An 82 year old woman came into my office yesterday in amazing shape complaining of low back pain. She works still as a professor and works out about 1 hour per day doing Pilates, yoga and stretching. In addition, she uses a Jacuzzi on a daily basis and once she does her routine, she is pain free for the rest of the day. She came to see me because she wanted to tweak her work out routine and try to reduce her symptoms, if possible.
After I examined her, I noted that her right knee was limited by both flexion (bending) and extension (straightening) and she complained that most of her pain complaints were in her knee but she was more concerned about her back pain. I asked her why she never addressed the knee problem. She said that she injured it in a biking accident 50 years before and never wanted to have surgery. She also said that an orthopedist mentioned that she would feel and function so much better if she had a total knee replacement, which she wanted to avoid.
I explained to this unusually intelligent and active 82 year old that the fixed bend in her knee or her knee flexion contracture may have been partially to blame for her back pain and functional leg length difference. After aligning her pelvis, I gave her a heel lift to try and attempted to explain the potential benefits of a knee replacement surgery. After all these years, the problems caused by the difference in leg length may not be reversible, but maybe addressing it can help keep her from getting worse.
A 50 year old knee problem can most definitely have an effect on someone’s back today. Lower extremity problems should never be ignored. They can grow to be problems somewhere else in the body, including the back. If they don’t go away within a few days on their own, problems grow, so address them when they are easy to treat, at the beginning.
