Have you ever stood over the ball and felt like you could not completely trust one of your knees?

Maybe your knee hurts while walking the course.

Maybe stepping out of a bunker has become uncomfortable.

Maybe you hesitate to squat while reading a putt or bend down to pick up your golf ball.

Eventually, you may begin telling yourself:

“My knees are getting old.”
“My knees are worn out.”
“My knees are weak.”

There may be a legitimate structural problem inside the knee, especially if you have arthritis, a previous meniscus injury, cartilage damage, ligament damage, or a history of surgery.

Those issues matter and should never be ignored.

However, the knee may not be the only area contributing to the problem.

The hip above the knee and the foot below it can both influence how the knee moves, manages pressure, and tolerates the demands of golf.

​The knee may be where you feel the pain, but it is not always where the problem begins.

The Golfer’s Myth: “My Knee Hurts, So My Knee Is the Problem”

It is natural to focus on the area that hurts.

If your knee bothers you while walking, climbing stairs, squatting, or swinging a golf club, you assume that the entire problem must be located inside the knee.

Sometimes that is true.

An X-ray or MRI may identify:

• Arthritis
• Cartilage damage
• A meniscus injury
• Tendon irritation
• A ligament injury
​• Changes related to a previous trauma or surgery

These findings are real, but identifying a structural change does not always explain why the knee became overloaded or why certain activities continue to aggravate it.

This becomes especially important when knee pain develops gradually.

There may not have been a major fall, sudden twist, or single moment of injury. The knee may have simply started aching.

Then stairs became uncomfortable.

Walking 18 holes became harder.

Squatting to read a putt became a problem.

Eventually, the golfer began avoiding more activity because the knee no longer felt trustworthy.

​That is when it becomes important to examine what is happening above and below the painful area.

The PB&J Effect

I describe this relationship as the Peanut Butter and Jelly Effect, or the PB&J Effect.

the PB&J Effect is when a joint caught between two other joints is forced to absorb, redirect, or control additional stress because the joint above it, the joint below it, or both are not doing their jobs efficiently..

Think of your leg as a peanut butter and jelly sandwich.

The hip is the top piece of bread.

The foot and ankle are the bottom piece of bread.

The knee is the peanut butter and jelly caught in the middle.

What happens at the two outer pieces can directly influence what happens between them.

If the hip cannot move effectively or the muscles around it cannot control the thigh bone, the knee may be forced to manage additional movement and stress from above.

If the foot cannot adapt to the ground or the ankle cannot control the lower leg, the knee may be forced to manage additional movement and stress from below.

When both areas are struggling, the knee can become twisted and squeezed in the middle.

This does not mean that every knee problem begins at the hip or foot
.
The PB&J Effect simply reminds us that the knee does not function in isolation.

It is part of a larger system.

​Sometimes the knee is where stress from the rest of that system finally shows up

Structure Dictates Function

Before we discuss the hip and foot, we need to understand some basic knee structure.

One of the most valuable lessons I learned from Tom Purvis through the Resistance Training Specialist Mastery Program is:

Structure dictates function.

A joint’s structure helps establish what movement is available. The condition of that structure influences how much movement and force the joint may tolerate.

Three primary bones are important to this discussion:

The femur, or thigh bone
The tibia, or shin bone
The patella, or kneecap
​
The relationship between the femur and tibia is called the tibiofemoral joint.
​
The relationship between the patella and the groove on the front of the femur is called the patellofemoral joint.

Most people think of the knee as a simple hinge that only bends and straightens.

The knee is actually a modified hinge joint.

Its largest movements are flexion and extension, but the knee also allows smaller amounts of internal and external rotation, particularly when it is bent.

As the knee bends and straightens, the femur and tibia do not rotate around one fixed point. They roll, glide, and rotate relative to each other.

The menisci, joint surfaces, ligaments, capsule, and muscles help guide or control this changing pathway.

That is why a previous meniscus injury, ligament tear, surgery, arthritic change, or patellofemoral issue may affect the movement available at the knee and what the knee can tolerate.

This does not mean improvement is impossible.

It means that every painful knee should not be treated exactly the same.

The structure establishes the available pathway.

​The muscles help control movement through that pathway.

