There are oh-so-many ways that the low back and knees are connected. One that has been catching my attention of late is that people who complain of chronic low back pain invariably have grainy, mealy, lumpy, unhealthy soft tissue on the popliteal fossa (backs of the knees). In the middle of the popliteal folds (transverse crease of popliteal fossa, to be precise) is Bladder 40 (UB40, Wei Zhong), a potent acupoint for low back pain. How did the ancient Chinese physicians make this connection? There are many theories and beliefs about how acupuncture came to be. But I wonder if perhaps some physicians, who were more focused on manual modalities and the cadaver studies done at the time, noticed this difference in the tissues and that perhaps this contributed to the discovery of the acupoint.

Tissues reflect the health of the structures with which they are related. Often these are contiguous (next-door or adjacent) structures, but sometimes these structures are related through their fascial connections (like the low back & knees). It is through these fascial connections that tissues can, in turn, influence the health of other organs and structures in the body. It goes both ways. So keeping the tissues healthy through hydration, nutrition, massage, manual therapies, skin brushing, etc is important to overall health of the internal organs.

An item I share in my Bladder & Pelvic Floor Health for Practitioners class from Haslam & Laycock's "Therapeutic Management of Incontinence and Pelvic Pain", 2nd edition:

When pain persists, even after healing has taken place [from a trauma], the nerve cell membranes undergo a change in conformation, establishing new receptor sites and the formation of new neural pathways that become embedded into the central nervous system. Once established, the chronic pain pathways are difficult to eradicate. Chronic pain no longer serves a useful purpose, but leads to physical, behavioral, and psychological changes that combine to produce the pain experience.

There are a couple very practical implications here. Firstly, chronic pain causes very real physical changes, even when the physical cause can no longer be detected. Secondly, the longer someone waits to get treatment for pain, the more established will be those physical changes and the more treatments they will require to try to reverse the pathology.

I have had patients who have become frustrated with western medical practitioners who told them that the pain "is in your head". It's an unfortunate (and rather dismissive) way to language it, but sometimes this is to what they refer. The physical cause has resolved; the pain now lives in their neurology. Chronic pain requires both physical modalities and CBT (cognitive-behavioral therapy) in order to be addressed completely. It will not be resolved by medications or surgery.