The Overlooked Link Between Hip and Knee Pain: How Your Thigh Bones Could Be the Missing Piece
Introduction: Building on the Systems Approach to Joint Pain
In my recent magazine article, The Systems Connection Between Hip and Knee Pain: Fix the Root Cause, Not Just the Symptoms, I explained why hip and knee issues rarely occur in isolation.
We explored how shared anatomy, movement dysfunction, and muscular imbalances across the hip and knee create a chain reaction that can lead to long-term pain.
In this follow-up, we’ll go one step deeper, focusing on a structural factor that most people (and even many professionals) never consider: the natural shape and rotation of your thigh bones.
Known as femoral anteversion and femoral retroversion, these bone structures can quietly influence joint alignment, walking patterns, and the forces placed on your knees, hips, and even lower back.
“Once you understand how your femurs are shaped and how they move, everything about your pain starts to make more sense,” explains Rick Olderman, MSPT, author of Pain Patterns: Why You Are in Pain and How to Stop It.
Let’s take a closer look at how your femoral structure could be the missing link to solving chronic hip and knee pain.
Quick Insights: Knee & Hip Pain
- Why hip and knee pain are rarely isolated issues
- What femoral anteversion and retroversion are — and why they matter
- How to identify your femoral structure at home
- Movement strategies to protect your joints and relieve pain
- How understanding your unique anatomy can lead to lasting pain relief
How Your Thigh Bone Influences Hip and Knee Pain
Your femur is more than just a link between your hip and knee.
Its natural shape – specifically, whether it twists inward or outward –
significantly impacts how your joints absorb stress.
Two common femoral variations affect biomechanics:
| Term | Meaning |
| Femoral Anteversion | The thigh bone twists inward. More common in women. |
| Femoral Retroversion | The thigh bone twists outward. More common in men. |
These variations are normal and unchangeable. But if unaddressed, they can contribute to:
- Hip arthritis
- Labral tears
- Bursitis
- Meniscal damage
- Knee ligament strain
- Lower back pain
- Foot and ankle problems
Femoral Anteversion: Inward Twisting Problems
When the femur twists inward:
At the hip:
- Increases internal rotation
- Raises compression and shearing forces inside the joint
- Over time, this can lead to femoral acetabular impingement (FAI), labral tears, bursitis, or hip osteoarthritis.
At the knee:
- Internal rotation stresses the ligaments and cartilage
- Increases the risk of patellofemoral pain syndrome ("runner’s knee"), meniscus tears, and arthritis.
Femoral Retroversion: Outward Twisting Problems
When the femur twists outward:
At the hip:
- Forcing the feet to point straight forward (rather than naturally outward) causes chronic tension in the inner thighs.
- This can lead to hip stiffness, pelvic pain, back pain, and even sciatic nerve irritation.
At the knee and foot:
- Misalignment stresses ligaments and the meniscus
- Rotational forces transfer to the ankles and feet, increasing injury risks.
Simple Self-Test: Discover Your Femoral Structure
Want to find out if you have femoral anteversion or retroversion?
You can perform a basic test at home:
Step 1: Lie on Your Stomach
Bend your knees so your feet point toward the ceiling. Allow your lower legs to fall outward naturally.
Step 2: Cross Your Legs
Straighten one leg toward the ground. Cross the other leg toward the opposite side. Compare the angles on each side.
Interpreting Your Results:
- If your feet fall outward more easily: Likely femoral anteversion (inward femoral twist).
- If your feet fall inward more easily: Likely femoral retroversion (outward femoral twist).
How to Adjust Your Movement Based on Your Structure
Knowing your femoral shape allows you to adapt your posture and activities to reduce stress and pain.
If You Have Femoral Anteversion:
- Strengthen your glutes: Strong glutes stabilize the femur and reduce dangerous internal rotation.
- Adjust foot positioning: Slightly turning your feet outward during walking and exercise can help align the femur better.
- Reprogram your gait: Focus on activating glutes naturally with each step rather than locking your knees or over-striding.
If You Have Femoral Retroversion:
- Let your feet turn outward naturally: Forcing feet straight can create dangerous compensations up the chain.
- Stretch your inner thighs: This relieves tension caused by habitual forced straight-foot positions.
- Strengthen hip stabilizers: Target the glutes and external rotators to improve pelvic control.
Why Ignoring Your Femoral Structure Leads to Bigger Problems
Femoral anteversion and retroversion don’t just affect your hips and knees.
Over time, they can contribute to a cascade of issues:
- Pelvic misalignment
- Lumbar spine strain
- Sacroiliac (SI) joint irritation
- Foot instability and ankle injuries
- Chronic sciatic nerve symptoms
Pain migrates if the underlying mechanics aren’t addressed — making healing harder and injuries more frequent.
Your body will always adapt — but it may adapt badly if you don’t honor your natural design.
Ready to Fix the Root Cause of Your Pain?
Understanding your femoral structure is one of the most important steps you can take toward long-term joint health.
Here’s how to dive deeper:
👉 Read my book:
Pain Patterns: Why You Are in Pain and How to Stop It
This resource explains the hidden biomechanical links behind chronic pain — and how to fix them naturally.
👉 Try my digital programs:
Get step-by-step movement reprogramming at home.
Visit rickolderman.com and use code RICKBLOG20 for 20% off.
👉 Watch my videos:
Visit my YouTube channel for exercise demonstrations and free movement tutorials.
Your body’s design holds the clues to a pain-free life.
Start working with it — not against it — today.
FAQs: Understanding Femoral Variations and Pain
What symptoms suggest femoral anteversion or retroversion?
- Anteversion: Groin pain, hip impingement, knee tracking issues.
- Retroversion: Inner thigh tightness, stiff hips, low back discomfort.
Can femoral variations cause back pain?
Yes. Rotational stress shifts force into the pelvis and lumbar spine.
Is femoral twisting something I can fix?
No. Bone structure is set. But you can drastically improve how you move with it.
Should I avoid certain activities?
Avoid forcing artificial “perfect” posture. Adapt movement to your natural alignment.
Can I still run, lift, or play sports?
Absolutely—with the right adjustments, you’ll likely perform even better.