The Knee Is Controlled by More Than the Quadriceps

The quadriceps help produce and control knee extension.

The hamstrings help produce and control knee flexion, but they may also influence rotation.

Several other muscles cross or influence the knee and help control the relationship among the femur, tibia, and patella.

You do not need to memorize every muscle.

The important point is that the knee is more than a simple hinge, and proper knee function requires more than strong quadriceps and hamstrings.

The muscles must help control the pathway created by the joint’s structure.

But those muscles are not working alone.

The hip influences the femur from above.

The foot influences the tibia from below.

That brings us to the suspension-and-support system.

Credit to Muscle Activation Techniques™

Before diving into the suspension-and-support system, I want to give credit where credit is due.

This concept comes from something I first learned through the Muscle Activation Techniques™ specialist program—how limitations in range of motion or muscular function can affect the joints and muscles above and below the problem area.

I have adapted that concept into the suspension-and-support system to help golfers better understand how the hip and foot can influence the knee.

The Suspension-and-Support System

Think about a suspension bridge.
The cables above help suspend and control the bridge.
The pillars underneath support it from below.

For the knee:
The hip acts as the suspension system.
The foot and ankle act as the support system.

When both systems are doing their jobs, the knee has help controlling position, movement, and force.

When either system cannot do its job effectively, more responsibility may be placed on the knee.

​The knee becomes the joint caught in the middle.

The Hip: The Suspension System Above the Knee

The hip influences the position of the femur as it enters the knee.

The hip needs access to several movements:

• Flexion
• Extension
• Abduction
• Adduction
• Internal rotation
• External rotation
​
Access to movement is only part of the equation.
The muscles surrounding the hip must also be able to produce tension and control the femur through those movements.

When the hip cannot control the femur effectively, the thigh may rotate or drift inward.

The knee may then move inward during a squat, step, landing, or golf movement. This is often described as dynamic knee valgus.

This change may influence:

• How the joint surfaces meet
• How the kneecap tracks
• How force travels through the leg
• How much stress the knee must manage

The hip does not necessarily change a golfer’s bone structure.

However, it may change how that structure behaves during movement.

​That is the difference between looking at someone standing still and watching what happens when that person walks, squats, steps, rotates, or swings a golf club.

A Real-World Example

I work with a client who has experienced two medial meniscus injuries and one knee surgery.

His right knee frequently bothers him.

One of the most consistent findings, however, is that his right hip does not move or function as well as it should.

When we improve the movement and muscular function around the hip, his knee often feels better.

That does not mean his previous meniscus injuries have disappeared.
It means the suspension system above the knee is doing a better job controlling the femur.

The knee may no longer need to manage as much of the problem by itself.​

The Foot: The Support System Below the Knee

Now let’s move below the knee.

The ankle and foot must interact with the ground, manage pressure, and allow the lower leg to move over the foot.

The foot also needs to move through pronation and supination.
Pronation is not automatically bad.

It is a normal and necessary part of adapting to the ground and absorbing force.

Supination is also part of normal foot function.
It helps the foot become more rigid as the body prepares to produce force.

The problem occurs when the foot cannot control:

• How much it pronates or supinates
• How quickly the movement occurs
• How effectively it returns from that position

When the foot pronates, the tibia normally rotates inward.
When the foot supinates, the tibia normally rotates outward.

These are normal relationships.

However, if the ankle is restricted, the arch lacks control, or the muscles surrounding the foot and ankle are not producing enough tension, the tibia may rotate farther or remain in that position longer than the system can efficiently manage.

Remember the PB&J Effect:

The hip influences the femur from above.
The foot influences the tibia from below.
The knee is caught between them.

If the tibia rotates beneath the femur without enough control, the relationship among the femur, tibia, and kneecap changes.

​The direction of force through the leg may change, and the knee may be required to manage stress differently.

My Own Support-System Problem

I am a good example of a support-system issue.

I badly injured my left ankle in college.

Even now, when I play golf, I need to make sure that ankle is moving and functioning well.

When the ankle is restricted, it creates havoc in my golf swing.

It may also cause my left knee to feel significantly worse.

​The knee may be where I feel the problem, but limited movement and muscular support from the ankle and foot may be part of why that knee becomes irritated.

