The Hidden Link Between Lower Back Pain & Knee Osteoarthritis (KOA)

Many people try knee exercises to relieve knee osteoarthritis (OA), but still feel pain. Why?
New research shows that lower back pain (LBP) and knee osteoarthritis are closely connected — and this relationship can affect treatment success.

If you struggle with knee pain and back pain, understanding this connection is the first step toward proper recovery. Let’s break it down.

What Is Knee Osteoarthritis?

Knee osteoarthritis (KOA) — often called degenerative knee disease — occurs when the protective cartilage in the knee wears down over time. This can lead to:

• Pain

• Stiffness

• Swelling

• Difficulty walking

• Loss of mobility

OA is progressive, meaning symptoms get worse if not treated properly.

How Are Lower Back Pain & Knee Osteoarthritis Connected?

Research (Amarasinghe et al., 2023) shows that 57.4% of individuals with knee OA also suffer from lower back pain.

This means more than half of knee OA patients have both issues at the same time.

Why does this matter?
Because when back mechanics are faulty, the knee absorbs extra stress — leading to worsening knee pain and weaker response to knee exercises.

 Biomechanics: Why Back Problems Affect the Knee

1 Lumbo-Pelvic Misalignment

Your lower back and pelvis work as one unit.
When alignment is off, your body compensates at the hips and knees.

Common compensations include:

• Increased hip flexion

• Pelvic anterior tilt

• Excessive lumbar curvature

These changes shift load into the knee joint.

2 Increased Pelvic Anterior Tilt

Studies show that people with knee OA have a significantly higher anterior pelvic tilt angle (~44.68°).
This tilt affects:

• Hip mechanics

• Knee alignment

• Muscle activation patterns

Which can worsen osteoarthritis progression.

3 Pelvic Retroversion → Hip External Rotation → Varus Knee

When the pelvis rocks backwards (retroversion), the body compensates by:

• Rotating the hips outward

• Shifting the knees inward (varus deformity)

Varus alignment increases load on the medial knee joint — the most common site for OA.
Over time, this accelerates joint degeneration.

Why Knee Exercises Alone May Not Work

If back and pelvic alignment issues are not addressed, knee-focused exercises may fail.
This explains why many patients:

Still feel knee pain
Have trouble walking
Experience recurring stiffness
See little progress after months of exercises

To truly improve knee OA, the lower back, pelvis, and hips must be assessed and treated.

How Physiotherapy Helps

At Benphysio, we approach knee osteoarthritis holistically, treating BOTH the knee and the lower back to restore balance.

Our treatment includes:

 Manual Therapy — to release stiff joints and restore mobility
 Myofascial Release — to ease tension in lumbar–pelvic structures
 Strengthening — targeting hip stabilisers, core muscles, and knee muscles
 Movement Correction — fixing compensatory patterns that overload the knee
 Education & Home Plan — strategies to maintain long-term joint health

What Happens If the Back–Knee Link Is Ignored?

Patients with severe lower back pain often show:

• Worse knee pain scores

• Higher pelvic incidence

• Greater compensatory movements (pelvic tilt, hip extension, ankle dorsiflexion)

These compensations place extra load on the knee, accelerating osteoarthritis progression and contributing to conditions like spondylolisthesis.

Conclusion: Treat the Back to Save the Knee

Lower back pain is strongly linked to knee osteoarthritis.
If you only treat the knee, you may never fully recover — because the root problem may be higher up in the body.

By addressing both back and knee alignment, physiotherapy helps:

Reduce pain
Improve walking and daily movement
Slow OA progression
Restore healthier biomechanics

FAQs About Lower Back Pain & Knee Osteoarthritis

1. Why do I still have knee pain even after doing knee exercises?

Because the root cause may not be the knee.
If your lower back or pelvis is misaligned, the knee absorbs abnormal stress.
Knee exercises alone won’t solve the issue until the back and pelvic mechanics are corrected.

2. How does lower back pain affect my knee?

Lower back pain changes your posture and movement pattern, leading to:

• Pelvic tilt

• Hip rotation

• Varus knee alignment

These changes overload the knee joint and worsen osteoarthritis.

3. Can treating my lower back reduce my knee pain?

Yes.
Correcting lumbar–pelvic alignment reduces knee joint stress and improves outcomes — especially if knee exercises haven’t worked well.

4. Why do more than 50% of knee osteoarthritis patients also have lower back pain?

Because the spine, pelvis, hips, and knees function as a connected chain.
If one area is stiff or weak, other areas compensate — often overloading the knee.

