Low Back pain? Assess the Knee

There are exactly 2 bijillion (bajillion? bigillion?) ways that the knee and the low back relate to each other. Here are a few.

Holding Up Your Weight: Of course, the knee often finds itself between the earth and the low back, so it’s a big part of the mechanism that supports it, so of course there is a gravitational/gait relationship between knee problems and low back problems and vice versa. Louise Hay, who developed a system of relationships between body parts and identity, said that knee problems had to do with responsibilities and holding up the weight of the world, and that makes intuitive sense. Without knee support, low back overwork is a given.

Rotation: When you turn to look at something behind you, the main areas you turn from are not the neck, low back or hips. They’re the knees and lower ribs.

Surprised? So are most of my clients. [Pause to gasp and clutch your pearls.]

Ever wonder why athletes have their knees bent 99.5 percent of the time? It’s because when your knees are bent, you can rotate, making it possible to move quickly in any direction. A freely twisting ribcage is also central to the range and ease of your rotation, and it keeps the rotation from stressing the low back, which is not built for rotation.

Rotation/Flexion/Extension: The mere act of bending the knee depends on rotation. Internal rotation is required for bending and external rotation for straightening.

So when rotational motion is restricted, bending and straightening can be limited as well. As soon as those motions are restricted – which usually happens on one side only – first there’s an asymmetrical impact on the hips, which have to compensate, and then on the S/I and lumbar spine, which have to balance out the asymmetrical motion of the legs.

Muscles from the whole trunk are all going to be off, because of the asymmetry below the waist. More specifically, hip and knee muscles will be affected:

• the quads and hamstrings cross both joints. The quads flex the hips and extend the knees, and it’s vice versa with the hamstrings.
• the psoas connects from the hips into the low back. If the quads are tight, psoas tends to shorten and contract. If the hamstrings are tight, the psoas ends up contracting in a lengthened position. Either way, the psoas pulls forward on the ilium and the lumbar vertebrae, usually asymmetrically, resulting in shearing tensions in the S/I joint and lumbar discs.
• The hips have to rotate more if the knees won’t rotate. The result can be tightness in the rotator muscles.

Knee and Opposite Hip: Shifting away from a painful knee reduces stress on the painful joint. Of course, the compensation stresses other joints, the opposite side hip in particular, which often develops restriction and labral stress. The muscles tense asymmetrically, and once again, the S/I and discs are stressed. The opposite is also true – when a hip is restricted and stressed, the opposite knee will have extra strain as will the low back.

Still curious? Great! Here’s another correlation: if the knees are valgus (knock knee), which happens in people with wider hips (often women) or who are extra flexible (often women), the arches tend to collapse and the inner leg can’t galvanize, which makes it hard to connect the pelvic floor, and that means that the lower back isn’t supported and has to overwork. That’s one reason why the outer glutes are so important in knee and low back health: they abduct the femurs, which allows the inner leg to lengthen and the pelvic floor to engage.

 

 

“When life shuts a door…open it again. It’s a door. That’s how they work.”