3 Signs It Could Be Your Back Causing Your Knee Pain - Regenexx®

3 Signs It Could Be Your Back Causing Your Knee Pain

Back Causing Knee Pain

Just about everything you think you know about your knee pain is probably wrong. This is because so much of what you hear is based on a surgical and old-school impression of the musculoskeletal system. Most physicians hold fast to what they learned in medical school, but the truth is, the science of medicine is constantly evolving, finding less invasive ways to treat our ailments, and discovering the root causes of our pain.

Could It Be Your Back Causing Your Knee Pain?

An important thing to understand is that what hurts is not necessarily the problem, but a symptom of the problem. For knees, the first thing to consider if knee pain isn’t the result of traumatic injury is, are issues in your back causing your knee pain? Not determining the root cause of your pain could sadly result in a shiny, new (and unnecessary) knee replacement that doesn’t actually address the source of your pain. And as we’ve seen in research studies, an unacceptably high percentage of patients still have chronic pain after knee replacement.

How Are The Knee and the Back Connected?

Your back houses the nerves that drive the muscles around the knees. Hence, a problem with a nerve in your back can impact how those muscles work. Low-level nerve irritation usually isn’t noticed by patients as back or leg pain. It just causes the muscles to misfire, destroying the otherwise needed protection for the knee joint.

Given the importance of nailing down the actual source of your pain, you need to know the 3 signs that it could be your back causing your knee pain.

The Three Signs

1. Knee Pain Accompanied By Back Pain

If you have acute or chronic knee pain, mentally and purposefully scan for other pains or discomforts that accompany it. These pains or discomforts may seem completely unrelated, but consider them anyway.

Back pain can be related to knee pain simply based on the phenomenon of referred pain. The nerves to the lower extremities branch directly off the lower spine. So it’s easy to see how a pinched nerve, perhaps due to a bulging lumbar disc in the lower back, could direct pain down that nerve branch and into the knee.

If you sit a lot—maybe you travel for a living and spend a lot of time on airplanes, or maybe you have a desk job and don’t get up and move around like you should—sitting reduces the disc height and increases the disc bulge by pushing water out of the disc. So if you sit a lot, and you have both back and knee pain, it’s possible the knee pain is due to your back.

You might not even consider your back discomfort to be pain. It may just be a little tense or tight. It could be very mild, but don’t discount it. Before deciding on a major knee surgery, you owe it to yourself to have even the mildest back discomfort investigated to determine if it’s your back causing your knee pain.

2. Tightness in the Hamstrings

Ever see people in the gym every day using a foam roller to massage and relax their hamstrings? These people can never seem to get permanently rid of the tightness. If this is you, there’s a reason this is happening, and it’s not good for your knees.

The L5 nerve travels from the lumbar spine and down the outside hamstring muscle to power the biceps femoris. Hamstring pain or tightness that won’t go away despite repeated stretching is one of the first signs in the lower extremity that there could be a nerve issue in your back causing knee pain.  When the hamstrings become tight, painful, or inflamed, this will impact how the knee joint works. So not only is the knee affected directly by the nerve but also by the adjustments you might make in how you move to compensate for the stressed hamstring.

After a few weeks of hamstring tightness, the meniscus will begin to suffer and your body will attempt to repair it by mobilizing the stem cells in your knee and other inflammatory cells in the body. Since the trauma will be constant and ongoing, the cells’ efforts will be futile, and the swelling will live there until the root cause is addressed.

3. Bunion Formation

Bunions? Really? You might wonder what in the world bunions have to do with your back; however, bunions can be a direct result of back issues, and where there are bunions and back issues, there is probably knee pain. When there is a problem in the back, this can cause the stabilizing muscles of the foot to weaken and lead to bunions. The L5 spinal nerve goes to the muscles that help support the inside of the foot, while the S1 nerve goes to muscles that support the outside of the foot.

