the knee works under load together with the hip joint: during squats, lunges, running, jumping, going down stairs and standing on one leg.

Which gluteal muscles are especially important?

The word "buttocks" covers several muscles with different functions.

Muscle	Main function	Why this might be important for the knee
Gluteus maximus	hip extension, participation in hip rotation and power movements	helps distribute work when lifting, squatting, running and accelerating
Gluteus medius	hip abduction, pelvic stabilization	especially important when standing on one leg
Gluteus minimus	abduction and stabilization of the hip joint	helps control the position of the pelvis and hips
Deep external rotators of the hip	femoral rotation control	participate in the control of the lower limb in multiplanar movements

This distinction explains why a single exercise like the glute bridge is insufficient if the goal is to improve the function of the entire leg. The bridge effectively engages the hip extensors, but it doesn't really replicate the complex task of supporting the pelvis and leg while walking, running, or descending stairs.

What happens to the knee when the hip moves inward?

When weight is placed on the foot, the femur can be adducted and rotated internally relative to the pelvis. At the same time, the knee sometimes appears to shift inward—this is called dynamic valgus.

The gluteal muscles may be involved in counteracting some components of this movement. A 2023 systematic review found that during single-leg tasks, lower gluteus maximus activity was associated with greater hip internal rotation, while lower gluteus medius activity was associated with greater hip adduction and some measures of frontal plane knee motion.[5]

Biomechanical studies of the anterior cruciate ligament also show that the gluteus medius is capable of counteracting the moment that causes the knee to roll into valgus. This is one of the reasons why hip exercises are included in comprehensive neuromuscular training programs for athletes. [6]

However, this is where the simple part of the story ends.

Strong glutes don't guarantee that your knee won't collapse.

Muscle strength and quality of movement are not the same thing.

For a long time, the common model looked like this:

Weak hip abductors → hip rolls inward → knee collapses → pain or injury occurs.

New systematic reviews show that this chain is far from always confirmed.

In a 2024 review that included 41 studies of single-leg movements, most associations between hip muscle strength and hip or knee kinematics were absent or weak.[7]

An even more recent systematic review from 2026 specifically examined the relationship between hip abductor and external rotator strength and dynamic knee valgus in healthy individuals. Of the 22 included studies, most did not find the expected association, and meta-analyses found no statistically significant relationship. The authors cautiously concluded that weakness of these muscles alone likely does not explain dynamic knee valgus in healthy individuals. [8]

This is one of the most important practical nuances of the topic.

If the knee shifts inward when squatting, a diagnosis cannot be made based on a single video:

"You have a weak gluteus medius."

Movement is also influenced by body structure, trunk control, coordination, ankle mobility, fatigue, speed of movement, habit, and the demands of the task itself.

Then why strengthen your buttocks at all?

Because the lack of a simple "strength = ideal knee trajectory" correlation does not mean that strong muscles are useless.

Strength is a physical resource. To control the body when climbing stairs, shifting weight onto one leg, accelerating, or landing, the muscles need to generate sufficient torque.

But the body still needs to be able to use this resource at the right time.

Therefore, effective rehabilitation usually combines:

• increase in muscle capacity;
• coordination of movement;
• gradual increase in load;
• exercises in functional positions;
• if necessary, retraining a specific movement.

This is where a simple “butt workout” becomes a proper lower limb recovery program.

The most compelling evidence is for pain around the patella.

For patellofemoral pain, hip exercises do have clinical value, especially as part of a program along with knee exercises.

Patellofemoral pain is typically felt around or behind the kneecap and is often made worse by squatting, running, jumping, climbing or descending stairs, and sitting for long periods with the knees bent.[9]

The updated 2024 best practice guideline combined the results of 65 high-quality randomized trials with 3,796 participants, patient experience, and expert opinion. The authors believe that the mainstay of treatment is patient education and knee-focused therapeutic exercises, supplemented by hip exercises when necessary. [10]

This is a very important formulation.

The modern recommendation looks different:

"If your knee hurts, forget about the knee and train your glutes."

It looks like this:

"Train the lower limb as a system; the knee remains an important part of the program, and hip exercises are added depending on the clinical picture."

Glute exercises or quadriceps exercises?

It is usually wrong to contrast them.

The quadriceps directly extends the knee and plays a key role in walking, rising from a chair, squatting, and climbing stairs. Strengthening it has long been used for patellofemoral pain.

