Why Do My Hips and Knees Hurt? The Pain May Not Start in the Joint

My hip hurts. My knee hurts. It seems logical to blame the joint. After all, that is where we feel the pain.

But what if we limit our thinking when we immediately call it “joint pain”? What if the hip joint represents only one place worth looking? A tendon may hurt near the joint. Muscles may change how we move. A nerve may send pain into the area. Even the spine may contribute to what we feel at the hip or knee.

That question becomes even more interesting as we get older. Many women notice aching hips, knees, or other joints around menopause. We often dismiss those changes as aging, yet menopause changes much more than our reproductive cycle. Estrogen communicates with tissues throughout the body. At the same time, muscle strength may decline, tendons continue responding to the loads we place on them, collagen turns over, sleep may change, and recovery may take longer.

Suddenly we have several dots worth connecting.

Where You Feel the Pain May Not Tell the Whole Story

Think about everything surrounding your hip. The hip joint sits deep within the body, surrounded by muscles, tendons, connective tissue, nerves, and blood vessels. Above it, the pelvis and lumbar spine influence movement. Below it, the femur travels toward the knee. Every step asks these structures to communicate and respond to one another.

The knee works within that same network. Your quadriceps and hamstrings control movement. Muscles around the hip influence the position of the femur above the knee. Tendons transfer force from muscle to bone. Nerves carry information between the tissues, spinal cord, and brain. Your feet influence movement from below while your pelvis and spine influence it from above.

Once we look at the hip and knee this way, “joint pain” starts to describe where we feel something rather than necessarily telling us what created it.

Someone may show osteoarthritis on an X-ray and also struggle with weak hip muscles. Another person may show relatively modest changes on imaging but experience considerable pain. Someone else may point directly to the outside of the hip while the painful tissue lies outside the hip joint.

The image, the pain, and the source do not always line up neatly. That gives us a reason to remain curious.

What Does the Pain Actually Feel Like?

Before we decide what the joint needs, pay attention to the pain itself. An ache that appears when you load your leg tells a somewhat different story from burning, tingling, numbness, or an electrical sensation traveling down the leg.

Nerves carry information from our tissues toward the spinal cord and brain. The nervous system then processes and interprets those signals. When something irritates or damages a nerve, the resulting sensation may feel quite different from the soreness we associate with an overworked muscle or joint.

The lumbar spine deserves a place in this conversation because nerves leaving the lower back travel toward the hips, thighs, knees, legs, and feet. Research continues to remind clinicians that knee pain does not always begin in the knee. Problems involving the L3-L4 region of the lumbar spine, for example, may refer pain toward the thigh and knee.

Hip and spinal problems may also overlap. Clinicians sometimes use the term hip-spine syndrome while sorting through which structure contributes most to a person's symptoms.

We don't need to blame the back every time a knee hurts. Instead, we keep it in mind when the pieces do not quite fit. Perhaps the knee looks relatively good on examination or imaging, yet the person continues to experience pain, weakness, altered sensation, or symptoms that travel. That pattern invites another question: What else might contribute?

Peripheral neuropathy adds another dot. Altered nerve function may produce pain directly, but nerves also help us sense position and movement. Changes in sensation or proprioception may affect balance, muscle recruitment, and gait. Those changes may then influence how the hip or knee handles load.

One change may begin influencing another.

Muscles Change How Your Joints Handle Load

Muscles do much more than move bones. They stabilize joints, absorb forces, control movement, and help us manage the loads of everyday life.

The gluteal muscles offer a great example. Gluteus medius and gluteus minimus help stabilize the pelvis as we walk and whenever we stand on one leg. Every step briefly asks one leg to support us while the other moves forward.

When hip strength or muscle recruitment changes, pelvic control may change too. The femur may move differently underneath the pelvis, which may change how the knee below handles load. This connection helps explain why researchers studying knee pain also pay attention to hip strength.

The quadriceps tell a similar story. They help us rise from a chair, climb stairs, walk downhill, and control the knee as it bends. Pain may reduce normal quadriceps activation. We hurt, so we change how we move or move less. Over time, the muscle may lose capacity. That loss changes movement, and movement changes the forces passing through the knee.

This relationship may work in both directions. Pain changes movement, while altered movement may contribute to more pain.

Even the word weakness may oversimplify the problem. Strength matters, but so do timing, coordination, endurance, and the demands we place on a muscle. A muscle may test reasonably strong yet fail to contribute well during a particular movement.

Instead of asking only, “What hurts?” we begin asking, “How does the whole movement system work?”

