The Link Between Back Pain and Knee Pain

It always feels like if it's not one thing hurting, it's another. Even more frustrating, pain always seems to occur in more than one body part at once. But is there a link?

Can back problems cause knee pain?

In a word: yes. But it gets more complicated than that. The line from back pain to knee pain may not always seem easy to draw. Can back injury cause knee pain? Can a pinched nerve in your back cause knee pain? Can lower back pain cause hip and knee pain? The answer to all these questions is yes. But how?

How can a bad back cause knee pain?

So why can back issues cause knee pain? At first glance, they're not related. Your back isn't connected directly to your knees, after all.

A large part of the relationship between your back and your knees is how you hold yourself (posture) and how you walk. Everything from low back pain to tension in your shoulders can affect how you stand and walk. For example, If you're trying to compensate for a herniated disc or chronic pain in your spine, you'll start to walk differently in an attempt to relieve the pain. This is a common cause of joint pain in your knees, as you put more pressure on the ligaments and meniscus there. Additionally, even if you aren’t experiencing pain in your back, you may have problems with tightness or flexibility in your neck, back, hips, or upper legs, with all can contribute to posture problems and gait problems. Without the support usually offered by your back and spine when it is strong, with optimal flexibility and posture, your knees are left to do all the work. Unfortunately, that's not what they're made for.

When both are perfectly healthy, your back and knees work together to help you move. Your knee joint allows you range of motion. Your back helps keep you stable and absorbs some of the shock from your movements. When both are pain-free, and moving healthily, they support each other so they can both do their jobs easily.

However, leg pain or back pain puts the entire system out of balance. Without pain relief or pain management, you will automatically try to cope by using the parts of your body that DON'T hurt. When your knee is forced to do your back's job, it can quickly get overloaded from the extra pressure or strange new angle you use when you walk.

What's causing your back pain (that's causing your knee pain)?

There are plenty of possible causes for a hurt back. Overuse, especially without proper stretching, can strain your back. Or you may UNDER use your back. If you have a job where you sit all day, your back muscles and buttox muscles may be weak, and not provide proper support to your spinal cord. Poor posture can put a lot of pressure on the lumbar spine (or lower spine).

You may also have a medical condition that causes pain, like spinal stenosis (a narrowing of the spaces in your spine). Sciatica pain is a fairly common cause for back and knee problems. You may have chronic pain from something like osteoarthritis or rheumatoid arthritis. Without management, the pain can start affecting your knees, hips, and ankles.

A back injury may be one of the more concerning causes of back pain. Any injury to your back or spinal cord could cause some serious damage. If you've had a recent back or spine injury, make sure to talk to your doctor as soon as possible.

What to do if your back is causing pain in your knees

If your back can cause knee pain, it's obvious that helping fix your back pain is a necessary part of your treatment plan. Luckily, there are plenty of ways to address back pain.

Speak with your medical provider about evaluation and referral to a physical therapist. A physical therapist can help you with strengthening exercises. Specifically targeting problematic weak areas, or areas that are not as flexible as they should, the physical therapist will help stabilize and strengthen your spine to improve your pain. Physical therapy exercises help strengthen your back, abdominal, and lower body muscles to prevent future damage. It can help you build proper posture and support for your back, so you don't return to the same problems. Some people choose to visit a chiropractor. Chiropractors have helped many people with problems related to the spine through spinal adjustments (‘cracking your back’). However, in some injuries or cases this treatment is not recommended, and chiropractic treatments also have risks. Consult with a Babylon healthcare provider for more information.

Over-the-counter (OTC) painkillers can help you manage chronic pain or pain from an injury. These include tylenol, ibuprofen, aleve, and naproxen. Prescription strength ones are also available. You can pair them with heating pads, especially for stiff backs from arthritis, or ice packs, for swelling and inflammation from injuries. There are also some topical ointments available over-the-counter for back pain.

Orthopedic shoe inserts are useful for helping correct your gait. They can also provide some of the shock absorption usually done by your back. This can lessen the pressure on your knee and hip joints, when they don't have to take up as much slack. It is best to seek orthotic fittings from a professional service who specializes in customizing the fit and mold to your health needs. Some orthotics are covered by insurance if your health care provider refers you for them.

If the nerve root in your lower back is inflamed, your physician may recommend steroid injections. This is usually only used after other methods have been tried. In extreme cases, you may need corrective surgery, but other treatment plans are likely to be recommended first.

Seek medical advice from a healthcare professional if your back pain gets in the way of your daily life or spreads into your legs below the knee. It's also important to seek help after a traumatic back injury (like a car crash or fall), as you may need x-rays or imaging to determine the amount of damage.

FAQs

Can lower back pain cause knee pain?

Yes. In fact, lower back pain is very likely to change your gait or make you compensate with your knees. In addition, the nerve root that sends feeling to your legs is located in your lower back. If there's any swelling in your spine, or anything (such as a herniated disk) is pressing on that nerve, you could feel sharp, shooting pain radiating down into your legs and knees.

Can sciatica cause knee pain?

Yes. The sciatic nerve, which is one of the spinal nerves, connects from your low back, through your leg into your knee. Sciatica feels like a shooting pain running from your lower back, down your leg, and can contribute to knee pain. It usually has some other root cause, like nerve degeneration or an injury.

Can arthritic knees, a knee injury, or a knee replacement cause back pain?

Yes, the transfer works both ways. A dislocated kneecap, torn ACL, or arthritic knee can all change the way you walk. Your back may have to pick up some of the slack for your knees, putting strain there.

Can tight hamstrings cause back of knee pain?

Yes. When your hamstrings are tight or weak, it can cause you to destabilize back and hip muscles. It puts pressure on your back and knees and can even change the way your spine curves. All of this puts pressure on your knees and back to make up for the stability and motion.

Can back pain cause knee and hip pain?

Yes. Not only can pain in your back cause pain in your knees, the pain can also spread to your hips or even your ankles. Whatever parts of your body you use to move, you can strain by changing the way you walk.

Can back pain cause knee swelling?

Yes. The knees can become inflamed from pressure or pain which causes swelling of the joints The extra pressure may also make existing conditions, like osteoarthritis, worse. You can use ice or OTC medication like ibuprofen or ibuprofen to help reduce the swelling.

Can knee surgery cause back pain?

Some knee surgery can cause back pain, especially if you limp during your recovery. As you recover and have less pain in your knee, you should also be able to reduce the pain in your back.

Consult a doctor if your back and knee pain don't go away as you begin to heal.

Can knock knees cause back pain?

Knock knees happen when your knee joints press together inward while your ankles are spread apart. Because of the odd angle and misalignment, knock knees can cause knee, hip, and back pain. It can be corrected with surgery and/or physical therapy. Treatment often helps get rid of the pain.

Can total knee replacement cause back pain?

Total knee replacement can cause some back pain, especially as you learn to walk and move differently with your new knee. However, it's likely to get rid of some of your pre-surgery back pain over time. It's likely that the pain from your bad knee caused you to move in a way that was bad for your back. With a new, and hopefully pain-free, knee in place, you should be able to move more naturally and relieve pressure on your back.

Sources

• The Link Between Your Back and Knee Pain - Advanced Bone and Joint
• Does Sciatica Cause Knee Pain - Veritas Health
• Back Pain - University of Washington Health
• Ask the Expert: Dr. Austin Fragomen, Orthopedic Surgeon, Answers Your Questions on Knock-Knees - Hospital for Special Surgery
• Back Disorders and Knee Pain - Very Well Health