5. What signs suggest my knee pain is coming from my back?

You may notice:

• Pain in both lower back and knee

• Little improvement despite knee strengthening

• Visible posture changes (pelvic tilt, swayback, uneven hips)

• Altered walking mechanics

These indicate that your knee pain may be secondary to back or pelvic issues.

6. Can pelvic tilt worsen knee osteoarthritis?

Absolutely.
Both anterior and posterior pelvic tilt change how force travels down the leg, increasing stress on the knee joint and accelerating wear and tear.

7. When should I see a physiotherapist?

If you have:

• Persistent knee pain

• Combined knee + back pain

• Difficulty walking or climbing stairs

• No improvement after home exercises

A physiotherapist can assess your entire kinetic chain — spine, pelvis, hips, knees — to find the true cause.

Your Recovery Starts Here

At Benphysio, we’re committed to helping you move without pain.
Through expert manual therapy, personalised exercises, and education, we treat the root cause — not just the symptoms.

Let us help you reclaim your health and return to the activities you love.
 

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Expert Physiotherapy & Sports Recovery Near You – We offer sports massage, deep tissue therapy, injury rehabilitation, and recovery programs for conditions such as back pain, neck pain, slipped discs, knee pain, sciatica, and sports injuries. Whether you’re an athlete, recovering from surgery, or managing chronic pain, our personalised treatments help you move better, recover faster, and stay active.
At our clinic, we provide a full range of physiotherapy and sports recovery services to support your health and performance. Our treatments include sports massage, deep tissue massage, sports injury massage, rehabilitation massage, recovery massage, myofascial release, trigger point therapy, mobility massage, kinesiology massage, and targeted therapy for sprains, strains, and muscle tension. We also offer pre-event and post-event sports massage, manual therapy for athletes, and injury prevention programs.
We treat a wide variety of conditions, including back pain, lower back pain, neck pain, shoulder pain, stiff neck, slipped discs (L4L5), scoliosis, spinal pain, sciatica, nerve pain, carpal tunnel syndrome, ACL injuries, knee arthritis, osteoporosis, osteoarthritis, headaches, migraines, jaw pain, TMJ disorders, sports injuries, posture issues, pregnancy pain, frozen shoulder, and post-surgery rehabilitation. We also address gastric issues, bloating, shortness of breath, foot cramps, and numbness.
Conveniently located across Malaysia, we welcome clients from Kuala Lumpur, Selangor, Melaka, Johor, and Pahang — including key areas such as KLCC, Bangsar, Cheras, TTDI, Mont Kiara, Petaling Jaya, Shah Alam, Subang Jaya, Puchong, Klang, Ayer Keroh, Johor Bahru, Iskandar Puteri, Skudai, Kuantan, and more. If you’re nearby, you’re close enough to benefit from our professional physiotherapy services. Book your appointment today and take the first step towards a stronger, pain-free you.
 

Location:

Benphysio @ Oval Damansara
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Unit 2-1 & 2-2, 2nd Floor, Oval Damansara, Jalan Damansara, 60000 Kuala Lumpur, Kuala Lumpur

Benphysio @ Puchong
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40-G, Jalan Puteri 1/2, Bandar Puteri, 47100 Puchong, Selangor

Benphysio @ Bangsar
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17, Persiaran Ara Kiri, Lucky Garden, Bangsar, 59100 Kuala Lumpur

Benphysio @ KL Ampang
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Lot G.09, Ground Floor, The Grange @ Ampwalk, 218, Jalan Ampang, 55000 Kuala Lumpur

Benphysio @ Cheras
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213, Jalan Sarjana, Taman Connaught, 56000 Kuala Lumpur

Benphysio @ Kota Damansara Giza
016-439 2015  WhatsApp
C-11-G, Sunway Giza Mall, Dataran Sunway, Kota Damansara, 47810 Kota Damansara, Petaling Jaya, Selangor

Benphysio @ Puncak Alam
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No. 25, Jalan Niaga Bestari 7, Puncak Bestari, 42300 Puncak Alam, Selangor

Benphysio @ Ayer Keroh Melaka
018-985 2015  WhatsApp
No. 1, Pusat Komersial, C-G-9, Jalan Pkak 1, 75450 Ayer Keroh, Melaka

Benphysio @ Mount Austin Johor
018-288 2015  WhatsApp
Room 15, Nook Workspace•Storage Mount Austin, 117, Jalan Mutiara Emas 10/19, Taman Mount Austin, 81100 Johor Bahru, Johor Darul Ta'zim

Benphysio @ Iskandar Puteri Johor
018-288 2015  WhatsApp
B-02-01, Pusat Perdagangan Ion Akses, Persiaran Medini Sentral 6, Bandar Medini Iskandar, 79250 Iskandar Puteri, Johor Darul Ta'zim