Back Disorders and Knee Pain

Can knee pain come from your spine?

Most people assume if they have knee pain it is due to a problem with the knee joint. This is not always the case. While the discomfort can be due to a knee condition, it can also be the result of a disc protrusion or a pinched nerve in your lower back. Working with a physical therapist can help determine if that is the case.

pinched lower back nerve signs
Illustration by Brianna Gilmartin, Verywell

How the Spine Causes Knee Pain

The nerves that transmit the sensation of pain to the legs and feet are located in the lower back. Occasionally with age or injury, the discs between the vertebrae can bulge out and press on these nerves.

When this occurs, the nerve becomes irritated and sends out pain signals. The location of the pain depends on which disc is protruding. The severity of the pain depends on how much of the disc is pressing on the nerve The nerves that send fibers to the knee are located at the second, third, and fourth lumbar vertebral levels in the lower back area.

If a bulging disc, bone spur, or arthritic joint in the second, third, or fourth lumbar vertebra compresses ("pinches") a nerve, the referred pain will often be felt in the knee.

Referred pain is pain perceived at a location other than where the cause is situated. It is the result of pain signals being sent along the network of interconnecting sensory nerves.

This condition can be diagnosed by your physician with a thorough history and physical exam. If the nerve that travels to your thigh and knee is irritated or pinched, you may feel a host of symptom, including:

  • Pain in the front of your thigh
  • Knee pain
  • Numbness or tingling in your thigh
  • Weakness in your hip or quadriceps muscle

If you have any of these symptoms, see a doctor. In some cases, the hip may be the culprit, so a careful examination is necessary to find the true cause of your knee pain.

Treatment

Treating knee pain due to spinal nerve compression or irritation can be accomplished with surgery, but it is not recommended to even think about surgery until you have exhausted conservative measures. 

A conservative approach is usually favored. Steroid injections may be used, if needed, to help decrease inflammation around your nerve root, but, again, these should not be your initial treatment plan.

Physical therapy is central to the treatment plan and may include interventions such as back stretching and core strengthening exercises.

A physical therapist trained in the McKenzie Method may be able to determine if your pain is originating from the spine or knee based on specific movements.

Generally speaking, if you do a back exercise and the pain centralizes in the spine, your knee pain is likely being referred from the back.

Continuing through a progression of exercises to centralize your pain can help you quickly and safely get rid of your knee pain and get back to normal activity. If your knee pain is improved by exercises for your spine, your physical therapist can also show you postural correction exercises and strategies to keep pressure off the compressed nerve.

On the other hand, if movements in your spine have no effect on your knee pain, the physical therapist may use the Mackenzie Method to determine if your pain is caused by a problem with the knee or hip joint.

A Word From Verywell

Pain in your thigh or your knee can certainly be coming from the knee joint proper, but it can also come from a pinched nerve in your back.

Visiting your doctor and then working closely with a physical therapist who is a spinal specialist can help you quickly and safely determine the cause of your pain and can help you fully return to your normal active lifestyle.

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