3 Signs It Could Be Your Back Causing Your Knee Pain

By Chris Centeno, MD /

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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.

Category: Back/lumbar, Knee

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50 thoughts on “3 Signs It Could Be Your Back Causing Your Knee Pain

  1. Dane Cumella

    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.

    1. Regenexx Team Post author

      Yes! Even completely asymptomatic back issues can create problems in the hip area but back pain creates even greater likelihood. The right type of exam would reveal the source of the issue: http://www.regenexx.com/the-regenexx-procedures/back-surgery-alternative/ http://www.regenexx.com/library-complimentary-regenexx-resources/

  2. Mary Bradish

    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. Regenexx Team Post author

      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. Migdalia Ramos

    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. Regenexx Team Post author

      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. maria mcaleavy

    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

    1. Regenexx Team Post author

      Yes, it can. Please see: https://regenexx.com/blog/back-of-knee-pain-whats-wong/

  5. Tom

    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. Regenexx Team Post author

      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://regenexx.com/blog/stem-cell-disc-injection/ and https://regenexx.com/the-regenexx-procedures/back-surgery-alternative/ and https://regenexx.com/blog/stem-cell-disc-injection/ If you’d like us to weigh in, please submit the Candidate form.

  6. Michael C. Taylor

    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. Regenexx Team Post author

      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://regenexx.com/blog/laser-spine-surgery-side-effects/

  7. Pat

    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. Regenexx Team Post author


      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://regenexx.com/blog/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://regenexx.com/blog/knee-replacement-outcomes-back-pain/

  8. Aimienoho Sophia

    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.

    1. Regenexx Team Post author


      The first step would be an MRI of the low back and the type of exam that examines spine to foot. The doctors on this list that have Spine listed in their treatment areas can do that: https://regenexx.com/find-a-physician/ Once they’ve made a diagnosis, treatment options can be discussed.

  9. R Allen

    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. Regenexx Team Post author

      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. Hollis Hall

    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..

    1. Regenexx Team Post author

      We’d need to examine you to see what’s going on in your particular case, but this was a similar case: https://regenexx.com/blog/mountain-climbing-with-bad-knees/ These are the locations that can do that type of exam: https://regenexx.com/find-a-physician/

  11. Carol Davis

    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?



    1. Regenexx Team Post author

      Sorry to hear of your back/knee pain; it is a very common combination. Please see: https://regenexx.com/blog/backs-can-cause-knee-pain/ and
      https://regenexx.com/blog/low-back-and-knee-pain/ We’d need more information through the Candidacy process to see if we can help. To do that, please submit the “Are You a Candidate” form, or call 855 622 7838.

  13. Andy Simpson

    I have severe knee pain when I sit down (desk job) for long periods of time. Previous hypothesis has included patellofemoral pain and patellar tendinitis, however physical/Stem Cell therapy has not helped. Have had MRI to rule out knee arthiritis. I also suffer from very tight thigh and calf muscles which do not improve with stretching. Knee pain/tightness has been getting progressively worse for 4 years to the point where sitting for longer than a couple of hours is incredibly painful. My lower back is occasionally sore however the symptoms are very mild compared to my knee.

    After reading this article, could my knee pain and muscle tightness be primarily caused by the back pain? If so, how would you recommend I go about diagnosing and treating the back pain issue?

    1. Regenexx Team Post author

      It’s not unusual for the knee symptoms to be worse than the back symptoms. But to confirm or deny the relationship and come to an accurate diagnosis you would need to be examined by a Doctor who can do that type of exam and offer a treatment plan to address both issues. Our UK Provider, Algocells is up and running. Please see: https://www.algocells.com/?utm_source=regenexxreferral&utm_medium=webreferral&utm_campaign=regenexxlocations

  14. Taniya Saroha

    Hey! My name is Taniya and I’m 18.
    I’m having blurred vision since last week, though I use specs. Along with it sometimes my back and knees also hurts, thirsty when I wake up. Have eye pain, headaches, so I also saw eye specialist..She prefered to change my lens since power of my left eye had raised, as she told. But today, I’m feeling very weak , it’s like very low strength in my hands and legs, also a little bit of numbness specially in my hands.
    Please tell me what should I do?

    1. Regenexx Team

      Hi Tanya,
      Please see a Doctor for a thorough exam to rule out important medical issues.

  15. Rebecca Baker

    My name’s Rebecca, I have been suffering from sore knees since November having overdone it in the HIIT studio. I then saw a physio who gave me exercises and did some acupuncture on me. Since then I have had a persistent burn in my knees that worsens through the day. I also get pain / burning in my right foot and in my hands. I have had an MRI and whilst there is some inflammation in my knee, there is nothing wrong structurally. I am concerned I have something wrong with my nervous system. Please will you advise me what I should do?
    Thank you,

    1. Regenexx Team

      Hi Rebecca,
      We’d need to examine you to advise. Our UK provider has an Office in London: https://www.algocells.com/?utm_source=regenexxreferral&utm_medium=webreferral&utm_campaign=regenexxlocations

  16. Delmo Mendez Casarez

    My name is Delmo Casarez 62 years old … a disabled military veteran with chronic back pain . I had back surgery in Aug. 9, 2016 . My surgery was perform by Dr. Balani from Houston,Tx .He did a minimal invasion surgery in the lumbar L 2, 3, bulging disc and L5 bones spurs. I suffer from excruciating sciatica pains in my legs and knee areas . I just had right full knee replacement April 16, 2019 . My sciatica pains have tremendously flare up in my right leg 24/7 . I question my surgeon doctor if there was a connection between my lower back pain and knee pain . He said no. After doing some medical research there is a connection.