Why the Hip, Knee, Ankle, and Foot Matter in Golf

The golf swing requires the legs to manage pressure, rotation, and force.

During the backswing, the trail hip must accept pressure and help control the position of the femur.

During the transition, pressure begins moving toward the lead side.
The lead foot must interact with the ground.

The ankle must allow movement while helping control the tibia.
The lead hip must accept and control the femur as the golfer rotates through impact.

The knee is caught between all of it.

When the Trail Hip Is Limited

If the trail hip cannot accept or control rotation, the golfer may:

• Shift or sway
• Shorten the backswing
• Lose balance
• Alter posture
• Find another way to complete the turn

When the Lead Hip Is Limited

If the lead hip cannot accept pressure or control the femur, the golfer may avoid moving completely into the lead side.

This may affect the golfer’s ability to rotate, extend, and finish the swing with confidence.

When the Lead Foot or Ankle Is Limited

If the lead ankle is restricted or the foot cannot manage pressure, the tibia may not move or rotate efficiently beneath the knee.

The golfer may become hesitant to post into the lead leg.

They may:

• Stand up early
• Hang back
• Shorten the finish
• Avoid rotating through the lead side
• Swing around the painful knee rather than through it

The effect is not limited to the golf swing.

Think about everything else that happens during a round:

• Walking hills
• Stepping out of bunkers
• Moving across uneven lies
• Squatting to read putts
• Bending down to pick up the ball
• Getting in and out of a golf cart
• Playing several days in a row

​The knee needs help from the systems above and below it during all of these activities.

What Should a Golfer Do About Knee Pain?

The first step is not choosing a random knee exercise.

The first step is determining what the body can and cannot do.

1. Rule Out a Significant Medical or Structural Issue

Seek an appropriate medical evaluation if you have experienced:

• A recent injury
• Significant swelling
• Locking or buckling
• A major loss of motion
• Difficulty bearing weight
• Pain that continues to worsen

Do not attempt to diagnose a ligament tear, meniscus injury, fracture, arthritic condition, or patellar problem using a podcast, blog, or social-media movement test.

2. Assess Above the Knee

Start with the hip.

Can each hip flex and extend?
Can it internally and externally rotate?
Can the muscles around the hip produce and control tension in those positions?
Does one hip move or feel significantly different from the other?

3. Assess Below the Knee

Next, examine the ankle and foot.

Can the ankle dorsiflex and plantar-flex?
Can the foot pronate and supinate?
Can you raise and lower the arch with control?
Can you produce pressure through the heel, base of the big toe, and base of the little toe?
Can you balance without the arch collapsing or the toes gripping the floor?

4. Assess the Knee

Then examine the knee itself.

Can it fully straighten?
Can it bend comfortably?
Does one side move differently from the other?
Does the knee drift inward or outward during movement?

5. Isolate and Strengthen What Is Missing

Once a meaningful limitation has been identified, begin rebuilding capacity with light isometrics and controlled resistance.

Improve the individual joints and muscles before aggressively loading the entire system.

6. Integrate the Leg

Once the individual areas can produce enough control, begin integrating them into larger movements.

Examples may include:

• Sit-to-stands
• Step-ups
• Split squats
• Hip hinges
•.Lateral movements
• Rotational movements

The goal is not simply to complete the exercise.

The goal is to determine whether the hip can control the femur while the foot controls the tibia—and whether the knee can successfully manage the relationship between them.

7. Apply It to Golf

Finally, gradually apply that control to faster and more golf-specific movement.

The progression is:

Assess.
Isolate.
Strengthen.
Integrate.
Apply.

Do not select an exercise simply because someone calls it a knee exercise.
​Select it because it addresses something your body actually needs.

Three Key Takeaways

1. The Knee Does Not Function in Isolation
The hip influences the femur from above, while the foot influences the tibia from below.

2. The Hip Is the Suspension System
The foot and ankle create the support system. When either system cannot move or control force effectively, the knee may be required to handle additional stress.

3. Pain Does Not Always Identify the Cause
Pain tells you where something hurts. It does not always explain why it hurts.

​The knee itself must be evaluated, but the hip, ankle, and foot may also need to be part of the conversation.