In a 2021 systematic review, isolated hip exercises and knee exercises resulted in comparable improvements in pain and function on average.[11]

However, a 2025 meta-analysis of six randomized trials with 241 participants found better pain and function outcomes with a combination of hip and knee exercises compared to knee training alone. The results should be interpreted with caution: the studies were highly heterogeneous, and more than 96% of the participants were women. [12]

This is why modern practice is less and less trying to identify one “main culprit muscle” and more and more using complex strengthening of the leg.

Is weak glutes a cause or a consequence of patellofemoral pain?

This cannot be stated unequivocally.

People with patellofemoral pain do often exhibit lower hip abduction and external rotation strength compared to people without pain.[13]

But most of these studies compare groups after symptoms have appeared.

Therefore, at least three options are possible:

Weakness contributed to the problem;

Pain and decreased activity resulted in loss of strength;

Or both pain and loss of strength are related to other factors.

A systematic review of the biomechanics of patellofemoral pain clearly warns that without sufficient prospective studies, hip muscle weakness cannot be confidently assumed to be the underlying cause of the disease.[14]

This is an important distinction between:

"People with pain have weaker muscles"

AND

"Weak muscles caused pain."

Can glute training prevent knee pain in a healthy person?

There is insufficient evidence to support such a categorical statement.

Treating existing patellofemoral pain with hip and knee exercises is one thing.

Proving that isolated gluteal strengthening will prevent pain in a healthy person is a completely different scientific question.

Prospective studies of risk factors for patellofemoral pain provide a significantly less conclusive picture than treatment studies. In reviews, one of the more consistently supported muscle risk factors was knee extensor weakness, while the role of hip strength as a cause of the disease remains less certain. [15]

Therefore, it is more correct to say:

The gluteal muscles are an important part of the physical preparation of the lower limb, and not:

If you regularly do leg abductions with a rubber band, your knees will never hurt.

Gluteal muscles and knee osteoarthritis

In osteoarthritis, exercise is a fundamental part of treatment, but current guidelines do not single out the gluteal muscles as the sole or mandatory target.

NICE recommends individually tailored therapeutic exercise programs for all people with osteoarthritis, including local muscle strengthening and aerobic exercise. The guidelines specifically warn that pain may temporarily increase slightly at the beginning of exercise, but regular exercise improves pain, function, and quality of life over the long term. [16]

Research on hip exercises supports their inclusion in programs. A 2022 meta-analysis of seven randomized trials found improvements in pain and function with hip abductor muscle strengthening in people with knee osteoarthritis. [17]

However, more detailed studies do not show that the abductor muscles are a unique key. In a randomized trial of 66 patients, adding exercises specifically for the abductor muscles to a comprehensive program was not more effective than similarly adding exercises for the adductor muscles. [18]

Therefore, when it comes to osteoarthritis, it is wiser to think not about:

"Which one muscle will save the joint?"

A:

"How can I maintain my entire leg strength, ability to walk, stand, climb stairs, and maintain regular physical activity?"

Can Strong Glutes Prevent Osteoarthritis?

There is no evidence to support such a promise.

Osteoarthritis is a multifactorial disease. Its development and progression are influenced by age, previous injuries, body weight, genetic factors, joint characteristics, stress, and other factors.

Muscle strengthening is beneficial for function and is part of the treatment of existing osteoarthritis, but improving muscle strength is not proven to prevent structural cartilage wear.

Even for the muscles immediately surrounding the knee, the evidence is more cautious than popular claims. A systematic review of longitudinal studies found an association between knee extensor and flexor weakness and some measures of structural osteoarthritis progression, but the observed association alone does not prove that increasing strength will prevent this progression. [19]

For the gluteal muscles, such a preventative claim is even less substantiated.

Buttocks and ACL Injury

Here, too, it is necessary to separate understandable biomechanics from proven prevention.

The gluteus medius is capable of generating a moment that counteracts valgus loading on the knee, which could theoretically reduce some of the stress on the anterior cruciate ligament.[20]

Integrated neuromuscular programs do reduce the risk of anterior cruciate ligament injuries in athletes. A meta-analysis of high-quality preventive programs found a significant reduction in the incidence of such injuries, but the authors were unable to identify a single superior program. [21]

The key word here is complex.

Such programs include different combinations:

• strength exercises;
• jumps and landings;
• balance;
• changes in direction of movement;
• coordination;
• movement techniques.

Therefore, their preventive effect cannot be attributed only to the gluteal muscles.

The latest data from 2026 further cautions against the idea that a simple gluteal strength test can identify someone with dangerous dynamic valgus.[22]

What's more important for the knee: strength or coordination?

