Why Your Knee Pain Might Start at Your Core or Pelvic Floor

When your knees hurt, the last place you probably think to have checked out is your pelvis or core. But here’s the thing: the body doesn’t move in isolated parts—it functions as a connected chain; like links on a fence. If one link in the chain is weak, unstable, or overcompensating, it can cause pain somewhere else.

As a pelvic floor physical therapist, I often see patients with knee pain that hasn’t improved with traditional treatment. When we dig deeper, we find that the real problem lies in poor core or pelvic floor function. Here's why:

The Body Moves as a Chain

Imagine your body as a tent. Your legs are like the poles that hold it up, but the ropes and center stake (your core and pelvis) keep everything balanced and tensioned. If those central supports are loose or weak, the whole structure becomes unstable. That instability forces other parts (like your knees) to compensate just to keep you upright during activities like walking, running, or standing. Ultimately, your gait pattern (walking pattern) has changed causing pressures on that joint that it was not designed to withstand.

With every movement, force needs to be distributed efficiently from your core to your limbs. When your core and pelvic floor aren't pulling their weight, your knees take on more than they should. Over time, that added strain can result in pain, swelling, or even injury.

How the Pelvic Floor Affects Your Knees

The pelvic floor muscles work closely with your deep core, diaphragm, and hip muscles to stabilize the spine and pelvis. Think of them as siblings, when these muscles are weak, overactive, or not coordinating properly, it can change your posture and the way you move. AKA one sister is taking up the slack for the other sister. 

Common issues that can lead to knee pain include:

• Pelvic instability (excess motion or misalignment)
• Poor glute engagement
• Core weakness or diastasis recti (ab-separation)
• Hip rotation or alignment issues
• Compensation patterns (e.g., walking with a “hip drop”)

All of these can affect knee tracking, joint loading, and muscle balance—especially during weight-bearing activities.

What Pelvic Floor Physical Therapy Can Do

As a pelvic floor physical therapist, I look at more than just your knees. I assess how your entire body moves—especially how your core and pelvic floor are functioning in real life activities like squatting, walking, or climbing stairs. Pelvic floor care is just an extra tool in my toolbox that allows a full-body picture. 

Your treatment might include:

• Core retraining to activate deep abdominal and pelvic muscles
• Pelvic alignment and mobility work
• Glute and hip strengthening for better knee support
• Breathing and posture coaching to support spinal and joint health
• Gait and movement retraining to correct faulty patterns

We don’t just treat the pain, we find the source. 

When Knee Pain Doesn’t Improve with Traditional Care

If you’ve tried rest, ice, stretching, or even knee-specific physical therapy or chiropractic care without lasting relief, it may be time to look higher up the chain. Chronic or recurring knee pain can often be a sign that your body is compensating for weakness or imbalance elsewhere.

Pelvic floor PT isn’t just for incontinence or pregnancy—it’s about improving how your entire body functions from the inside out. It literally can be the missing piece to the puzzle. 

Final Thoughts

Your knees don’t work alone (and neither does the rest of your body). Knee pain may be your body’s way of asking for better core and pelvic floor support. By treating the source, not just the symptoms, pelvic floor physical therapy can help you move better, feel stronger, and get back to the activities you love.

If you’re struggling with stubborn knee pain, consider taking a more holistic approach. Sometimes, the problem isn’t at your knees; it may be your core and pelvic floor. 

~ Dr. Sara Panek PT, DPT, PCES