Back of Knee Pain

By Barbara Hales, M.D.
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Medical massage for back of knee pain in a physiotherapy center.

Back of knee pain, or pain behind the knee is also called posterior knee pain. It’s a common problem, typically from knee injuries. Swelling surrounding the knee joint or damage to any of the parts at the back of the knee can lead to pain behind the knee, making it difficult to walk or sleep.

Symptoms from back of the knee pain may arise suddenly due to a ligament tear, or gradually due to arthritis.

You may experience:

  • Swelling restricting leg motions
  • Sharp pain at the back of the knee
  • Achy feeling at the back of the knee

Causes For Back Of Knee Pain

The eight most common causes of pain in the back of the knee include the following.

  1. Bakers Cyst

This is the most common cause of back of knee pain, stemming from inflammation of the popliteal bursa (fluid filled sac). You experience swelling, tightness and back of knee pain, made worse with bending and straightening the knee during walking or kneeling. It is frequently found with arthritis.

  1. Calf Strain/Tear

Back of the knee pain with swelling, bruising and walking difficulties arise from tearing or overstretching part of the calf muscle. This may occur when suddenly changing speed or direction when running or jumping.

  1. Cartilage/Meniscus Tear

A tear in the back of the cartilage lining the joint causes pain in the back of the knee, swelling, locking and difficulty in straightening the knee. Walking, running, going up stairs and squatting make the symptoms worse.

  1. Deep Vein Thrombosis (DVT)

DVT is a blood clot in a deep vein of the leg causing swelling, warmth of one leg, redness and back of knee pain. Bringing your toes up towards you (dorsiflexion) causes increased pain in the back of the knee.

  1. Hamstring Injuries

A tear in one of the hamstring muscles behind the thigh causes an achy pain in the back of the knee where the hamstring tendon attaches to bone. Sudden motions and leg bends make this worse.

  1. Hyperextended Knee

When the knee joint bends back too far (hyperextended), swelling, pain, and bruises around the joint are experienced combined with instability. This is made worse by walking, standing and straightening the knee. (typically from a sports injury like getting tackled in football or skiing accident)

  1. Knee Arthritis

Osteoarthritis caused by wear and tear in the bone or inflammation seen in rheumatoid arthritis causes pain, swelling, clicking, grinding and stiffness in the morning with reduced leg movement. It is worse after prolonged activity, prolonged rest or cold weather.

  1. Knee Sprain

Tearing or overstretching of one of the knee ligaments causes pain, swelling, bruising, decreased movement and sometimes gives way. It is made worse by any knee motion.

Home Remedies For Back Of Knee Pain

Home remedies for back of knee pain generally involve:

  • Knee braces
  • Ice alternating with heat packs to decrease inflammation
  • Heel pads
  • Massage
  • Gel kneepads
  • Strengthening and stability exercise after a rested period of time

Medical Treatment Options For Back Of Knee Pain

Acupuncture and ultrasound therapy can help. In the case of a Baker cyst, aspiration of fluid may be done. In the case of a DVT, anticoagulants are prescribed (blood thinning drugs), with compression stockings.

Rarely, surgery is performed to rectify the problem.

What To Expect With Back Of Knee Pain

Depending on the symptom, one can suspect a specific cause for further diagnosis such as:

  • Back of knee pain with bending: Bakers Cyst
  • Back of knee pain with leg straightening: Meniscus tear
  • Pain behind kneecap: runner’s knee with friction or thinning of kneecap cartilage
  • Tightness behind knee: hamstring strain
  • Swelling behind the knee: Bakers Cyst
  • Back of knee pain with prolonged sitting: arthritis
  • Sharp pain behind the knee: meniscus tear

Of course, the best way to diagnose the cause of back of knee pain is to get a Health Care Provider consultation.

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