Both abilities are needed.

A muscle must have sufficient strength to cope with the load. But the nervous system must distribute this force in a timely manner among several muscles and joints.

You can have a strong glute on the machine and still have poor control over landing quickly on one leg.

Conversely, a person may perform a light squat with technical accuracy, but when the speed, weight, or fatigue increases, they may lose control due to a lack of physical ability.

A systematic review of exercises for patellofemoral pain found that many programs traditionally consisted primarily of relatively simple movements and did not adequately incorporate single-leg tasks, multiplanar movements, and rotational control. The authors believe that rehabilitation should better address the patient's actual movement requirements. [23]

Therefore, an effective program typically moves from building muscular ability to using that ability in a real task.

What exercises train the buttocks?

There is no one exercise that everyone needs to do.

Exercises can be conditionally divided according to the problem they solve.

Glute bridge and hip extension

These movements allow you to easily engage the gluteus maximus. They are useful in the early stages of training or rehabilitation, when it's still difficult to perform more demanding exercises while standing.

But the lying exercise does not well reproduce the requirements of descending stairs, running or jumping.

Leg abduction and lateral movements with resistance

These exercises primarily target the hip abductor muscles, including the gluteus medius.

They may increase muscle capacity, but they do not, by themselves, prove that the knee will become more controlled during complex movements.

Squats

Squatting requires both the hip and knee joints to work at the same time and is therefore a more functional exercise.

The load on the gluteal muscles depends on technique, depth, external resistance and individual anatomy.

Lunges and split squats

They increase the demands on each leg individually and gradually bring the training closer to the challenges of walking, climbing stairs and sports.

Stepping up and controlled descents from the step

These exercises are particularly good at showing the connection between the hip and knee joints, as a person has to simultaneously control the pelvis, hip, and knee of one supporting leg.

Single-leg exercises

Single-leg deadlifts, single-leg squats, and other variations require not only strength but also balance and coordination.

This is where it becomes apparent that "glute power" is much broader than just being able to move your leg out to the side.

Is it necessary to use rubber bands?

No. The rubber band is just one way to create resistance.

The gluteal muscles can be trained:

• body weight;
• dumbbells;
• barbell;
• exercise machines;
• elastic resistance;
• exercises on one leg.

Clinical guidelines for patellofemoral pain do not require specific equipment. The key is providing sufficient load and matching the exercises to the patient's goals. [24]

If a person performs light movements with the same resistance band for years, the body adapts and the stimulus for further increasing muscle capacity becomes small.

Therefore, the color of the rubber band is not as important as the gradual increase in difficulty of the task.

Should I feel a burning sensation specifically in my buttocks?

No. A burning sensation does not prove the exercise is effective.

The burning sensation is associated with intense local muscle work and the accumulation of metabolites, but training can be effective without severe burning.

It is even less reliable to use the rule:

"If your glutes don't burn, you're not doing the exercise correctly."

Functional exercises distribute the load across multiple muscles. For example, when squatting, it's perfectly normal to feel the front of your thighs and glutes working simultaneously.

The goal of knee health exercises is not to achieve maximum local sensation, but to improve the leg's ability to perform the actions a person needs.

Knee goes inward during squats: is it necessary to correct it?

Not every inward movement of the knee is pathological.

The lower limb moves in three dimensions, so a completely still frontal line is not a prerequisite for every safe squat.

It is especially problematic to use one external sign as an independent diagnosis.

As systematic reviews from 2024 and 2026 show, hip muscle strength has a weak or inconsistent relationship with the magnitude of dynamic valgus.[25]

It's more useful to evaluate movement in context:

• does pain occur;
• how big is the deviation;
• does it appear only when tired;
• does it change with a lighter load;
• Are there any consequences of a previous injury?
• what happens to the pelvis, feet and torso.

If the movement is painless and the person is functionally strong, not every visual asymmetry needs to be “treated.”

How to train your glutes to benefit your knees

The most sensible strategy is built not around a single exercise, but around a gradual transfer of strength into functional movements.

Initially, the person should be able to perform the exercises without significant pain. Then, the resistance or difficulty is gradually increased. After basic strength work, it makes sense to progress to standing movements, single-leg exercises, and tasks that correspond to the person's normal activity level.

For example, for someone who has difficulty descending stairs, endless leg abduction while lying down has limited specificity. Once sufficient strength has been developed, it's logical to practice controlled step descents.

