International Journal of Orthopedic and Orthodontic Research

Pelvic Floor Muscle Weakness in Anterior Knee Pain in the Lumbopelvic-Hip-Knee Kinetic Chain: Narrative Review

Manish Singh¹, Tarun Kumar², Zahid Ahmad Khan³, Amisha Gaur⁴

1. ¹
2. ²
3. ³
4. ⁴

Abstract

Background : Anterior knee pain rarely originates from the knee joint alone, and hip and core weakness are established contributors to patellofemoral pain syndrome (PFPS) and dynamic knee valgus. A separate literature treats the pelvic floor as an active member of the lumbopelvic core rather than a passive continence structure, but the two literatures have developed largely independently. Objective : To bring together anatomical, biomechanical, and clinical evidence on pelvic floor muscle function and anterior knee pain within the lumbopelvic-hip-knee kinetic chain, and to identify where a direct relationship is supported by evidence and where it is only inferred. Findings : Cadaveric dissection shows direct fascial continuity between the pelvic floor and the obturator internus, and electromyographic studies confirm pelvic floor co-activation with the gluteal and abdominal muscles during gait. Hip and core weakness are repeatedly and independently linked to PFPS and dynamic knee valgus across adolescent, adult, and older populations. Postpartum runners, female athletes, and older women show high rates of both pelvic floor dysfunction and hip or core weakness, but no study reviewed measured pelvic floor function directly against a knee-specific outcome, and two studies testing adjacent hypotheses found either no association or evidence of antagonism between hip and pelvic floor activation. Conclusion : A pelvic floor-knee relationship is anatomically plausible and clinically suggestive through shared core control, but it has not been directly demonstrated in the literature reviewed. A three-pathway conceptual framework and a targeted research agenda are proposed to test the relationship directly.

Keywords: pelvic flooranterior knee painpatellofemoral pain syndromekinetic chaincore stabilitydynamic knee valgus

How to cite

Licensed under CC BY 4.0.