What Causes Back and Knee Pain Together? Treatments and Exercises for Relief

Your back and knee go together like peanut butter and jelly. They work together to support everyday movements, including walking, going up and down stairs, and playing sports like tennis. So if your back hurts, it’s not uncommon for your knee to experience some discomfort — and vice versa.

“When you feel pain in your back or knee, it can affect how the other one feels and works,” says Dominica Sourial, PT, DPT, a physical therapist with Hinge Health. One study found that about 57% of people with knee osteoarthritis pain also have lower back pain.

Here’s a closer look at the connection between back and knee pain and how to treat and prevent it ‌ — ‌ especially with exercises from Hinge Health physical therapists.

What Causes Back and Knee Pain?

Back and knee pain often occur together because of the way the body’s movement system is interconnected. Here are the main reasons you may have both back and knee pain:

1. Shared movement patterns. The back and knees are both part of the same “kinetic chain,” which is physical therapy-speak for how areas of the body affect each other as you move. If one area is not functioning well, it can put extra stress on the other. For example:

• If your back is stiff or painful, you might change the way you walk, which can put more pressure on your knees.

• If your knees hurt, you may change how you stand or walk, which can lead to increased strain on your lower back.

2. Core and hip muscle weakness. The core and hip muscles help stabilize both the spine and the knees. Stiffness or weakness in these muscles can lead to issues with knee movement and less spinal stability, leading to compensatory back pain.

3. Nerve connections. Some of the same nerves run through your lower back and knees. If there is irritation in the lower back, it can cause back pain that radiates to the back of the knee. This is often mistaken for knee pain when the real issue is in the back.

4. Arthritis-related changes. Osteoarthritis (OA) commonly affects both the back and the knees, particularly as people age. OA (the most common type of arthritis) occurs when the protective cartilage that cushions the ends of bones changes over time. It typically only causes pain when it’s severe. 

5. Prolonged sitting. Too much sitting can contribute to both back and knee pain. It can cause tightness in the hips and hamstrings (which can strain the lower back) and weakness in the muscles around the knees (leading to joint stress). 

6. Overuse. Activities that require a lot of bending, squatting, or kneeling can strain your back and your knee joints, if your body isn’t prepared for those movements. This can cause inflammation and pain in both the back and knees.

Symptoms of Back and Knee Pain

“Movement that triggers both knee pain and back pain, like standing up from sitting or bending forward to pick something up, can be a sign that the two are related,” Dr. Sourial says. But there may be some other hints, such as include:

• Tight hamstrings. Your hamstrings are muscles that run along the back of your thighs. Tight hamstrings and knee pain and back pain are linked. “When the hamstrings are tight, they can put more stress on your spine, and that stiffness can affect your knees and legs,” says Dr. Sourial. 

• Weak quadriceps. Your quad muscles, located at the front of your thigh, help you straighten your knees. If they’re not strong, you may feel some pain in your knees. A muscle imbalance in your lower body, like weak quads, can cause changes in how you sit and stand, which can strain your lower back muscles, Dr. Sourial explains.

How Movement Helps Back and Knee Pain

Targeted exercises can help treat back and knee pain by building strength, improving flexibility, and encouraging movement. Strengthening the hips and core, in particular, provides support for the back and knees to make everyday activities feel easier. Exercises that improve mobility in the hips and ankles can also help distribute movement more evenly, reducing strain.

These strengthening and stretching exercises are designed to support the muscles in and around your lower back and your knee, so you feel less discomfort. You can do these stretches and exercises to strengthen your back and knees when you have back and knee pain and to help prevent pain in both areas. 

The information contained in these videos is intended to be used for educational purposes only and does not constitute medical advice or treatment for any specific condition. Hinge Health is not your healthcare provider and is not responsible for any injury sustained or exacerbated by your use of or participation in these exercises. Please consult with your healthcare provider with any questions you may have about your medical condition or treatment.

Back and Knee Pain Treatment 

Back and knee pain usually responds well to conservative treatment, says Dr. Sourial, including:

• Physical therapy and targeted exercises. Targeted exercises (like those above) play a key role in easing tension, increasing blood flow, and promoting better back and knee function. “A physical therapist can help you find the right balance of strengthening and stretching to improve comfort and mobility,” says Dr. Sourial. You can either do exercise therapy at home or work with a physical therapist who can guide you through movements tailored to your needs. You can see a physical therapist in person or use a program like Hinge Health, where you may access a PT via telehealth/video visit.

• Keep moving. When you’re in pain, rest might seem like the best option, but staying active helps your body heal. “Movement increases blood flow, relieves tension, and keeps joints and muscles working smoothly,” says Dr. Sourial. Activities like walking, swimming, yoga, or tai chi can be especially helpful for both back and knee pain.

• Ice or heat. Both can be useful, depending on what feels best for you. “If you notice pain after activity, ice can help calm inflammation. Heat is great before movement, as it loosens muscles and reduces stiffness,” says Dr. Sourial. Try both and see what works best for you. 

