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 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.
Torn Anterior Cruciate Ligament
You hear a pop and cant move after you suddenly change direction often while playing soccer, football, or basketball. You may have torn your ACL, which connects the femur and the tibia and prevents the tibia from moving too far forward. Your knee will hurt and swell and feel unstable.
You can tear or strain any of the tissues that hold your knee together: Ligaments connect bones to each other tendons connect muscle to bone. Irritated tendons from using them too much? Thats tendinitis.
Can Arthritis Represent A Medical Emergency
In the situation that the patient presents high fever, severe inflammation and leg pain, he/she might suffer from what is known as septic arthritis.
This is a medical emergency, requiring immediate intervention if the condition is not treated in due time, life-threatening symptoms can occur and the risk of death becomes considerably higher.
It is common for the joints of the hip and knee to be affected by this infection, with a negative impact on the entire leg.
This condition is present in both children and adults, especially in those who have a compromised immune system.
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How To Tell The Difference
If you have leg pain without significant back pain, it can be hard to tell if the problem is your back or your hip. Vinita Mathew, MD, FAAPMR, is a physical medicine and rehabilitation specialist at Northwestern Medicine Integrated Spine Center. Here, Dr. Mathew explains what to look for and what to expect if you see your physician for leg pain.
Lower Leg Pain Caused By Veins And Nerve Issues
1. Blood Clot
When blood thickens in veins, it can develop a clot. This typically happens in the thigh or lower leg, commonly leading to pain from knee to ankle. There is a higher risk if you are overweight, on certain medicines, or inactive for a long car ride or flight.
2. Varicose Veins
Varicose veins are caused by weakness in the vein walls or valves and can lead to a dull ache, particularly after standing.
3. Lower-Extremity Peripheral Arterial Disease
This occurs if your legs arteries get damaged and harden. The legs begin to miss needed blood flow, leading to pain or cramps when walking or climbing stairs.
4. Narrowed Spinal Canal and Sciatica
When the spinal canal narrows due to a herniated disc, arthritis of the spine, or another cause, it can lead to weakness, fatigue, numbness, tingling, or cramping, burning leg pain when you sit or stand. It may start in the hip and the back before extending down the leg.
5. Diabetic Neuropathy
This diabetes complication can be due to high blood sugar levels and leads to pain in both legs. It also features less sensation and numbness in lower legs.
When to See a Doctor
You should see your doctor for pain from knee to ankle if you have the following symptoms:
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What Causes Pain At The Top Of The Leg
But pain above your knee whether in the front or back of your leg may have a different cause. Common causes of pain above your knee include quadricep or hamstring tendonitis, arthritis, and knee bursitis. Your tendons attach your muscles to your bones. Tendonitis means your tendons are irritated or inflamed.
How Is Sciatica In The Knee Diagnosed
To make a diagnosis and determine the cause, your doctor will review your medical history and perform a physical exam.
To diagnose sciatica, your doctor will tap on the area around the top of your tibia. This is where the nerve in your knee is located. You probably have a pinched peroneal nerve if you feel shooting pain down your leg.
Diagnosing sciatica also involves getting an X-ray so that the doctor can check for fractures or abnormal masses in your knee.
A knee MRI can confirm the diagnosis and show details of the fractures or other issues in the bones, including masses within the nerves.
The doctor will also test your muscles using electromyography and do a nerve conduction test to determine how fast signals travel along a nerve for a more accurate diagnosis.
Sciatica can be mistaken for the runners knee. Make to get a proper diagnosis from a doctor or therapist.
This medical condition can have several underlying causes, such as cysts and tumors. Injuries in the hip joint may also cause it. Make sure to seek medical care when pain in the knee is reoccurring more than usual.
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Muscle Tendon Injuries Mcl And Lcl Injuries Acl Injuries And Meniscus Tears
Muscle Tendon Injuries
Almost all of these strains are treated with ice, elevation, and rest. Sometimes compression with an Ace wrap or knee sleeve is recommended, and crutches may be used for a short time to assist with walking. Ibuprofen or naproxen can be used as an anti-inflammatory medication.
The mechanism of injury is either hyperextension, in which the hamstring muscles can be stretched or torn, or hyperflexion, in which the quadriceps muscle is injured. Uncommonly, with a hyperflexion injury, the patellar or quadriceps tendon can be damaged and rupture. This injury is characterized by the inability to extend or straighten the knee and a defect that can be felt either above or below the patella . Surgery is usually required to repair this injury.
Except for elite athletes, tears of the hamstring muscle are treated conservatively without an operation, allowing time, exercise, and perhaps physical therapy to return the muscle to normal function.
