Why Knee, Hip, and Low Back Pain Are All Connected

Jessica Bento, Physical Therapist (Creator of NEW DVRT Rx Total Body Rebuild Program, DVRT Restoration Certification, DVRT Rx Shoulder, Knees, Pelvic Control, & Gait Courses)

In recent years, there’s been a surge—an epidemic, even—of people worrying that their glute medius isn’t working. As a physical therapist, I’ve heard this concern countless times. But let’s clear something up right away: if your glute medius weren’t working at all, you wouldn’t be walking, climbing stairs, or standing on one leg. So, what’s really going on?

It’s not that the glute medius is “off” or “nonfunctional,” but rather that the entire system it’s part of is out of sync. And that system includes the hip, knee, and low back, all parts of the body that are inherently connected through what we call the lateral chain or lateral sling.

When I assess a patient, I doesn’t just poke and prod at individual muscles. Instead, I observe how a person moves, walking, balancing on one leg, or stepping laterally. What I’m really looking at is how well the body’s chains of muscles are coordinating together.

The glute medius is part of the lateral chain, a network that spans from the foot all the way up to the head. This includes not just the glute medius, but also the glute minimus, tensor fascia latae (TFL), obliques, IT band, latissimus dorsi, quadratus lumborum, and piriformis. If just one area along this chain is underdeveloped or misfiring, the effects can show up as knee pain, hip instability, or even low back discomfort.

For example, if your foot isn’t stable on the ground, your glutes can’t fire properly (PMID: 33028280). Similarly, if your core isn’t engaged, your glute medius can’t do its job well either (PMID: 28732494). This interconnectedness explains why issues like IT band syndrome, patellar tracking problems, and lower back pain often trace back to how this chain of muscles is functioning, or not functioning, together.

Motor Control > Muscle Isolation

One of the biggest misconceptions in both rehab and fitness is that the answer lies in isolating a weak muscle and hammering it with reps. The reality? The body doesn’t work in isolation, and muscle strength alone isn’t enough to prevent or fix pain. In fact, research shows that motor control, how muscles work together in coordinated patterns is often more impactful than simply getting a muscle “stronger” (PMID: 31638962).

Take the glute medius again: its job isn’t just to move the hip. It also plays a huge role in resisting movement, especially during single-leg actions. That’s why exercises that challenge stability and dynamic control are often more effective than traditional isolation drills.

 

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What the Research Actually Says

Let’s talk evidence. A 2020 meta-analysis (the gold standard in research) found that single-leg exercises like step-ups activated the glutes more than hip thrusts, yes, you read that right. Even popular bilateral exercises don’t match the total glute engagement you get from unilateral movements, which force the glutes to stabilize across all planes of motion.

Why? Because real-life movement isn’t done with both feet planted. Think about walking, going up stairs, or running all involve single-leg phases that require a well-functioning lateral chain.

 

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Foot, Core, and Glutes: The Posterior Oblique Sling

Another major player in glute function is your core, especially when connected to the Posterior Oblique Sling, a powerful network involving your glutes, lats, and core muscles. This system transfers force diagonally across the body, which is critical for movements like walking, rotating, or picking something up off the floor.

If your foot, core, or lats aren’t contributing, your glutes are left to overcompensate or underperform. That’s why training the glutes in isolation misses the bigger picture. You need to activate the entire chain for real, lasting change.

This is where functional training systems like DVRT (Dynamic Variable Resistance Training) come in. Rather than isolating the glutes, DVRT exercises integrate the entire chain using tools like the Ultimate Sandbag (USB) and Mobility Balls.

For example:

• Single-leg bridge with USB: Pulling the sandbag apart activates the lats, engages the core, and lights up the glutes—tapping into the Posterior Oblique Sling.

• MAX rear step deadlift: This multi-axis movement forces your glutes to react dynamically, building stability and strength at the same time.

• Mobility Ball drills: These enhance reflexive core engagement, reinforcing the entire gluteal and core chain.

These types of exercises don’t just “work the glutes.” They teach your body to move better as a whole. That’s the real secret to resolving nagging issues in the knees, hips, and low back and preventing them from coming back.

Check out how we put it all together in Jessica’s NEW DVRT Rx Total Body Rebuild 6-month program 30% with code “rebuild” HERE

 

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