• Over-the-counter (OTC) medication. Pain relievers such as ibuprofen (Advil, Motrin), naproxen (Aleve), and acetaminophen (Tylenol) can be helpful for back and knee pain. It’s important to make sure that you are safely able to take these medications, based on your medical history. You can also consider trying topical pain relievers, like creams, salves, ointments, and patches.

• Compression and elevation. If your knee feels swollen and uncomfortable, you can try wearing a compression sleeve or brace to help reduce inflammation and allow the tendons, ligaments, and muscles in and around your knee to rest. Elevation can further help reduce swelling. 

• Alternative treatments. Talk to your provider if you’re interested in trying alternative treatments for back and knee relief, such as massage, acupuncture, or chiropractic care. They often complement your main treatments for pain management. 

• Steroid injections. If over-the-counter medication does not offer sufficient pain relief, your doctor may suggest cortisone injections to help counter pain and inflammation. The effects of an injection vary and can last from a few weeks to a few months. Injections can make exercising more tolerable so that when the benefits wear off, your pain will likely be less intense.   

How to Prevent Knee and Back Pain

There are many lifestyle changes you can follow to keep back and knee pain at bay. Here’s what Hinge Health physical therapists recommend:

• Stay active. Regular exercise will help to keep both back and knee muscles strong, says Dr. Sourial. Exercise alone, for example, has been shown to reduce the risk of developing chronic back pain by about one-third.

• Comfortable footwear. Supportive shoes or orthotics can help reduce stress on your knees and back. Consider swapping worn-out shoes for a pair that provides good cushioning.

• Stretch regularly. Stretching can help relieve tension in your back and knees, which can reduce pain. This is especially the case if you’ve been sitting or standing in one position for a long time, says Dr. Sourial.

• Lift heavy items with comfort. When lifting something heavy, use a comfortable, balanced stance. Try to keep the load close to your body and use your legs to power the movement, rather than rounding forward. Small adjustments, like shifting your weight evenly and moving with control, can help you feel more supported and reduce strain on your back and knees.

• Movement habits. Small changes in how you sit, stand, and move throughout the day can make a big difference. Try to avoid staying in one position too long. Also, take movement snacks and set up your workspace for comfort. 

• Stress management. Pain and stress are closely related, and techniques like deep breathing, meditation, and mindfulness can help calm the nervous system and reduce pain sensitivity. “Relaxation techniques don’t just help your mind — they can help ease tension in your muscles and joints, too,” says Dr. Sourial.

• Improve your sleep. Rest is essential for recovery. If pain interferes with sleep, experiment with pillows for support, try gentle stretching before bed, and create a calming nighttime routine.

PT Tip: Use Pain As a Clue to Get Moving 

“Back and knee pain are very common, and they’re both very treatable,” says Dr. Sourial. The first twinges of pain are often a sign that you could benefit from some strengthening and stretching exercises like the ones listed above. If your pain persists for more than a couple of weeks, see a physical therapist or healthcare provider.

How Hinge Health Can Help You

If you have joint or muscle pain that makes it hard to move, you can get the relief you’ve been looking for with Hinge Health’s online exercise therapy program.

The best part: You don’t have to leave your home because our program is digital. That means you can easily get the care you need through our app, when and where it works for you.  

Through our program, you’ll have access to therapeutic exercises and stretches for your condition. Additionally, you’ll have a personal care team to guide, support, and tailor our program to you. 

See if you qualify for Hinge Health and confirm free coverage through your employer or benefit plan here.

This article and its contents are provided for educational and informational purposes only and do not constitute medical advice or professional services specific to you or your medical condition.

References 

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2. Kaya, D., Atay, O. A., Callaghan, M. J., Cil, A., Çağlar, O., Citaker, S., Yuksel, I., & Doral, M. N. (2009). Hallux valgus in patients with patellofemoral pain syndrome. Knee Surgery, Sports Traumatology, Arthroscopy, 17(11), 1364–1367. doi.: 10.1007/s00167-009-0775-3

3. Hsu, T.-L., Lee, Y.-H., Wang, Y.-H., Chang, R., & Wei, J. C.-C. (2023). Association of Hallux Valgus with Degenerative Spinal Diseases: A Population-Based Cohort Study. International Journal of Environmental Research and Public Health, 20(2), 1152–1152. doi: 10.3390/ijerph20021152

4. Knee Pain:Safely Strengthening Your Thigh Muscles. (2014). Journal of Orthopaedic & Sports Physical Therapy, 44(5), 328–328. doi: 10.2519/jospt.2014.0503

5. Deepeshwar, S., Tanwar, M., Kavuri, V., & Budhi, R. B. (2018). Effect of Yoga Based Lifestyle Intervention on Patients With Knee Osteoarthritis: A Randomized Controlled Trial. Frontiers in Psychiatry, 9. doi: 10.3389/fpsyt.2018.00180

6. Shiri, R., Coggon, D., & Falah-Hassani, K. (2017). Exercise for the Prevention of Low Back Pain: Systematic Review and Meta-Analysis of Controlled Trials. American Journal of Epidemiology, 187(5), 1093–1101. doi: 10.1093/aje/kwx337