Knee Arthritis More Severe in Those with Low Back and Knee Pain

Our orthopedic-care model has taught us that if a patient walks in with knee pain, you only perform an exam of and ask questions about the knee. However, the body is far more complex and connected, with the knee just being a specialized part of the leg, which connects to the pelvis and spine. Hence, only looking at the knee is about as smart as an auto mechanic only looking at the right front tire because it’s shredded due to a bent axle and frame. Hence, let’s explore some research that continues to show that the back and knee are connected.

The Knee Really Is Connected to the Back

It might not look like it on the surface, but the knee really is connected to the back. In fact, as I’ve shared many times before, knee pain may be stemming from the low back even if there’s no obvious pain in the back. Why? The nerves that exit the lower spinal column branch into the lower limbs, supplying all of the muscles in their path, not just at the knee but all the way down to the toes. If there is a problem affecting a nerve in the low back (e.g., pinched nerve, spinal stenosis, disc problem, etc.), there may be only back pain, only knee pain (or pain in some other lower-limb structure), or back and knee pain.

A new study focused on the severity of pain and dysfunction of the knee in knee arthritis patients with accompanying back pain. Let’s take a look at what was found.

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Targeting Back and Knee Pain in Knee Arthritis Patients May Be the Best Treatment

The new study consisted of 260 subjects with knee arthritis with knee pain, 58% of whom also had low back pain. Many variables were examined, including the severity of pain and disability levels related to arthritis. The results? Researchers found that both pain severity in the knee and disability was higher in those who also had low back pain when compared to those who did not have low back pain. This led them to conclude that targeting treatment to both the back and knee may provide the best outcomes (for pain and disability) when treating knee arthritis patients who also have back pain.

These direct links between the knee and low back are nothing new. Let’s review other low back and knee connections I’ve posted on this blog.

More on the Connections Between Back and Knee Pain and Arthritis

It’s easy to see why just focusing on the knee when there is knee pain could be a huge mistake. Even when there’s knee arthritis, this doesn’t mean it’s the cause of knee pain as a problem in the low back, with or without back pain, could be the culprit. This is why investigating the connection between back and knee pain is so important before you have a knee replacement.  Having your low back thoroughly examined first is crucial as replacing the knee is unlikely to result in positive pain or function outcomes if the knee pain is rooted in the low back.

In addition to irritated nerves in the back, weak muscles in the back have also been linked to knee arthritis and knee pain. Participants in another study who had knee arthritis were also found to have smaller, weaker paraspinal muscles (an intermediate layer of back muscles running along either side of the spine), which researchers suggested were contributing to the arthritis.

Here is a quick look at just a handful of some of the other knee and low back links I’ve shared over the years:

• Knee and back pain combined may actually disrupt not just the quality of sleep but the amount of sleep as well, much more so than just having pain in the back or the knee.
• Signs that you may have a problem in your low back causing your knee pain include bunion formation, hamstrings tightness, or pain in the low back.
• Lack of knee control, for example when running (as my video below shows), may actually be caused by a slightly irritated nerve in the back.

The upshot? Your back and knee are connected and a high proportion of people with knee arthritis have low back problems. Hence, if you walk into a doctor’s office with knee pain and he or she never asks about your back and then never performs a back exam, you may want to consider finding a new doctor!

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. View Profile