When “Hip Pain” Comes From a Tendon

Pain along the outside of the hip gives us one of the clearest examples of why location does not always identify the tissue causing the trouble.

The gluteus medius and minimus muscles attach around the greater trochanter through their tendons. You can feel the greater trochanter as the prominent area along the outside of the upper thigh. Those gluteal tendons may become painful, particularly in women during midlife and beyond.

For years, people often called this lateral hip pain “trochanteric bursitis.” Research now points toward gluteal tendinopathy as an important contributor for many people.

A person may notice discomfort while lying on that side, walking farther than usual, climbing stairs, standing on one leg, or getting up after sitting. She points to her hip because that spot hurts. The more useful question asks which tissue hurts there.

That distinction changes our thinking because tendons respond to load. They need enough challenge to maintain and build capacity, yet too much load may exceed what they currently tolerate. Certain positions also compress the gluteal tendons against the greater trochanter. For that reason, aggressively stretching every painful or “tight” hip may not help and sometimes may irritate the tendon further.

The knee gives us similar examples. The quadriceps tendon connects above the kneecap, while the patellar tendon continues below it toward the tibia. Activities such as stairs, squatting, running, or repeatedly rising from a chair increase demand on this knee-extensor system.

We may feel pain around the joint even when the cartilage inside the joint does not drive the entire problem.

Menopause Changes the Conversation

Many women notice something puzzling as they move through perimenopause and menopause. Their hips ache. Knees complain. Tendons seem less forgiving. Activities they once tolerated easily may require more recovery.

Research increasingly recognizes this pattern. A recent systematic review and meta-analysis involving more than 93,000 women found reports of muscle or joint pain increased from about 40 percent before menopause to approximately 57 percent during perimenopause and 59 percent after menopause.

Those numbers do not prove that declining estrogen directly causes every painful hip or knee. They do tell us that the pattern deserves attention.

Estrogen communicates with far more than reproductive tissues. Estrogen receptors and signaling occur throughout the body, including bone, muscle, connective tissue, and other parts of the musculoskeletal system. Researchers continue exploring how changing estrogen levels may influence muscle, tendon, cartilage, bone, inflammation, and pain processing.

Collagen connects several of these tissues. Tendons contain large amounts of collagen. Collagen gives cartilage its framework. Bone develops around a collagen matrix before minerals add more strength. Ligaments and other connective tissues depend heavily on collagen too.

Research suggests estrogen influences collagen metabolism and tendon biology, although many questions remain about what those changes mean for an individual woman. Research examining menopausal hormone therapy and musculoskeletal pain also shows mixed results. Hormone therapy may make sense for some women for a variety of menopausal concerns, but the evidence does not support a simple equation of estrogen replacement equals no more joint pain.

I find a broader question much more useful. If your hip or knee started hurting during the same season of life when your hormones, sleep, muscle strength, activity, recovery, or body composition changed, could several of those changes contribute to what you feel?

Biology rarely gives us one isolated dot.

Collagen, Vitamin C, and the Materials Your Body Uses to Rebuild

Once we start talking about tendons, cartilage, muscle, and bone, nutrition naturally joins the conversation. These tissues do not sit unchanged inside us until they simply “wear out.” Your body continually breaks down, repairs, remodels, and adapts tissue in response to activity, nutrition, hormones, age, injury, and recovery.

Collagen provides structural proteins throughout connective tissue. Researchers have studied collagen supplementation increasingly for joint health. A 2024 meta-analysis of 35 randomized controlled trials reported improvements in osteoarthritis pain and function among people using collagen derivatives, although results and the size of the benefit varied among studies.

That research does not mean taking collagen rebuilds a worn-out knee. Digestion breaks collagen into peptides and amino acids that the body may use as raw materials, while researchers continue investigating whether certain collagen peptides also send signals that influence connective-tissue metabolism.

Vitamin C contributes something different. Your body requires vitamin C during collagen synthesis. Without adequate vitamin C, normal collagen formation suffers.

Protein matters. Minerals matter. Hydration matters. Adequate calories and the overall nutritional environment matter. Focusing on collagen while ignoring everything around it would repeat the same mistake we make when we focus only on the painful joint.

I think about tissue support as a conversation between materials and signals. Nutrition supplies materials. Movement supplies information.

When we progressively challenge a muscle or tendon, the load sends a message: we need more capacity for this activity. The body then needs adequate nutrition and recovery to respond to that message.

This helps explain why endless rest rarely rebuilds capacity, while pushing through significant pain may simply overload a tissue that already struggles to keep up. Somewhere between those two extremes lies an appropriate amount of challenge that encourages adaptation.

