“Are you using your butt?”

Menopause coincides with (or contributes to) an uptick in joint pain generally, and many women find their knees are causing quite a bit of trouble at this time.

At genneve, we’ve heard from a lot of women that knee pain makes it tough to exercise. Since exercise is really important for helping reduce the risk of osteoporosis, heart disease, and dementia; since it helps us control weight and alleviate depression; since it helps us sleep … well, not being able to move just isn’t an option.

So we turned to our two awesome DPTs, Dr. Brianna Droessler-Aschliman of Four Pines Physical Therapy and Dr. Meagan Peeters-Gebler of Orthopedic & Spine Therapy, for some help.

Meagan and Brianna, physical therapists

So, are you using your butt?

If you’re experiencing knee pain and you go to a physical therapist, “Are you using your butt” is one of the first questions you’re likely to hear, says Brianna. “If the pain is not from an obvious injury like a sprain or twist or tear, I start with the glutes.”

Why questions about the butt when it’s the knee that hurts? Well, knee pain is often caused not by a problem with the knee itself, but by tight, weak hips and weak glutes.

“The glutes are both stabilizer and powerhouse,” says Bri. “There are three muscles working together back there: your gluteus maximus, which is the big muscle of your butt cheek that provides a lot of power, and the gluteus medius and minimus, which are stabilizers that run along the sides of your hips. When people come to me with knee pain, I test these first, and often I find that weak glutes are the culprit.”

If you want to test your glutes, lie on your back and raise one leg. Ask a friend to push down against your leg and see if they can force it down. If there’s little resistance from you, chances are you’ve got some weak glutes. (Hint: it’s really best if your “friend” is a qualified PT or coach).

So what’s really going on here?

We spend a lot of the day on our butts, which can cause the hips and the smaller glute muscles (med and min) to tighten. Combine that with weak glutes generally, and you end up relying on the powerful quad muscles in the front of the thigh and the big hamstring in the back to do the power work the glutes should be doing.

The quads and hammies mostly do pretty well, which is why so many of us default to them. The problem is your body mechanics aren’t set up for the quads and hammies to take this much of the load. Your quads insert into your knee in a way that applies extra pressure when that big muscle contracts, compressing the patella into the knee. Glutes do the same job without that compressive kneecap force, Meagan says, so they don’t constantly inflame the knee and cause pain.

Fire up yer glutes!

Strengthening, stretching, and activating your glutes and hips may go a long way toward alleviating your knee pain. Clam shells, side hip raises, side walking, tightening and squeezing your butt while sitting at your desk or standing at the sink to do dishes – these can help you start to strengthen those muscles. Walk up and down stairs, but put your whole foot on the step and push up with your heel rather than your toe.

You can also do a “toes-up bridge” where you lie on your back, knees bent, toes pointed upward. Bring your hips up to form a straight line from shoulders to knees, while squeezing your glutes. Hold at the top for a count of 10, then come back down. Ten reps at a time a few times a week, and you can start to feel the glutes getting stronger.

Meagan demoing the bridge

Oddly, getting those big, powerful muscles to activate is harder than it seems, so for awhile you may have to consciously engage your butt. “Self-talk,” Bri advises. “You have to be intentional about it at first, think about those muscles firing as you walk or run or do a squat. You’ll tire faster than you expect, but that’s OK; you’ll get stronger and eventually you won’t need to concentrate as much.”

Check your posture as you walk, Meagan says. If you have your butt tucked under, your glutes can’t work as well. Think about leaning slightly forward so your “headlights” enter the room before your pubic bone does, as this forces the glutes to engage to move you forward.

And at the end of the day or after your workout, stretch and roll those big muscles with a foam roller to relieve the tension and relax tightness. Stretch out your quads by bringing your knee gently up to your butt, knee pointed down. Even if you didn’t get to exercise that day, just sitting is hard on your body, so give yourself a little love.

Solving from below: ankle, feet, and knees

Your glutes may not be (entirely) to blame. As Meagan says, when the middle joint is hurting, the problems often start in the joints above and below. Tight hips is one issue, but tight ankles and weak feet can also cause problems and pain in the knees.

Protect your knees by keeping your calves stretched out so your ankles stay flexible and have a good range of motion. Be sure the shoes you’re wearing have a decent cushion and good support. If you’re a runner or walker, have shoes fitted at a running store and replace often. Bri suggests over-the-counter orthotics or even prescription orthotics if a doc recommends them. 

How to deal with the pain now

So, you’re pretty sure the pain you’re feeling isn’t due to an injury or accident (you got a doc or PT to figure that out, right? And no, Dr. Internet isn’t good enough). How do you control the pain as you’re working to strengthen your glutes, hips, feet, and ankles?

Consider wearing a compression sleeve made for knee pain. Not only does it take some of the pressure off the knee, it also helps your brain be more aware of what your knee is doing as you move. (Note: do NOT use compression if you have circulation or blood clot issues or a skin sensitivity to the material.)

If you’ve ever seen a pack of distance runners, you may notice one or two have colored tape on their legs. That’s elastic therapeutic tape or kinesiology tape, and it could be well worth exploring. The tape works by lifting the skin off the fascial layer and connective tissue beneath so the body can flush out built-up toxins via the lymphatic system. It also allows in more oxygen and better blood flow for faster healing. With the tape “making room,” the layers of tissue and muscle glide over each other with less friction, and the brain sensory input reteaches your brain the proper movement pattern. The only concern is if you’re sensitive to the glue.

And the advice you knew was coming: “Relative rest,” says Meagan. “That doesn’t mean total inactivity, it just means you choose actions that don’t inflame the knee. If going down stairs hurts, take them one step at a time,” for example. Give the inflammation in the knee time to subside, and stop triggering more pain. “Ride a bike,” says Bri. “Maybe you can’t run a mile right now, but maybe you can bike for five. Just make sure what you’re doing isn’t making it worse.”

But as ever, be aware of limitations, and if something hurts, stop. “Knee pain isn’t something that gets better by pushing through it,” says Meagan. Catching and diagnosing the pain early gives you a great opportunity to fix less-than-ideal body mechanics. Pushing through it is a great way to make a small problem into a much bigger one.

How are your knees holding up? If you're managing knee pain, we'd love to know how you're doing it. Give us a shout via comment here, find us on Facebook or in Midlife & Menopause Solutions, our Facebook group. You can also join us, anonymously, if you prefer, on our community forums. 



Shannon Perry

Shannon is a celebrated author and global educator. Whether she’s interviewing a physician or producing a podcast, her appetite for research, facts, and truth culminates in credible health education and programming that women can rely on. An avid runner, cyclist, and climber, Shannon knows a thing or two about thriving in midlife and lives in Seattle with her cat, dog and boyfriend.


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