When the nerve is stressed or injured, the muscles that support the outside of the foot as you walk, run, or stand won’t be able to do their job. This will cause the foot to pronate, forcing a misalignment in the main tendon and leading to an unnatural tilting of the big toe joint. This tilting of the toe joint creates pressure in the joint, where bunions, or bone spurs, can form.

When you develop a bunion, it’s important to find its source. There’s a good chance your back is the culprit.

The upshot? It won’t do you any good if we just treat your knee pain with a knee stem cell injection if it’s an issue in your back causing your knee pain. It may provide some slight temporary relief, but it won’t fix your problem. Likewise, it won’t do you any good if a surgeon cuts out your knee and replaces it when the knee isn’t the true source of your pain.

To find out if you might be a candidate for a Regenexx procedure, complete our Regenexx Procedure Candidate Form online.




*DISCLAIMER: Like all medical procedures, Regenexx® Procedures have a success and failure rate. Patient reviews and testimonials on this site should not be interpreted as a statement on the effectiveness of our treatments for anyone else.
Read 22 Comments
  1. Can low back pain also affect and influence muscle knots around the hip joints making arthritis symptoms worsen? I have low back zings and fairly severe tightness along with knots in the muscles around my hip joints that seem to make the arthritis worsen until I roll out the knots and stretch. Thank you.

  2. Would an MRI assist in the diagnosis? One orthopod states I need a hip replacement another orthopod said get some physical therapy first and then reevaluate. I also have the piriformis syndrome and then discomfort from that never goes away and I have done pt, chiropractor adjustments, massage, water areobics, stretch exercises in bed before I get up and this is all good, but only for a short time. My main complaint is not being able to walk any distance standing in one position for any length of time. After standing for only a few minutes and then trying to walk again my legs feel as if they are not going to support me. I am not overweight (120#). Please help!

    1. Mary,
      An MRI is generally helpful, but often not definitive. The concern here would be whether this was a hip issue at all, or whether this is all about your low back. It sounds like you’ve tried several good sound conservative treatments. Next would be determine where this problem actually originates and treat the cause with biologics like your own platelets or stem cells before any talk of joint replacement. We would be happy to take a look and see how we might be able to help. There is a Regenexx Candidate form on both of these pages: http://www.regenexx.com/the-regenexx-procedures/shoulder-surgery-alternative/ http://www.regenexx.com/the-regenexx-procedures/hip-surgery/ http://www.regenexx.com/hip-tear-surgery-didnt-work/

  3. I have been undergoing trigger injections for what we now know is a pinched nerve in my C3 -C6 and last night I woke up with chronic pain in my left knee and I can barely stand and it appears to want to attack my right knee too. Is this pinched nerve the problem

    1. Migdalia,
      It could be related to the problem, the treatment, or someting else. With those symptoms important to contact your treating physician and get checked out.

  4. i have been having pain in the back of my knee and sometimes i can not put pressure on it , the dr did an mri but does not see anything wrong with my knee , can this be caused by back pain, i did not have back pain at all

  5. I played volleyball and ran cross country in HS and College and developed Patellar Tendonitis in both my knees and bunions in my feet. Not to mention I have always had extremely tight hamstrings. I went to PT last week for the 2nd time in the last few years for a soft tissue treatment for the tendonitis and the Therapist caught me trying to crack my back while on the table. After messing with my back a bit he hypothesized that my back was causing my other issues. This led me here to this article, which felt like it was written directly for me. As the idea that it is my back is new to me, are there treatments that you would recommend before stem cell treatment is considered?

    1. Tom,
      Your PT was likely correct as they are classic symptoms. Using the right procedure for the right issue is crucial to the effectiveness of the procedure, so correct diagnosis is key. Please see: https://www.regenexx.com/stem-cell-disc-injection/ and https://www.regenexx.com/the-regenexx-procedures/back-surgery-alternative/ and https://www.regenexx.com/stem-cell-disc-injection/ If you’d like us to weigh in, please submit the Candidate form.

