She spent the early seventies painting, writing and performing both poetry and a play (in a collaboration with Sam Shepherd), a career path subsidised by rock journalism. By 1974, however, she was performing rock music, initially with guitarist and rock archivist Lenny Kaye and later with a full band comprising Kaye, Ivan Kral (guitar), Jay Dee Daugherty (drums) and Richard Sohl (piano). Financed by money from Smith's friend and former lover Robert Mapplethorpe the band recorded a first single in 1974. The A side of "Piss Factory / Hey Joe" featured a story describing abuse received in an early job in on an assembly line in New Jersey, with the flipside a version of the blues standard with the addition of a rap/poem about fugitive heiress Patti Hearst.
1975 saw the release of their first album Horses, produced amidst some tension by John Cale, formerly of the Velvet Underground. The record fused rock and roll, early proto-punk rock with spoken poetry and is widely considered one the rock's greatest debuts. As Smith toured the United States and Europe, with the newly christened Patti Smith Group, punk's popularity grew and the second album Radio Ethiopia reflected this with a rawer sound, although the murky production contributed to its poor reviews.
While touring in support of the record, Smith fell from a stage in Tampa, Florida, falling 15 feet into a concrete orchestra pit and severely damaging a number of neck vertebrae. The injury required a period of rest, and an intensive round of physical therapy, during which time she was able to reassess, re-energise and reorganise her life, a luxury which had been denied her in her early rise to fame.
The group produced two further albums followed before the end of the 1970s, and while neither could match the first two records, Easter contained the hit single Because The Night which had been co-written with Bruce Springsteen.
In the 1980s she appeared to be in semi-retirement from music, recording only the album Dream Of Life in 1988, with her husband Fred "Sonic" Smith formerly of early punk agitprop stars, the MC5. Following Fred's death, 1995's Gone Again featured tributes to him and Kurt Cobain.