A runner's task is even more complex: the muscles must control the hip quickly and repeatedly. Therefore, a program may include not only strength training but also running technique or gradual load management. A modern best-practice approach to patellofemoral pain therefore involves a personalized combination of exercises, patient education, and, if necessary, movement retraining. [26]

Is it necessary to train the glutes separately if a person already does squats and deadlifts?

Not necessarily.

If the program already contains fairly heavy squats, deadlifts, lunges, step-ups, and single-leg movements, the glutes are getting a significant workout.

Isolation exercises may be helpful if:

• a specific muscle group is noticeably lagging behind;
• functional exercises still cause pain;
• you need to increase the volume of training without putting too much stress on the knee;
• this is required by the sports or rehabilitation task.

But adding five different band exercises just because they're considered "for knee protection" has no proven value on its own.

Is it possible to train your glutes if your knee already hurts?

In many cases, it is possible and useful, but the program must correspond to the cause of the pain and the tolerance of the load.

For patellofemoral pain, therapeutic exercises are the first line of conservative treatment. Current guidelines from 2024 recommend knee exercises with the addition of hip exercises, depending on individual factors. [27]

For osteoarthritis, NICE also recommends regular therapeutic exercise, warning that some additional discomfort may occur at the beginning of exercise. This does not necessarily indicate joint damage. [28]

However, a marked increase in pain, rapidly increasing swelling, or loss of function requires modification of the load and, if necessary, medical evaluation.

Training should not become a rule:

"It hurts - that means you need to pump up your buttocks even more."

First, it is necessary to understand at least the general clinical context.

When Butt Exercises Won't Solve Your Knee Problems

Knee pain has many possible causes. Strengthening your glutes won't automatically fix it:

• acute ligament rupture;
• significant damage to the meniscus;
• fracture;
• inflammatory joint disease;
• infection;
• mechanical blocking of the joint;
• some pronounced structural abnormalities.

If the pain occurs after a serious injury, the knee has rapidly increased in size, it is impossible to put normal weight on the leg, the joint actually locks, or a hot, red, swollen area with a fever has developed, attempting to "strengthen the stabilizers" on your own should not replace a medical assessment.

In a person with gradually developing exercise-induced pain without such symptoms, therapeutic exercises, on the contrary, are often an important part of a conservative approach.

What is often misunderstood

"If your knee hurts, the problem is in the knee."

Not necessarily. Lower limb movement is determined by the interaction of the hip, knee, and ankle joints, so rehabilitation often involves the entire leg. For patellofemoral pain, modern practice recommends knee exercises, possibly supplemented with hip exercises. [29]

"Weak glutes automatically cause valgus knees."

No. Systematic reviews show inconsistent and generally weak associations between measured hip strength and dynamic knee valgus.[30]

"If your knee is going inward, you only need to train the gluteus medius."

No. Movement is influenced by strength, coordination, trunk, foot, ankle, speed, and the task itself.

"For a bad knee, the buttocks are more important than the quadriceps."

There is no universal hierarchy. For patellofemoral pain, a comprehensive approach to the muscles of the knee and hip region is most appropriate. [31]

"Strong glutes prevent osteoarthritis"

This has not been proven. In pre-existing osteoarthritis, muscle strengthening and general physical activity improve symptoms and function, but the prevention of structural disease by gluteal exercises alone has not been established.[32]

"To protect your knees, it's enough to do a glute bridge."

No. The bridge can be a good strength exercise, but real leg function also requires standing work, single-leg control, and coordination.

A practical approach

If your knees are healthy and your goal is overall fitness, a separate "gluteal preventative protocol" is usually unnecessary. A program that regularly includes hip extension movements, squats, or similar exercises, working each leg individually, and gradually increasing the load is sufficient.

If pain occurs around the patella with stairs, running, or squatting, a hip exercise program is warranted, but gluteal exercises are best considered as one part of treatment along with knee exercises and overall load management.[33]

If the problem is that the knee noticeably rolls inward during movement, don't automatically start "training the gluteus medius." Strength may be a factor, but current data shows that the movement pattern itself doesn't reveal the cause. [34]

If osteoarthritis is present, the primary goal is regular, individually tailored physical activity, including muscle strengthening and aerobic exercise. Gluteal exercises can be included, but they do not replace a general lower limb program. [35]

Key points from experts

Bradley Neal, PhD, is a physiotherapist, specialist in musculoskeletal rehabilitation, and Honorary Lecturer at the School of Sport, Rehabilitation, and Exercise Sciences at the University of Essex. His official profile lists patellofemoral pain, biomechanics, and mechanisms of exercise action among his key research areas. [36]

