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This article will discuss why someone may be experiencing pain at the back of their knee

I have pain at the back of my knee, what is it?

Often knee pain can be a frustrating experience. There are many tissues and structures which overlay the knee joint and a careful examination of the site should be undertaken.

“Occasionally, pain at the back of the knee is a site of referred pain from the lower back, hamstring and the knee joint itself.”

The following article will explain the most common and not so common causes of pain at the back of the knee.

Joint Effusion (Joint Swelling)
Often due to a long term or acute injury the knee joint can experience swelling also known as an effusion. Essentially what occurs is there is an increase in inflammatory cells within the knee joint. More severe cases will show up as obvious swelling around the front and back of the knee. Often the patient will experience the following:

  • Swelling around the front of the knee
  • Reduced amount of knee flexion – amount the knee can bend
  • Pain at the back of the knee
  • Reduced muscle strength in the quadriceps

Treatment

These often settle down with time. Initial management may include ice, gentle range of motion exercises and inner range quadriceps exercises to ensure the quadriceps do not lose their contractility.

Popliteus Tendinopathy
The popliteus muscle arises from the posterior medial border of the proximal metaphysis and travels proximally beneath the lateral head of the gastrocnemius to insert into the lateral femoral condyle. The popliteus has a critical role in unlocking the knee joint to initiate knee flexion from an extended position.

Isolated injuries to this muscle are uncommon, they are more commonly injured during other injuries such as meniscus injuries and posterior cruciate ligament injuries. Injuries can otherwise occur due to:

  • Excessive twisting activities
  • Excessive activities involving prolonged acceleration and deceleration

Commonly the patient will experience an increase in instability in the knee more commonly reported during rotational activities of the lower leg.

Treatment

Management should follow a tendon rehabilitation protocol outlined from your Physiotherapist. Tibial rotation is an exercise to also include in the rehabilitation process. Exercise is still allowed with modification of activities.

Bakers Cyst
A Bakers Cyst is a fluid filled cyst located at the back of the knee. The mass is often an enlarged bursa which can eventually herniate (push out through) the back of the knee. Bakers cyst usually accompany some sort of joint pathology such as in osteoarthritis, meniscus tears, ACL deficiency and cartilage degeneration.

Large cysts are usually palpable to touch and the patient usually has restrictions in knee flexion range of motion. Deep squats and kneeling also reproduce pain. The treatment for bakers cyst is to treat the underlying pathology, such as if it is a meniscus involvement than rehabilitation exercises should focus on treating that.

What is known as aspiration; where the fluid is drained from the cyst can also be performed however its effectiveness is not guaranteed. Occasionally the cyst can burst and drain down into the lower leg.

Treatment

Treatment of a bakers cyst is of a conservative nature. This means the symptoms can be managed by quadriceps and joint strengthening and by releasing the quadriceps and gastrocnemius muscles. An aspiration can be performed which is when the cyst is drained under ultrasound guidance however the cyst may return after a few years.

Gastrocnemius Tendinopathy
The gastrocnemius is the large muscle which we see as the calf muscle. It inserts into the knee joint and the most common area for pain is the medial gastrocnemius (closer to the midline). This injury is common in runners especially in those running up hill or in those who have increased their amount of running in previous weeks.

Usually patients are tender at the insertion point of this muscle and there will be tight trigger points along the medial gastrocnemius. Assessment of this injury is essential so you should consult your physiotherapist who will examine your biomechanics, landing mechanics, muscle strength, flexibility and training regime. Stretching of the injured tissue may cause increased pain in the initial stage of injury.

Treatment

Treatment should include a tendon strengthening protocol outlined by your physiotherapist. This may initially involve isometric, concentric followed by eccentric muscle contractions until a tolerance can be built up in the tendon and muscle. Training can still be performed with some modification.

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