Is Your Joint Pain Really Coming From Your Spine? A Spine-First Physical Therapy Perspective

Joint pain isn’t always about the joint — the spine often plays a key role

Is Your Joint Pain Really Coming From Your Spine?

So often, patients come into my office and tell me that their knee hurts, their hip hurts, or their shoulder hurts — “it’s right here!” They’re understandably very certain about the location of their pain.

And more often than not, I have to tell them something surprising: while that is where they feel the pain, it’s probably not where the pain is actually coming from.

A Spine-First Way of Looking at Pain

I call myself a spine-first physical therapist, which means I evaluate injuries and pain patterns through the lens of the spine. And about 98% of the time, that ends up being the correct starting point.

The spine governs everything around it.

• The neck influences the shoulder blades, arms, and hands

• The low back influences the pelvis and everything below it

When the spine is irritated or not moving well, it can send pain signals into these surrounding areas. The tricky part? You may never feel pain directly in your spine at all.

That’s where the confusion — and frustration — often begins.

Could Your Joint Pain Be Coming From Your Spine?

These are some of the key questions I ask patients to help determine whether the spine may be involved. While these aren’t diagnostic on their own, they’re a very good place to start:

• Do you have morning pain, pain with sitting, or pain when moving from sitting to standing?These patterns are often associated with spinal involvement.

• Is your pain worse when you’re still versus when you’re moving? Joint pain that worsens with stillness is another common sign that the spine may be contributing.

• Do you have pain with sleeping or during transitions in bed? Difficulty rolling over or getting comfortable can strongly point back to the spine.

• Does your pain worsen with bending forward? Activities like picking something up, cleaning, or working out that involve forward bending often aggravate an unhappy spine.

There are many more nuances and possibilities — and I usually tease these out in much greater detail during an evaluation — but these questions can help you begin to connect the dots.

Why Treating Only the Joint Isn’t Enough

To be clear, the joint itself is involved. Once pain shows up in an area, that tissue can begin to degrade over time.

However, if the root cause — often the spine — is never addressed, the joint may never fully heal.

This is why some people continue to struggle with pain despite:

• Physical therapy

• Massage therapy

• Chiropractic care

If you’ve tried multiple approaches and your joint pain keeps returning, the missing piece may be specific, spine-focused intervention.

When to Seek a Spine-First Evaluation

If your joint pain has lingered longer than expected or keeps coming back despite treatment, it may be time to look deeper.

A spine-first assessment can help identify:

• Where your pain is truly coming from

• Why it hasn’t fully resolved

• What your body actually needs to heal long-term

Still dealing with joint pain that won’t fully resolve?

Book a one-on-one evaluation to find out if your spine may be the missing piece.

👉 Schedule an appointment at Union Yoga & Physical Therapy