Can knee pain cause lumbar spine arthritis?

Can Knee Pain Cause Lumbar Spine Arthritis?

No, knee pain does not cause lumbar spine arthritis—the relationship works in the opposite direction, where lumbar spine pathology can refer pain to the knee, and the two conditions frequently coexist due to shared biomechanical factors, but one does not cause the other. 1, 2

Understanding the Directional Relationship

Referred Pain: Spine to Knee (Not Vice Versa)

• Lumbar spine pathology must be considered as a source of knee pain when knee radiographs are unremarkable and clinical evidence suggests spinal origin. 1, 2, 3
• The American College of Radiology explicitly states that in patients with chronic knee pain, referred pain from the lower back should be evaluated, especially when knee imaging is normal. 1, 3
• This is a critical diagnostic pitfall—approximately 20% of patients with chronic knee pain undergo MRI without recent radiographs, missing the opportunity to identify referred pain from the spine. 2

Biomechanical Coexistence (Not Causation)

The two conditions frequently occur together through shared biomechanical mechanisms, but this represents concurrent pathology rather than one causing the other:

• High pelvic incidence is a risk factor for both spondylolisthesis development and knee osteoarthritis, suggesting a common biomechanical predisposition rather than direct causation. 4
• Elderly patients with degenerative lumbar spondylolisthesis and severe knee osteoarthritis demonstrate significantly greater mismatches in lumbo-pelvic sagittal alignment, increased sagittal malalignment with lack of lumbar lordosis, and greater knee flexion contracture. 4
• Development and progression of knee osteoarthritis in patients with degenerative spondylolisthesis may be induced by lumbo-pelvic sagittal alignment mismatches, but this represents biomechanical interdependence, not direct causation from knee pain to spine arthritis. 4

Clinical Implications of Concurrent Pathology

When Both Conditions Coexist

• Patients with concurrent low back pain and knee osteoarthritis report significantly higher knee pain intensity, worse function, and greater disability than those with knee osteoarthritis alone. 5, 4
• The lifetime prevalence of radicular, chronic, and recurrent low back pain is significantly higher in patients presenting with knee pain compared to controls. 5
• Range of movement of both the lower limb and lumbar region is more restricted in patients with knee pain compared to controls, and local subcutaneous tissue edema of the lumbar region is more prevalent. 5

The "Knee-Spine Syndrome" Concept

• When knee osteoarthritis and lumbar spine degeneration present concurrently, determining the predominant source of pain generation becomes challenging for clinicians. 6
• A thorough history and detailed examination with supplemental diagnostic testing is essential to differentiate the clinical entities and guide treatment—specifically looking for: radicular symptoms, lumbar range of motion restrictions, lumbo-pelvic alignment abnormalities, and whether knee pain follows dermatomal patterns. 6, 5
• Misdiagnosis may necessitate secondary site surgery and further treatment to adequately alleviate pain. 6

Diagnostic Algorithm to Avoid Missing Referred Pain

Initial Evaluation Steps

• Obtain anteroposterior and lateral knee radiographs first to exclude fractures, osteoarthritis, osteophytes, and loose bodies. 2
• Perform clinical examination of the lumbar spine and hip before attributing symptoms solely to knee pathology, looking specifically for: lumbar range of motion limitations, radicular pain patterns, straight leg raise positivity, and hip range of motion restrictions. 2, 3

When Knee Imaging is Normal

• If knee radiographs are unremarkable but pain persists, consider lumbar spine radiographs to identify possible spinal origin of pain. 1, 3
• Hip pathology should also be evaluated, as hip conditions commonly refer pain to the knee. 1, 2
• MRI of the knee should only be pursued after excluding referred pain sources and when knee-specific pathology is clinically suspected. 2

Common Pitfalls to Avoid

• Never overlook referred pain from the hip or lumbar spine before attributing symptoms exclusively to knee pathology. 2, 7
• Do not perform premature knee MRI without first obtaining recent radiographs and evaluating for referred pain sources. 2
• In patients over 70 years, bilateral structural abnormalities can exist with primarily unilateral symptoms, complicating the clinical picture. 2
• The coexistence of knee and spine pathology requires careful assessment of both regions, as treating only one site may provide inadequate pain relief. 6, 4