When your bad knee causes significant neck pain

Ross A. Hauser, MD, Danielle R. Steilen-Matias, MMS, PA-C

When loss of knee range of motion causes significant neck pain

Often a patient will come into our office and they will discuss with us their many pains and joint instability challenges. Many times a patient will report that they have primary foot and ankle pain and this is causing degenerative knee disease, or, that they have hip pain and low back pain and that their doctors are not sure which surgery to perform first, a spinal fusion or a hip replacement. Sometimes a patient will come in and tell us that they have pain all over but their knee hurts worse and more recently they have been developing significant neck pain. To some of these patients, these are seemingly not related problems but isolated problems occurring simultaneously. For others, the recognition is made that their knee pain IS causing their neck pain.

A September 2019 study in The spine journal from orthopedic and neurosurgeons at some of China’s leading medical universities suggested that: (1)

“The coordination of the alignment between the lower extremities and cervical spine helps to achieve balance and horizontal gaze during standing and walking. Malalignment in any segment can disturb the global balance, causing compensation in another segment. Knee flexion contracture (This is the inability to completely straighten or extend your knee) can cause spine inclination with increased C7 tilt or C7 SVA ((sagittal vertical axis) this is a malalignment in the natural curve of the cervical spine. Cervical alignment and the posterior muscles are essential for maintaining the horizontal gaze which are closely related to neck tension.”

Explanatory note: In brief, this opening introduction to this research study is suggesting that your inability to straighten or extend your knee is causing a body-wide disturbance that is altering the natural curve of the neck, that is causing cervical neck muscle tension or spasms and is impacting your ability to maintain balance because your neck muscles are now causing you to lose horizontal gaze. Horizontal gaze keeps you balanced. A sobriety test issued by police officers tests for horizontal gaze nystagmus, this test determines the ability of the eyes to work in concert to follow a moving object or to react to a moving object. Your knee’s range of motion is impacting all this.

The researchers of this study measured the cervical neck pain and range of motion or disability scores in the study participants. They used radiographic images to measure C0-C2 lordosis, C2-C7 lordosis, C2 sagittal vertical axis, C7 sagittal vertical axis, T1 (Thoracic) slope, thoracic kyphosis (the spine protruding outward as in “hunchback”), lumbar lordosis, pelvic tilt (please see our articles on leg length discrepancy and pelvic tilt), sacral slope, and knee flexion angle.

Let’s not again that to conduct this study, patients had to be divided into two groups. One group with knee problems underwent arthroscopic surgery to correct knee alignment. (In other words, they had a treatment that the doctors believed would help the neck pain).

What the researchers found is that if you fixed the knee, you could decrease spinal inclination (wrong way curvatures) and cranio-cervical malalignment, up and down the spine leading to neck tension or spasms and range of motion reduction.

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1 Ding Y, Liu B, Qiao H, Yin L, He W, Si F, Wang D. Can Knee Flexion Contracture Affect Cervical Alignment and Neck Tension? A Prospective Self-Controlled Pilot Study. The Spine Journal. 2019 Sep 13. [Google Scholar]

• Surgery
• NSAIDs
• Cortisone Shots
• R.I.C.E.