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 your healthcare provider and a physical therapist can help determine if that is the case.

pinched lower back nerve signs
Verywell / Brianna Gilmartin

How the Spine Causes Knee Pain

The nerve roots 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 degenerate or 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 healthcare provider 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 symptoms, including:

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

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


A conservative approach, including physical therapy and postural correction, is usually favored. The vast majority of people with this type of problem can find relief with non-surgical treatments.

Steroid injections may be used, if needed, to help decrease inflammation around your nerve root, but this intervention is not usually part of the initial treatment plan.

Surgery may be considered after conservative measures have been tried without success, but sometimes surgery is indicated as the initial treatment.

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

A range of tailored physical therapy techniques can be beneficial, including such methods as the McKenzie Method. Diagnostic testing is often an ongoing part of the therapy process. For example, if you do a back exercise and the pain centralizes in the spine, your knee pain might be referred from your 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 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 work with you 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. While you might try to rest or stretch your knee on your own, that might not be effective if your problem is arising from your spine.

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

2 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Cleveland Clinic. Pinched nerves.

  2. Cleveland Clinic. Pinched nerves: management and treatment.

By Laura Inverarity, DO
 Laura Inverarity, PT, DO, is a current board-certified anesthesiologist and former physical therapist.