Knee Pain Coming From the Hip or Lower Back

How a hip or back problem is felt in the knee

The nerves that supply the hip joint and the front of the thigh also carry sensation from the knee. When the hip is irritated, or when a nerve root in the lower back is pressed on, the brain can read the signal as coming from the knee. This is called referred pain.

The knee itself is healthy in these cases, so knee scans can look normal, or show only minor changes that are common at that age. Treating the knee alone does not help, which is why some patients go from one knee treatment to another without improvement.

Signs that the hip or back may be the source

• The pain is felt over the front of the thigh and the knee, rather than at one precise point on the knee
• Groin pain or stiffness, or difficulty putting on socks and shoes or getting out of a car
• A limp, or the knee feels fine to touch and moves fully
• Pain that spreads from the buttock or lower back down the leg
• Numbness, tingling or weakness in the thigh, shin or foot
• Pain that changes with sitting, bending forward or coughing
• Knee scans that do not match the severity of the symptoms

The main causes in adults

Hip osteoarthritis is the most common. Many people with an arthritic hip feel little in the groin at first and mostly describe an ache in the thigh and knee, especially after walking. Stiffness when putting on shoes or cutting toenails is a typical clue.

Nerve root irritation in the lumbar spine, from a disc bulge or narrowing of the spinal canal, is the other main cause. Upper lumbar nerves send pain to the front of the thigh and knee, while lower nerves, as in classic sciatica, send it down the back of the thigh and behind the knee into the calf. Back pain is not always present.

Less common causes include problems with the blood supply to the femoral head (avascular necrosis), stress fractures of the hip in runners and military recruits, and narrowed leg arteries causing calf and knee pain on walking that eases with rest.

In children and teenagers: do not miss SCFE

Slipped capital femoral epiphysis (SCFE) is a condition in which the ball at the top of the thigh bone slips on its growth plate. It usually affects children around the early teenage years, more often boys and children who are overweight, and many of them complain only of knee or thigh pain with a limp. The leg may turn outwards when walking.

SCFE is a red flag. A child or teenager with knee pain and a limp, or who cannot bear weight, should stop sports, avoid walking on the leg as far as possible and be seen the same day; an X-ray of both hips is needed. If the child cannot walk at all, go to an emergency department. Early treatment, usually surgery to fix the hip in place, protects the joint. Younger children can have other hip conditions, such as Perthes disease or an irritable hip, that also show up as knee pain.

How Dr. Gelber tells knee from hip or back

The examination includes the whole leg, not just the knee. Dr. Gelber checks the knee for swelling, joint line tenderness and stability, and then moves the hip, particularly turning it inwards, to see whether that reproduces the knee pain. He looks at the spine, tests the nerves with straight leg raises, reflexes and sensation, and checks the pulses in the foot.

An X-ray of the hip or pelvis often answers the question quickly. MRI of the spine is arranged when nerve signs point there. If the source is the hip or spine, Dr. Gelber explains the findings and refers you to the appropriate hip or spine colleague so you do not spend more time treating the wrong joint.

Treatment and when to book in Doha

Treatment depends on the source. Hip arthritis is treated with strengthening, weight management, activity changes, pain relief and, in advanced cases, hip replacement. Nerve-related pain often settles with physiotherapy, posture and core work, and time, with spinal injections or surgery for selected patients. Long hours sitting, long drives and long flights home can aggravate both, so short movement breaks help.

Book an assessment at Aman Hospital if knee pain persists despite normal or near-normal knee findings, if you have groin or back symptoms as well, or if you have numbness or weakness. A teenager with knee pain and a limp needs to be seen the same day.