Just about everything you think you know about your knee pain probably is wrong. Most physicians hold fast to what they learned in medical school, but the science of medicine is constantly evolving—finding less invasive ways to treat our ailments and discovering the root causes of our pain.

An important thing to understand is that what hurts is not necessarily the problem, but a symptom of the problem. If your knee pain isn’t the result of traumatic injury, a strong possibility exists that it could be caused by a problem in your back. Not determining the root cause of your pain could lead to an unnecessary knee replacement that doesn’t address the source of the pain. Research studies consistently show an unacceptably high percentage of patients continue to have chronic pain after knee-replacement surgeries.

Your back houses the nerves that drive the muscles around the knees. A problem with a nerve in your back can affect 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.

There are three signs that your back could be causing your knee pain.

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. 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. 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 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. 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
This may seem odd, but bunions can be a direct result of back issues. Where there are bunions and back issues, there is probably knee pain. 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.

“Could Your Back Be Causing Your Knee Pain?” first appeared as a post on the Regenexx blog.
Like all medical procedures, Regenexx procedures have a success and failure rate.
Not all patients will experience the same results.