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Could your knee pain be coming from your back?

knee pain

When you have knee pain, it is natural to assume that’s where the problem lies. You might assume it’s runner’s knee or a twinge of knee arthritis and start treatment accordingly.

Sometimes, however, the real source of knee pain may lie elsewhere. If you’ve been treating a sore knee for a while, it may be worth considering whether the real issue is in your lumbar spine (lower back).

A physiotherapist can examine your knee, lower back and other relevant areas to investigate what may be contributing to your symptoms.

 

Referred pain in the knee from the back

Referred pain occurs when a problem in one part of the body causes pain somewhere else. This happens because the pain travels down a nerve.

Nerves branch from your spine at different levels and travel to specific areas of your body. Two spinal nerve roots in the lower back, known as L3 and L4, connect with areas around the thigh and knee. Irritation or compression of these nerves in the lumbar spine can sometimes trigger knee pain.

Referred pain needs to be correctly diagnosed; otherwise you risk treating the wrong problem. If you can learn to understand and recognise the links between your knee and back pain, you’ll be better able to identify the real source of your knee pain.

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Four signs that your knee pain could be linked to your back nerves

1. Your scans look normal, but your knee still hurts

If your knee still hurts despite reassuring imaging, it can be worth looking beyond the knee itself.

In this situation, your physiotherapist may assess your lower back and the nerves that supply the thigh and knee to see whether they could be contributing to your symptoms.

2. You have knee pain and pain in your lower back or thigh

Tell your physio if your knee pain occurs alongside lower back pain or pain through the front of your thigh.

The L3 and L4 spinal nerve roots are associated with sensation around the front of the thigh and knee. If those nerve roots are irritated, it may trigger pain around the knee rather than obvious back pain.

3. You have tingling, numbness or altered sensation around your thigh or knee

Pins and needles, numbness or altered sensation around the front of the thigh or knee can suggest a nerve from the lower back is involved.

4. Your hips or quadriceps feel weaker

The nerves involved in referred or nerve-related pain around the knee also help control several movements at the hip and knee. When the L3 or L4 nerve roots are affected, weakness can sometimes show up during knee extension, such as straightening the knee, as well as hip flexion or hip adduction, which involve lifting the thigh or drawing the leg towards the midline of the body.

Your physiotherapist may assess these movements alongside sensation and the patellar reflex to see whether the pattern of weakness is consistent with involvement of the lower-back nerves rather than a problem isolated to the knee.

What happens during a physiotherapy assessment?

It usually involves a discussion of your symptoms and medical history, alongside a physical examination.

Your physiotherapist will usually begin by asking about your pain. When did it start? Where do you feel it? What tends to ease or aggravate your symptoms?

Then your physiotherapist is likely to examine your:

  • knee strength, mobility, sensations and reflexes
  • lower back
  • other areas depending on your symptoms.

Managing knee pain

If you’re experiencing knee pain, it’s important to get to the true cause, particularly before considering invasive procedures like surgery.

Treatment options may include:

  • Physiotherapy: Hands-on physical therapy, which may include putting pressure on muscle tissue or joint manipulation. Your physiotherapist can also teach you exercises, stretches, and strategies for strengthening your back muscles, managing pain, and helping your body to move more comfortably.
  • Posture correction: Having good posture means your hips, knees, back, and feet are aligned. This can keep the pressure off the nerves in your lower back and stabilise your lower body.
  • Self-care: Looking after your body by keeping within a healthy weight range, being physically active, and regularly completing your exercises and stretches is essential. Letting your body have enough rest to avoid fatigue or strain is also important.

Not sure where your knee pain is coming from?

If your knee pain is proving stubbornly persistent, then it’s possible that the real problem lies elsewhere. A physiotherapy assessment can explore whether your lower back is the true culprit.

The Brisbane Spine Clinic provides physiotherapy assessment for spinal and musculoskeletal concerns at Eight Mile Plains, North Lakes and Daisy Hill.

Book a physiotherapy appointment┃Call (07) 3841 3070

Disclaimer
All information is general and not intended as a substitute for professional advice.

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