    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.
    I am taking pain killers to control my high pain level . How can I convince my doctor that there is a Knee Pain Accompanied By Back Pain .

    Thanks , dc

  17. Nalini

    I learned a lot after reading your notes I think that is it I have very bad back pain in the morning some times lasts long some times less.now my knee started pain couple of days ago after reading your letter I agree to what you say thanks I am goinging to have physiyo as my doctor said to realise the trapped nerve very pain full do you agree with this thanks

    1. Regenexx Team

      Hi Nalani,
      We’d need to examine you to advise on your case. Generally, beginning with Physical therapy is a good idea. If that doesn’t help, we have a Regenexx Provider there who can examine you and see if they can help. https://www.algocells.com/?utm_source=regenexxreferral&utm_campaign=algocells

  18. Vijay Thareja

    I had back surgery from L3 to S1 in May 2019. Post Op MRI and CT Scan shows everything is fine. Yet I have pain in the muscle on the front and outside of my left thigh. The muscles feel fibrous and there is feeling of burning of the skin. Also pain in the left knee. No other pains. My surgeon in a recent evaluation says that the problem will resolve in about 6 months time. Pain is relieved by low dose opiates. I am able to live normally and drive. Could this situation damage my knee in 6 months time? Thanks for your input.

    1. Regenexx Team

      Hi Vijay,
      We’d need to examine you to answer your question. To set up an exam, please call 855 622 7838.

  19. Nora

    When I squeeze the side of my right knee, I get severe back pain.

    1. Regenexx Team

      Hi Nora,
      We’d need to examine you to see what’s going on. Here’s our UK location. Please see: https://www.algocells.com/?utm_source=regenexxreferral&utm_campaign=algocells

  20. Judy

    I have severe pain and burning starting I. My lower right side and goes down my hip and leg. This has been going on for over a year but is getting worse . I now cannot lay on either side or my back so needless to say, I get very little sleep. Pain meds help for about 2 hrs. I get pain when standing for a short time, but not when I walk. It feels like a knot inside my right side. I’ve had MRI and it shows degenerative disease and spinal stenosis.
    My life is miserable now and I’ve always been a very active person . I had knee replacement surg four months ago and still have very bad knee pain and very difficult to get up and down. I don’t know where to go for help. The neurosurgeon I’ve seen doesn’t seem to want to do anything. I’ve had epidurals but they have t helped.

    1. Regenexx Team

      Hi Judy,
      We’d need to examine you to advise or help. To do that, please submit the Candidate form here: https://regenexx.com/conditions-treated/spine/ or give us a call at 855 622 7838

  21. Martina

    Every time I squat,I get
    A crack in my knee,and lately
    When it happens the back of my knee is quite sore,would this be something to do with my back??

    1. Regenexx Team

      Hi Martina,
      It could be, we’d need to examine you to see what’s going on. Our UK Regenexx provider would be able to do that. Please see: https://regenexx.com/providers/algocells/

  22. Dennis Tatlock

    Have severe pain on inside of right knee. This worsens when weight baring, at times can hardly walk because of the pain. Hamstrings and quadriceps are very tight. Had lower back surgery five years ago. Herniated disk from l-3 to s-1. L-4 was operated on. Have had severe sciatica pain down both legs at times combined with tight piriformis muscles on both legs. Could any items I listed be causing that severe on the inside of my right knee?

    1. Regenexx Team

      Hi Dennis,
      We’d need to examine you to determine what’s gong on. Do you have a current low back MRI?

  23. Gerald

    The right hand side of my right leg has u burning sensation just above or near enough the side of my knee,and now and again and also my lower back is sore & uncomfortable
    This has come just recently and getting more frequent
    Could you please advise on what action I should take.

    1. Regenexx Team

      Hi Gerald,
      We’d need to examine you to advise. Our UK Regenexx provider can do the type of exam needed and provide treatment if neded. Please see: https://regenexx.com/providers/algocells/

  24. Linn Lowe

    I have already had one knee replaced and the other one supposedly needs to be replaced now. The pain in both knees is excruciating! But my low back also does hurt. That is why I was wondering if my back is causing my knee pain.

    1. Regenexx Team

      Hi Linn,
      That’s definitely possible as a great deal of non-traumatic of knee issues originate in the low back: https://regenexx.com/blog/knee-replacement-outcomes-back-pain/ If you’d like to set up an exam before your knee replacement, please give us a call at 855 622 7838.

  25. Sandin Wilson

    I was washing my car and bent down and was hit like a lightening bolt. My leg seized and on its on, free up off the ground as far as it would go. I fell over. Ambulance. Hospital. Bla bla bla. They say it’s my sciatic nerve which I agree with. What I don’t agree with is that I think I started on my knee,, then sent shock wa Ed all along the leg. Groin thigh knee ankle, all of these hurt at different twines. What happens to me. Back first, or knee nerve? Help

    1. Regenexx Team

      Hi Sandin,
      That’s the purpose of the extensive exams we do – to spend the time with the patient to diagnose the issue accurately, and determine the underlying cause. Please let us know if you’d like to set up an exam. 855 622 7838.

Chris Centeno, MD

Regenexx Founder

Chris Centeno, MD is a specialist in regenerative medicine and the new field of Interventional Orthopedics. Centeno pioneered orthopedic stem cell procedures in 2005 and is responsible for a large amount of the published research on stem cell use for orthopedic applications.
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Regenerative procedures are commonly used to treat musculoskelatal trauma, overuse injuries, and degenerative issues, including failed surgeries.
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Hand and wrist injuries and arthritis, carpal tunnel syndrome, and conditions relating to overuse of the thumb, are good candidates for regenerative treatments. Before considering surgery, consider an evaluation of your condition with a regenerative treatment specialist.
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