Back, Hip, and Knee Pain
By Debbie Rockett, PT
The goal of this article is to describe the back, hip and knee connection. Often, patients ask me if their back pain is coming from their hip or knee. Or if their hip pain is coming from their back. In the human body, we have anatomical connections by muscles, ligaments, nerves, and bones acting as the building blocks. How these components work together determines how our joints feel. Ligament stability, muscle strength, joint mobility and the ability of the nerves to operate without irritation or blockage are key to normal function.
The lower back area, known as the lumbar spine, is made up of bones called vertebral bodies, discs that act as “shock absorbers” between the bones and ligaments that help, along with muscles, support these structures. Inside this “column” of structures is the spinal cord. At each vertebral level, spinal nerves exit from the spinal cord on either side. In the lumbar spine, these nerves supply both lower extremities. Back problems that involve nerve irritation or compression can lead to hip and knee pain depending on the levels involved. Certain muscles of the low back also attach to the hip. Issues with these muscles can lead to pain in the hip or restrictions that lead to problems of normal hip movement and pain is the manifesting result.
Have you ever had a diagnosis of bursitis of the hip? There are several diagnosis that involve pain on the outside of the hip, and these issues alter how you walk. Weakness of the muscles in the area reduces support to the pelvic area and resulting back pain can occur. In addition, increased internal rotation of the femur can lead to knee pain as changes in the movement of the knee cap can result.
The iliotibial band is a structure that runs from the outside of the hip to the side of the knee. Tightness here can cause irritation of the bursa on the side of the hip and pain results. Restrictions in hip joint mobility can not only cause hip pain, but also affect the back and knee by changing the mechanics of how they move. Tightness of the hip flexors located at the front of the hip can affect the position of the low back and sacroiliac joints and how they function in relation to each other.
In reference to the iliotibial band once more, this structure attaches to the fibular head. This is located on the side of the knee, just below the knee joint. Tightness of this band can not only manifest as hip problems, but cause pain also on the outside of the knee. This band also attaches to the outside of the patella (knee cap). Tightness can cause the patella to track to the outside of the knee and cause pain.
The rectus femoris muscle is one of four muscles located at the front of the thigh. These muscles are responsible for straightening the knee. The rectus femoris starts above the hip at the front (the pelvic bone) and also crosses the knee to join the other three muscles as they attach below the knee. The patella movement and position are partly controlled by these muscles. Tightness here can cause both hip and knee problems.
A Physical Therapy evaluation is essential for your therapist to assess how all these factors interrelate and to address the problem effectively. In conclusion, the back, hip and knee are connected by the anatomy of the muscles, nerves, bones and ligaments. They are also connected by pain and dysfunction. It is important if you have pain to be properly evaluated to determine the cause of the pain. This will help in the treatment of your condition and improve your outcome.
To schedule an appointment with JOI Rehab, please call 858-7045 and to schedule with a JOI Physician, please call JOI-2000.