Hormones, Metabolism, and the Bigger Picture

Once hormones enter the conversation, the word support needs some clarification because people often group very different approaches together.

Some nutritional approaches use botanicals, adaptogens, minerals, and other compounds to support normal stress responses, sleep, energy, and endocrine physiology. Adaptogenic herbs fit into this category. They do not supply estrogen.

Other approaches involve compounds that participate more directly in steroid-hormone pathways. DHEA and pregnenolone provide two examples. The body naturally produces both and uses them within pathways involved in steroid-hormone production.

Those approaches differ from each other, and both differ from prescribed menopausal hormone therapy. Understanding those differences becomes important before deciding which type of support fits an individual person.

Metabolic health gives us another connection. For years, discussions about body weight and joint pain focused heavily on mechanics: additional weight places additional load across the hip and knee. That mechanical relationship matters, but fat tissue also communicates chemically with the rest of the body. Adipose tissue releases signaling molecules that influence inflammatory and metabolic pathways.

Blood sugar regulation may influence connective tissue too. Persistently elevated glucose promotes glycation, a process in which sugars attach to proteins and contribute to advanced glycation end products, often shortened to AGEs. Researchers continue studying how those changes affect collagen-rich tissues, cartilage, inflammation, and osteoarthritis.

Diabetes may also bring us back to the nervous system because peripheral neuropathy may alter sensation, balance, and movement.

Other systemic problems sometimes masquerade as “joint pain.” Severe vitamin D deficiency may contribute to muscle weakness and bone pain around the hips or legs. Thyroid disorders may produce aching muscles, stiffness, weakness, or nerve-related symptoms.

None of this suggests ordering every laboratory test because your knee aches. Instead, it reminds us to widen the lens when the pattern does not make sense or when several other things changed at roughly the same time.

Start With One Question: What Changed?

This brings us back to one of the simplest questions in the Connect the Dots™ approach: What changed?

If your hip or knee recently started hurting, think about what happened before you noticed it. Maybe you started walking farther, gardening more, sitting longer, or exercising differently. Perhaps you stopped doing something that had quietly maintained your strength. Your shoes changed. Sleep deteriorated. Menopause entered the picture. Your weight changed. An old back problem resurfaced. Nutrition shifted. An illness or injury kept you less active for several weeks.

Sometimes nothing obvious comes to mind. That tells us something too.

Next, notice the pain itself. Where exactly do you feel it? Does it stay there or travel? Does it ache, burn, tingle, or shoot? What happens when you climb stairs, lie on that hip, or rise after sitting? Does changing the position of your back change the discomfort? Have you noticed weakness, numbness, or changes in balance?

Those observations do not diagnose the problem. They give you better information and better questions to bring to your healthcare professional.

Some patterns deserve prompt medical attention. Seek professional evaluation for new significant weakness or numbness, inability to bear weight, a hot or markedly swollen joint, fever, significant trauma, rapidly worsening symptoms, or persistent unexplained pain.

For everything else, we can begin with curiosity rather than immediately reaching for something labeled “joint support.”

Where do I feel it? What does it feel like? When does it happen? What else changed?

Then we begin connecting the dots.

Where you feel the pain gives you a clue. It doesn't always tell you where the story begins.

References

Kruse C, et al. Musculoskeletal Manifestations of Perimenopause: A Systematic Review and Meta-Analysis of 93,021 Women. JB & JS Open Access. 2026.

Overton R, et al. The Effect of Hormone Replacement Therapy on Musculoskeletal Pain in Menopausal Women: A Systematic Review and Meta-analysis. Post Reproductive Health. 2026.

Lygrisse KA, Mont MA, Scuderi GR. Knee Pain Is Not Always the Knee. JBJS Reviews. 2025.

Cordeiro TTP, Rocha EAB, Silva RS. Effects of Exercise-Based Interventions on Gluteal Tendinopathy: Systematic Review With Meta-analysis. Scientific Reports. 2024.

Liang CW, et al. Efficacy and Safety of Collagen Derivatives for Osteoarthritis: A Trial Sequential Meta-analysis. Osteoarthritis and Cartilage. 2024.

Simental-Mendía M, et al. Effect of Collagen Supplementation on Knee Osteoarthritis: An Updated Systematic Review and Meta-analysis of Randomised Controlled Trials. Clinical and Experimental Rheumatology. 2025.

*Statements regarding dietary supplements have not been evaluated by the Food and Drug Administration. Dietary supplements are not intended to diagnose, treat, cure, or prevent any disease.

This article provides general educational information and does not replace individualized medical advice, diagnosis, or treatment. Talk with your qualified healthcare professional about questions specific to you.