MCL and LCL Injuries
Rheumatoid Arthritis Of The Knee
Rheumatoid arthritis is an autoimmune condition that causes the tissue around the joint to become inflamed and thickened. Chronic inflammation often leads to damage and loss of cartilage.
Rheumatoid arthritis occurs in about 0.6 percent of the U.S. population and is two to three times more common in women.
Symptoms of rheumatoid arthritis are similar to other types of arthritis in the knee:
- stiffness
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What To Expect At Your Office Visit
Your provider will perform a physical exam, and look at your knees, hips, legs, and other joints.
Your provider may do the following tests:
- MRI of the knee if a ligament or meniscus tear could be the cause
- CT scan of the knee
- Joint fluid culture
Your provider may inject a steroid into your knee to reduce pain and inflammation.
You may need to learn stretching and strengthening exercises. You also may need to see a podiatrist to be fitted for orthotics.
In some cases, you may need surgery.
How Are Knee Problems Diagnosed
In addition to a complete medical history and physical exam, other tests for knee problems may include:
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X-ray. This test uses invisible electromagnetic energy beams to make images of internal tissues, bones, and organs onto film.
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Magnetic resonance imaging . This test uses large magnets, radiofrequencies, and a computer to make detailed images of organs and structures within the body can often determine damage or disease in a surrounding ligament or muscle.
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Computed tomography scan . This test uses X-rays and computer technology to make horizontal, or axial, images of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general X-rays.
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Arthroscopy. A minimally-invasive diagnostic and treatment procedure used for conditions of a joint. This procedure uses a small, lighted, optic tube , which is inserted into the joint through a small incision in the joint. Images of the inside of the joint are projected onto a screen used to evaluate any degenerative or arthritic changes in the joint to detect bone diseases and tumors to determine the cause of bone pain and inflammation.
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Radionuclide bone scan. A nuclear imaging technique that uses a very small amount of radioactive material, which is injected into the patient’s bloodstream to be detected by a scanner. This test shows blood flow to the bone and cell activity within the bone.
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When Should I See A Doctor
If pain is interfering with normal daily life activities, it is time to talk to a doctor about the problem. It is important to diagnose the cause of the pain quickly and begin treatment to relieve pain and maintain healthy, functioning joints.
You should see a doctor if:
- Pain is accompanied by a fever
- There is unexplained weight loss
- Pain is preventing you from walking normally
During the appointment, the doctor will ask many questions to figure out what may be the cause of the pain. The patient should be ready to answer questions about previous injuries to the joint, when the joint pain began, a family history of joint pain, and the type of pain experienced.
An examination of the affected joint will follow to see if there is pain or limited motion. The doctor will also look for signs of injury to the surrounding muscles, tendons, and ligaments.
If necessary, the doctor may also order X-rays or blood tests. X-rays can show if there is joint deterioration, fluid in the joint, bone spurs, or other issues that may be contributing to the pain. Blood tests will help confirm a diagnosis or rule out other diseases that may be causing the pain.
Last reviewed by a Cleveland Clinic medical professional on 03/28/2018.
References
Lower Leg Bone Fracture
A bone break or fracture in one of your lower leg bones may be caused by falling or by a traumatic blow to your leg, such as a car accident.
This injury may cause severe calf pain. Additionally, your lower leg may be quite swollen, making it difficult to walk or bear any weight on your leg.
A complete bone break can cause your leg to look deformed. This can also happen if the broken bone does not heal properly. To prevent this from happening, you may need a cast or, in some cases, surgery.
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How Does Sciatica Of The Knee Happen
Knee sciatica can have several causes. Prolapsed discs are common culprits for sciatica in the knee. There is a possibility that the material that makes up the vertebral disc can leak out, resulting in pain that can extend down as far as the knee.
Infection, bone disease, spinal stenosis, malignancy, and trauma are just some of the additional causes of sciatica.
Sciatica is characterized by body pain originating in the lumbar spine and spreading to areas along the sciatic nerve path, such as the knee. Depending on the severity of the injury, you may also experience pain in your buttocks, back of your thigh, calves, and feet.
It is essential to consult a professional as soon as you are experiencing symptoms of sciatica of the knee. Several tests might be necessary, including X-rays and MRIs or CT scans.
Accurate Diagnosis Is Key
If your physician examines your hip joint and notes no hip pain, and then examines your back and notes leg pain, the spine is usually the source of the problem. Some people may have localized hip pain without leg pain, but are found to have a normal hip and an abnormal spine. Others may have only leg pain, but are found to have an abnormal hip and a normal spine. Therefore, in addition to a good physical examination, imaging is important. Plain X-rays may be helpful, but sometimes an MRI is needed as well. If imaging does not determine the source of the pain, the next step would typically be to perform an injection of pain-relieving medication directly into the area suspected of causing pain. Whether you get pain relief from the injection can help your physician better understand where the pain is coming from.
