How Knee Pain Develops With Back Pain

Issue 23

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You might be thinking what on earth knee pain has to do with the lower back, and that’s understandable, however today we’re going to make the case for the intrinsic relationship between these two areas. Particularly for those who’ve had more long standing back troubles. Be they sciatica, be they back pain specifically. And to the degree you have a more formal diagnosis of “things going wrong in the lower back” this applies more to you. By this we mean, degenerative change identified in areas of the lower spine, we mean disc injuries, bulges and the like, we mean stenosis, the list goes on.

The simple fact of the matter is that we know this is the case because we see this phenomenon in almost all patients, we see it even, in ourselves.

How do I fit into this topic?

The first notable point here would be a reflection whilst at university, whereby during training i really noticed a limitation in my ability to squat to a reasonable depth, the load here is irrelevant, but squatting down low was a real issue and something I set about working on in my training and improvements where made, significantly so, at the time. Fast forward over a decade and practicing new movements that involved the collapse of the knee joint (complete flexion) with load, weaknesses again were exposed, and have been worked on for a considerable amount of time and the work isn’t done yet. 

Why share this brief anecdote, only to say that what we’re about to discuss here affects us all! Whether you have “knee pain or not,” our legs are so very important for life, ask someone who is not able to walk, or has poor balance. The simple fact of the matter is that long before we have any knee trouble the degradation of these structures starts to take place due to modern life. If we are aware of this, we can take action, no matter whether we have knee pain or not, no matter how old or young. 

Please pay specific attention to the fact that in my anecdote, I did not say: “and it all changed overnight!”, the phrase “considerable amount of time” was instead used!

When does your knee pain originate?

Let us take the journey back to when we were all first able to walk, anyone who’s been around small children will note the ease with which they move from the deep squat with knees in full flexion, all the way up to standing and back down again. Regularly, not thinking twice. They are efficient. They’re developing full use of the knee joint. Full mobility of the knee joint. Every single one of you reading this, was in this position at some point in the past. 

Understand that the joints, all synovial joints in our body, require good full range of motion to remain healthy and strong. Also know that we don’t just have one or two muscles controlling the knee. A quick google images search of “muscles of the knee” will reveal the interwoven mesh of support for this joint.

You see, the knee joint amounts to two sticks standing on top of one another, hardly a recipe for stability! It is however the muscular mesh that provides the incredibly powerful support for this section of the body. Know that all of these different muscles are in prime position to bear load and control the knee at different ranges of motion. So as you go through a full squat all the way down like when you were a toddler, different muscles at the knee but also higher up will bear the load to varying degrees, to support this joint effectively. In doing so, you also support the many ligaments within the knee and tendons of the knee joint are stressed to stimulate strength and collagen lay-down. 

Use it or lose it

The simple phrase applies to our bodies in a way that is inescapably true. The moment you’re offered the chair’s at preschool, things start to change, “sit here” “sit there” etc. From this point early in our life – in western cultures at least – the process of weakening our knees begins to take hold. We stop using them as fully.

Take us back to those muscles that we mentioned, as you are at the bottom of the squat there is a degree of mechanical disadvantage, meaning that the leg muscles are in a weaker position compared with standing erect. So they have to work harder to keep the knee joint working effectively.  As many of you find out when you’re working through your exercises in the program, as you go to certain depths you begin to wobble. So what does the body do, it stiffens up.

Your muscles know that you’re not worthy of this depth, that if they let you misguidedly go down to the floor and collapse your knee joints like your former self, trouble will likely result. And so begins the process of losing what you once had. 

At the end of the day, your body is just protecting you from yourself!

The less you do, the less you can do

This process evolves over your schooling life as you spend more and more time every day in seats, very rarely requiring your knee to do anything more than a half squat, if that. And so those muscles continue to stiffen up and weaken. 

It requires a lot of energy and resources to maintain good muscle mass, and if you’re hardly using these muscles your body will naturally divert resources away from maintenance of this costly infrastructure and put it elsewhere. Not to mention the fact our dietary quality is substantially reduced compared to prior generations, but that’s a whole other topic. 

Gradually you work your way through life doing less and less, and so the knees become more and more vulnerable. Most of us will then mold our activities or hobbies to fit the mobility we have. For example, you might work to just do running or hiking. You might do some simple cardio classes, you might do some work on the cross trainer or spin bike in the gym, you might partake in some gardening, the list goes on. But how much knee bending, under load actually takes place when doing these activities. Relatively little. Even in cycling which is a whole other story, saddles certainly aren’t placed low down, they’re often ridiculously high, for many reasons, but one of which is that it is more mechanically efficient in cycling if the knees can remain closer to straight than collapsed – it’s easier.

Hopefully you did have a look at the anatomy of the knee earlier, but as you can surmise by this point the process of slow degradation of these muscles is a lifelong pursuit for so many of us. As a result, we have an inability to move properly as a human being.

We’ve lost muscle mass, we’ve lost tendon strength, we’ve lost joint strength, and joint health, is it any wonder that we then start to notice some discomfort and vulnerability in these knees? In the back too?

How does knee pain relate to the lower back?

Well many of those muscles that support the knee and should ordinarily be used on a daily basis, are also heavily involved in lower back health. The glutes literally being a huge one!

If you’ve stopped bending your knees properly, how are you going to do all these daily activities we mentioned, getting out of chairs, lifting things etc. Your stiffness won’t allow you to do them with your knees. 

Your back does the bending your knee should have done! A recipe for disaster!

You gradually, often without significant knee pain, used your lower back more for these movements, getting out of chairs you round your back and tip yourself out, or the reverse and drop yourself into the chair from a great height. When lifting it’s straight legs, rounded back, instead of bent legs, straight back. When out in the garden it’s more of the same. 

You see this inability to move correctly has been a slow erosion over time of our ability to be mobile. Look at older family members that lose their independence mobility wise, it’s their legs. The balance and unsteadiness when moving around, it’s the legs. The severe, sometimes mortal, costs as we age of having a fall, it’s the legs.  

For the next few days or a week, look at people, out and about, family at home, see how they actually move, how little we use these joints properly, and reflect on your own practice. 

Have you fallen off the wagon here too?

What are you going to do to fix this knee pain?

I believe it is the Chinese proverb that states, the best time to plant a tree was 20 years ago, the second best time is today. The best time to fix your knee pain was when you were a child and by not losing the innate strength and ability we all had, to function as we should in the adult world, following the precedent for movement that is literally hard wired into our very genes.

Failing that, as we all have, myself included; the second best time is today!

As the new year approaches, start now in the closing weeks of 2022, to be more aware of your knees, no matter your age, but not from a point of paralyzing fragility. Instead be aware of them from a point of regeneration. Slow and steady over the coming years, starting now. Work with the exercises many of you are doing in the various stages of the program, to start to increase your strong range of motion.

There is a reason we perpetually insist on taking (and sharing) videos for critique of technique, and why it is so often the squats, lunges and hip hinges that we reference. We know how important they are, but also how challenging they are to do fully and properly for us all! Together though, with slow progress we can all dramatically improve the durability of our knees and doing so will only be a boon to our lower back health too! 

Acknowledge that the road ahead is a steady one, but with diligent practice and consistency, we can significantly improve our knee pain, knee vulnerability and knee strength. Leaving us feeling better, living better and able to flourish well into old age, whatever “old age” is these days!

Comment of the Week – Lindy

“I wondered why I felt so stiff afterwards when I first started. Now the towel is relieving bliss. Stick with it, and the benefits will come.”

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