Knee pain due to back pain?

June 18, 2019

Hi. I have had sever lower back pain (primarily lower right side) for the past 13 weeks. It occurred when doing air squats (no weights) which was part of a physio program for a suspected 18 month piriformis injury from running.

After my lower back ‘went’ I was hardly able to walk or move for the first 6 weeks, after which the pain slowly began to ease a little. I then started to also suffer from referred pain deep in my right hip. It was too painful to walk on. I am now at week 13 and have no pain in my hip but a very centralised aching pain in my lower spine.

During the 13 weeks I saw 3 doctors who each gave a different diagnosis – pulled muscle, ligament damage to the back and hip and a herniated disc. I saw a chiropractor who refused to give a diagnosis, 2 sports massage therapists who said it was a trapped nerve in my upper back, and 2 physios – one who said it was a herniated disc and one who said it was an annular tear.

The last physio said I should start swimming and cycling again now that the pain has eased. Swimming is okay for about 20-30 minutes before it starts to hurt. However, I did a cycle, pain free but the following day my right knee really hurt.

It is now 6 days later and the pain has eased a little. When I bend my knee there is no pain but it feels tight, like a large elastic band is wrapped around the knee, but on the inside of the knee. When the bent knee has weight on it and I stand up from laying on the floor the knee ‘freezes’ just before the leg is straightened. This is not painful, but feels like a frozen knee. If I kneel down, the knee feels very tight when at it is in the most bent position. The pain is usually when the leg is straightened and is sometimes at the front of the knee, but feels like it is under the knee cap. Sometimes it is at the outer side of the knee, but most commonly it is at the back of the leg where the leg bends. There is no swelling or bruising, but hurts most when I straighten my leg.

Walking is okay but standing is painful. The knee really wants to click or pop. If I really straighten my leg (almost over straighten it) the area where it hurts does pop and the pain goes away for a few minutes. Yesterday I swam and when doing breaststroke my knee would get gradually more uncomfortable with each kick (although not painful when in the water) and then it would pop and be fine for a few kicks before repeating the process. The pop is not painful. I don’t know if this is related to my back injury (possibly sciatica?) or if it is a completely separate injury?

I feel like I have been given lots of the wrong diagnosis and advice. Having stumbled across your website it sounds like you guys are pretty good and having pulled out of the London Big Half, the Paris Marathon and now possibly the London Duathlon in September, I would just like to get back to doing some decent level of exercise, even if it is not competing.

Any advice would be gratefully received. I live in Somerset but am prepared to travel to London if you think a visit would help.

June 18, 2019

Hi Neil

I’ll start at the end rather than the beginning – yes, I absolutely think it would be worth you hopping on the train and coming to see us.

I probably think you’ve got a really simple issue that has been made over complicated because nobody is trying to identify and change the cause of your symptoms, but rather doing stuff just to make your symptoms feel better, but not changing the “why”.

He’d be my simple take – you’ve got a single issue with multiple symptoms, and this is how they connect.

You had acute onset low back pain. The most common reason for this is when you “overstretch” your lower back because you either haven’t got enough control of the muscles around your lumbar spine like your glutes (not strength) and/or you’ve got a really stiff, painless, flexed thoracic spine that forces your lower back to overcompensate for this lack of motion. Doesn’t need to be a lot as it’s about the quality of movement and not necessarily about the quantity.

The body will (and does) compensate and cheat because it’s forced to moves poorly in the wrong places (too much and uncontrolled in your lumbar spine) and the effect of poor control of your glutes allows your thighs to roll in, which makes your knee cap track poorly and painfully across your knee when you bend and straighten….

Improve your thoracic mobility, improve your glute control and slowly increase your loading, endurance and power and you’ll be good to go.

Simple things done well will get you right back on track.

The Guru

Guru Responded

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