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How To Know If Your Knee Pain Comes From Your Spine
Many people assume knee pain is always caused by a problem in the knee joints. However, that is not necessarily the case. If youre suffering knee pain or discomfort, there is a possibility that a problem with your spine is the cause.
So how do you know if your knee pain comes from your spine? The muscles around your knees are connected to the nerves in your lower spine so if these nerves are irritated or compressed, your knees may be affected by symptoms such as intermittent back pain, hamstring tightness, weakness in the hips or quads, and the development of bunions on your feet.
How To Get Rid Of Leg Pain Caused By Bunions
Fortunately, you can get rid of any leg pain you experience as a result of bunions by removing the source of the problem. A bunionectomy can either correct the malalignment of your joints or remove the bunion entirely. In any case, this minimally-invasive procedure will permanently fix the issue of bunions, thereby eliminating any bunion-related pain in your feet, ankles, or legs.
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You Have Tightness In Your Hamstrings
When you are getting ready to exercise and begin to stretch your hamstrings, do you notice if there is a tightness to it that wont go away despite frequent stretching? If so, this is one of the first signs in the lower extremities which suggest there is a nerve issue in your back causing knee pain.
The hamstrings are a group of muscles located in the back of your thighs. When these muscles are tight, the stability of your lower back is decreased. Stress builds up in the spinal joints and the normal curvature of your lower spine alters itself to adjust to the need. These changes cause lower back pain and stiffness to radiate down the knee and leg. As you move around with tight hamstrings, your knees are unable to function properly and may be damaged.
Hamstring tightness is also linked to a lumbar problem. The L5 nerve travels from the lumbar spine and connects through the outer hamstring muscle to power the biceps femoris. If this nerve is irritated or damaged, the hamstrings will become inflamed or even painful. Your knees will have to adjust when in motion to compensate for the strained hamstring.
After a few weeks of hamstring tightness, the meniscus cartilage in each knee joint will suffer. Your body will mobilize its stem cells to repair the damage but because the trauma is ongoing, the swelling will remain until the root problem is addressed.
Are There Any Complications That Can Develop
If a Bakers cyst ruptures, it can be quite difficult to tell the difference between the ruptured cyst and a deep vein thrombosis in the leg. A DVT is a blood clot that forms in a leg vein. In these cases, it is important that investigations are carried out to exclude a DVT because it can be a serious condition that needs treatment. See the separate leaflet called Deep Vein Thrombosis for more detail.
Very rarely, a Bakers cyst may become infected.
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The Pros And Cons Of Cortisone Shots
If you’re experiencing pain that makes it difficult for you to start physical therapy to address your knee problem, your doctor might recommend that you get an injection of cortisone to lessen the pain.
The shot injects a corticosteroid drug and a local anesthetic into the joint to temporarily relieve pain and swelling. But it isn’t a long-term fix. “Often people think that injections, especially cortisone injections, will fix a knee problem. What they do is provide a window of pain relief so you can make progress with rehabilitation,” says Dr. Rebecca Breslow, an instructor in orthopedic surgery at Harvard Medical School. “But when cortisone injections are overused, there is some evidence that they can actually accelerate osteoarthritis.”
In short, while cortisone shots put you on the path to healing, they should be used judiciously and aren’t a permanent solution to the underlying problem that’s causing your knee pain.
Your Hips Or Quadriceps Feel Weak
Your quads are a group of muscles located at the front of your thigh. The three vastus muscles and rectus femoris make your thighs, one of the most powerful parts of the body, as they allow you to extend your knees and move your hips.
On the other hand, each hip is a ball-and-socket joint responsible for bearing most of your bodys weight. The hips have many ligament attachments for stability and muscular attachments to help control the motion of your leg and knee joints. The rectus femoris muscle crosses over from the quads and connects to the hip so if a problem occurs with the quad muscles, your hips will be affected.
Now, the parts of the human body are connected like a chain. Even if you didnt experience an injury or a major trauma to your hips and quadriceps, you may suddenly feel like youre unable to move them at full strength. This is a condition that may be caused by a spinal problem since the nerves that control the motor functions of the quads are located between the vertebrae of the lumbar spine.
If those nerves become irritated or get pinched by the vertebrae, the movement of your hips and quads will be affected. Weakness in these areas will cause the knee joints to work harder and wear out faster, which explains the knee pain you might be feeling.
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