Rethinking Knee Pain: Why Hip Control Comes First with Dr. Christopher Powers

Why does knee pain so often start somewhere other than the knee? For decades, clinicians treated the knee in isolation — until dynamic imaging research revealed the real story: it's often the femur moving under the kneecap, not the kneecap tracking poorly, that drives the pain. Dr. Brent Anderson sits down with Dr. Christopher Powers, professor and associate chair in the Division of Biokinesiology and Physical Therapy at USC, to unpack what that discovery means for how we understand and treat the knee. Dr. Powers has spent his career studying the hip's role in knee health, and in this conversation he explains "glute amnesia" — the surprisingly common phenomenon where patients simply can't activate their glute muscles, even when they want to. He and Dr. Brent trace the connection from sedentary lifestyles and lost childhood movement patterns all the way to a troubling rise in ACL injuries among kids as young as ten. Along the way, they make the case for prevention, screening, and looking at movement — not just strength — as the real key to lasting knee health. In this episode: How dynamic imaging changed our understanding of patellar tracking and hip-knee mechanics What "glute amnesia" is and why so many patients can't activate their glutes Three activation exercises shown to improve neural connection to the glutes Why ACL injuries are showing up in children as young as ten years old The link between hip strength and future ACL injury risk Gender differences in movement patterns and injury risk Why movement strategy, not isolated strength, is the real key to prevention Definitions: Glute amnesia — A reduced ability of the brain to activate the gluteal muscles, often from disuse, making it hard to strengthen them until activation is restored first. Arthrogenic inhibition — A reflex where pain or swelling in a joint causes the surrounding muscles to shut down or weaken. Valgus — An inward collapse of the knee, often seen during walking, running, or squatting, that signals poor hip control. Patellofemoral joint — The joint where the kneecap (patella) meets the thighbone (femur); problems here are a common source of knee pain. Neuroplasticity — The brain's ability to change its connections to muscles over time, for better or worse, based on how often those muscles are used.