A 2024 best practice guideline developed by Neal and colleagues, based on a systematic review, patient input, and clinical expert opinion, cites patient education and exercise as the mainstay of treatment for patellofemoral pain. Knee-focused exercises are recommended, with the addition of hip exercises based on the individual's presentation, rather than a one-size-fits-all approach to isolated gluteal strengthening for all patients. [37]

Kay Crossley is a professor and director of the La Trobe Sport and Exercise Medicine Research Centre, a physiotherapist, and a researcher on patellofemoral pain and early osteoarthritis following sports injuries. Her official La Trobe profile lists the prevention and treatment of patellofemoral pain and early osteoarthritis as key areas of research. [38]

Research in the direction pursued by the Crossley group supports the modern concept of comprehensive knee rehabilitation: hip musculature is important, but lower limb function must be assessed more broadly than through a single muscle group or biomechanical indicator. Specifically, modern systematic reviews show that the simple relationship between hip strength and knee kinematics is significantly weaker than early biomechanical models assumed. [39]

Frequently Asked Questions

Is it true that weak glutes cause knee pain?

Not always. People with patellofemoral pain do often have decreased strength in some of the thigh muscles, but this does not prove that weakness was the original cause of the pain.[40]

Which gluteal muscle is most important for the knee?

There is no single primary muscle. The gluteus medius is particularly important for pelvic control during single-leg support, while the gluteus maximus is important for powerful hip extension and functional movements. [41]

Can glute training reduce pain around the kneecap?

Yes, it can be part of an effective program. The best-supported approach is one that combines knee and hip exercises. [42]

Do you need to exercise your glutes if you have knee osteoarthritis?

They can and often are rationally included in a treatment program, but modern recommendations speak primarily of individually selected muscle strengthening and general aerobic activity, and not of mandatory training of one specific group. [43]

Will strong glutes save you from arthrosis?

There's no evidence to support this. Strengthening the muscles improves function and may reduce the symptoms of existing osteoarthritis, but there's no evidence that strengthening the glutes alone prevents the condition.

If your knee collapses inward, does that mean your glutes are weak?

Not necessarily. In the most recent systematic review from 2026, hip abductor and external rotator strength were not consistently associated with dynamic valgus in healthy individuals.[44]

Which exercise is better: bridge or squat?

They address different issues. The bridge is good for localized strength training, while the squat better simulates the combined action of the hip and knee. A complete program can utilize both.

Is it necessary to do leg abductions with a rubber band?

No. This is an option, not a required component. Similar muscular ability can be developed through a variety of exercises.

Does a runner need to train his glutes separately?

Sometimes yes, especially when strength is insufficient or as part of rehabilitation. But for a runner, load management, functional strength, and movement technique are also important; band work alone is not enough. [45]

Can exercise make knee pain worse?

Exercise may temporarily increase sensations, especially at the beginning of a program. NICE specifically warns of this in osteoarthritis, while recommending regular exercise for its long-term benefits. A significant or persistent exacerbation requires adjustments to the exercise program. [46]

Is it possible to train the glutes after knee replacement?

Hip strengthening is sometimes included in postoperative rehabilitation, but the program depends on the stage of recovery and the recommendations of the surgeon and physical therapist. A 2024 meta-analysis found a possible improvement in single-leg balance with the addition of such exercises, but no convincing benefit for most other outcomes. [47]

How long does it take for exercises to help the knee?

There is no universal time frame. It depends on the cause of the pain, initial physical fitness, exercise load, and program. For patellofemoral pain, current clinical guidelines consider exercise as a rehabilitation process, not a quick symptomatic treatment. [48]

Main

The gluteal muscles are important for knee health because they help control the femur and pelvis, generate force during functional movements, and coordinate the entire lower limb. It is especially beneficial to include hip exercises in the rehabilitation of patellofemoral pain and as part of a comprehensive strength training program. [49]

However, the current evidence base doesn't support the overly simplistic "weak glutes = knee collapse = inevitable injury" model. Recent systematic reviews show that measured hip strength is a poor predictor of knee performance. Therefore, joint health depends not only on maximal strength but also on coordination, functional load, and the condition of the muscles of the knee, foot, and ankle. [50]

In practice, this means: the glutes are worth training, but not in place of the knees or for the sake of a mythical "perfect leg position." The most effective program is one that develops strength throughout the entire lower limb and gradually transfers it to real-world movements—stairs, squats, walking, running, or athletic tasks.