  6. I have had a muscle lump in my lower back after a fall. I have severe pain in my right knee & sometimes in my right hip, along with the lump in the back. I have had several MRI’s, laser surgery on my lumber, injections in my back. Out of 3 back doctors & a pain doctor, nobody can find out what is causing my pain. I find it difficult to do regular house chores & have to use a riding cart whenever I shop. For over 2 years my wife has been rubbing my lump every night with icy hot & capison. Is ther anything you can recommend? Thanks for your help!

    1. Michael,
      There are a few things that can cause what you describe, and we’d need to examine you to see what’s going on in your particular case to suggest anything. This blog explains one of the possibilities. If you’d like to see if you’d be a Candidate for us to help, please submit the Candidate form to the right of the blog. Please see:https://www.regenexx.com/laser-spine-surgery-side-effects/

  7. I have had knee pain now for a long time. Had X-rays done and have a lot of arthritis in them. Could this pain be caused by my back even though my back doesn’t hurt? I am a cashier and it is so painful to even work. Had a shot in the knee and it helped for 3 days that is it. Would you suggest me seeing a chiropractor to get an adjustment done??

    1. Pat,

      A thorough exam to see what’s causing what, would be a good place to start, as there are also other issues that can be causative in knee arthritis. Please see: https://www.regenexx.com/arthritis-from-injury/ In reference to backs and knees, because the nerves that control the muscles that protect your knee are in the back, when they misfire and don’t do their job, the knees are unprotected. In that case, knees are exposed to the wear and tear that causes arthritis, so the back is often the root cause of knee issues. When that is found to be the case, both back and knees should be treated. Please see: https://www.regenexx.com/knee-replacement-outcomes-back-pain/

  8. HV been having a pain on my left side of my back and its also affecting my knee making it week and I can’t sleep at night but when I tried to balance my back and my knee on d bed d pain its reducing a lillte.pls wat do u think is the prob or wat should I do.

  9. 59 y/o male. 6-1 220
    L4-L5 fused with spiral cages 20 years ago.
    Some minor issues over the years, nothing serious until a mid-Dec 2017 fall. Stumbled backward & “sat down” from a standing position.
    After X-rays, MRI and finally a CT-scan, there is a hairline fracture across the 2 L4-L5 cages. Additionally, L4-L3 is herniated but not compressing any nerves. Very tight & achy in my middle back with constant pain in lower back. On a 1-10 scale W/ 10 being “please sedate me”, my lower back varies from 3 (decent ache) to 6-7, (throbbing pretty hard). In the past week, my left knee has become swollen, painful and my left foot has a light tingling sensation. I stay as active as possible, working 25-30 hrs a week driving a delivery van. Ortho’s options are surgery or pain mgmt. Please share your advice & a sincere thank you for your time

    1. R Allen,
      Staying active is great! Unfortunately, fusion is irreversible. We’ve helped a great many patients with Adjacent Segment Disease which is the result of overloading the vertebrae above and below the fusion, treating the nerve issues, disc issues and arthritis issues that result. L3, 4,and 5 can cause those types of symptoms, but we’d need to examine you to see what’s going on in your particular case.

  10. Pain in the lower calf muscle below the knee, pain in the upper muscle above the knee, plus knee pain..hurts when I turn different ways in bed, when I get in my trk. Its very painful to the lower calf of
    The knee, when I do stairs up or
    Down….or turn the wrong way while walking or just sitting..

  11. Developed Lt lower back pain after reaching for something at waist level. That evening woke up to severe LT groin pain. Within 2days, started noticing numbness on inside of Lt knee and felt like my kneecap was being pulled off. Ct scan found a spur on L4-L5. Hip/pelvis diagnostics neg. Just completed 7th PT visit and no more pain. Still have numbness and feels like I have a tight band around the top of my knee. Any recommendations?

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