Knee Pain 101: Is Your Back the Culprit?

Knee Pain 101: Is Your Back the Culprit?

Research shows that a shockingly high number of patients still experience chronic knee pain, even after a full replacement. This can be discouraging to patients, and is one of the many reasons that it is critical to understand the root of your pain before you seek out treatment or relief. After all, you can’t fix what you don’t know is broken.

Most people have the wrong information about knee pain and joint health. This isn’t anyone’s fault, but simply a result of doctors clinging to their medical school training and the outdated ideas about the musculoskeletal system. Knees often develop pain for a variety of reasons. In the majority of cases, this has little to do with the knees themselves. Instead, it could be related to other areas of the body that are having issues. One of those areas is the back.

It’s All Connected

The lower back, especially, is prone to strain and injury. Your back is also home to all of the nerves that are responsible for operating the muscles and around the knee. Therefore, it is entirely possible that there is a problem in your back causing knee pain. In fact, it is more common than you think. Chronic knee pain stems from many different ailments and issues, but when it comes with back pain, you might want to reconsider what is really going on.

Look for Clues

If you can’t find the source of your pain, you will never find the right treatment or relief. Therefore, you should be checking out clues that will help you narrow down the cause and get a better sense of what’s actually going on. There are plenty of things to consider, but there are three big signs that everyone should be looking for. Read on to find out if your knee pain is really a result of something in your back.

Pain Usually Comes in Pairs

If your chronic knee pain is not the result of the knee itself, you will likely have other areas of pain or discomfort at the same time. Even if you aren’t aware at the time, you should pause to consider any recent aches and pains that you have had in tandem with the aching knees. Whether it is referred pain or actually related pain, you need to figure out what is going on. A pinched nerve, bulging disc, or other back-related health issues could easily send pain throughout the body, including to the knees.

People who sit a lot usually find that their back and knee issues are related when they occur simultaneously. Frequent sitting leads to compression of the discs in the back, which causes pain that can travel through the nerves into the knees and other areas of the body. Some people don’t even have real “pain”. There are many people who blame the knee for its own pain because they think they just have occasional stiffness or soreness in the back that is just a fact of life. It’s important that you don’t discount any pain when you’re considering how to resolve chronic knee pain because there are plenty of potential causes, including the back.

How are Your Hamstrings?

People who experience chronic back pain and knee pain often suffer from tightness in the hamstrings and other muscles of the upper leg. The nerves in the body are all connected and go right through these muscles, leaving plenty of evidence of potential nerve issues in the back, rather than a knee injury or issue. If the hamstring muscles aren’t working properly, they are going to cause pain and stress on the knee joints.

When your hamstrings are tight or painful, it affects the way that you move and the way that your body responds to movement. This could result in compensating by putting more stress on the knees, which could be deliberate or just an automatic response by your body. Either way, it is going to be evident here that it is the back causing knee pain, and not the knee itself.

Bothersome Bunions?

While bunions might not seem like more than pesky pressure spot that makes it difficult to walk comfortably, they can be a sign of a lot more going on in the body. While bunions can form for many reasons, they are also a result of back pain. The spinal nerves in the back go straight to the foot, and when those are stressed or injured, the feet will respond differently. Walking and standing will be difficult and painful, which can reiterate the knee pain already radiating from whatever happened in your back.

Bunions, like any other small issue, have a cause that is generally beyond just a simple toe or foot issue. As stated before, it is crucial to find the authentic, original source of the issue. In most cases, it’s usually the back causing knee pain.

The Bottom Line

If you have something going on in your back causing knee pain, you need to know that this is the source so that you can get the right treatment. Chronic knee pain is one thing. Back pain is another. It makes no sense to treat knee pain and inflammation with steroid injections, therapy, or even knee replacement if the knee is not also the root of the cause. Fortunately, with the right knowledge about how pain works and the right doctor, you should have no trouble getting the treatment that you need.


In this instance, an athlete was originally diagnosed with minor quadriceps muscle strain and was treated for four weeks, with unsatisfactory results. When he came to our clinic, the muscle was not healing, and the patients’ muscle tissue had already begun to atrophy.

Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider. To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected.

The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. Using dynamic MSUS, we can see what happens when patients contract their muscles, something that cannot be done with MRI. From a diagnostic perspective, this interaction is invaluable.

Dynamic ultrasonography examination demonstrating
the full thickness tear and already occurring muscle atrophy
due to misdiagnosis and not referring the patient
to proper diagnostic workup

Demonstration of how very small muscle defect is made and revealed
to be a complete tear with muscle contraction
under diagnostic sonography (not possible with MRI)


Complete tear of rectus femoris
with large hematoma (blood)


Separation of muscle ends due to tear elicited
on dynamic sonography examination

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