Pain Behind the Knee
Written By: Chloe Wilson, BSc(Hons) Physiotherapy
Reviewed by: KPE Medical Review Board
Pain behind the knee is a common problem.
Not only can it affect your ability to walk and carry out your usual activities, posterior knee pain can also really affect your sleep.
Posterior knee pain may develop gradually over time, or suddenly with an injury.
There may be a general ache, leg movements may be restricted by swelling or there may be a sharp pain at the back of the knee.
So let's have a look at the most common causes of pain behind the knee.
Bakers Cyst
Swelling develops in the popliteal bursa at the back of the knee. Bakers Cyst is the most common cause of pain behind the knee.
Causes: Excess fluid in the knee e.g. from an injury or arthritis
Symptoms: Small bulge (like a water balloon), tightness and pain behind the knee when bending the leg, walking and kneeling
Full Article: Bakers Cyst Knee
Knee Sprain
Overstretching of one or more knee ligaments, which can result in a full or partial thickness tear
Causes: Sudden twisting movements or a large force through the knee
Symptoms: Knee instability, pain, swelling, bruising, decreased knee movement
Full Article: Knee Ligament Sprains
Posterior Cartilage Tear
A tear in the cartilage aka meniscus at the back of the knee
Causes: Sudden twisting, a force through the knee or gradual wear and tear
Symptoms: Swelling, locking and pain behind the knee with knee extension, walking, running, squatting & going up stairs
Full Article: Meniscus Tears
Calf Strain/Tear
Overstretching, partial or complete tear of one of the two calf muscles
Causes: Suddenly changing speed or direction when running, or repetitive running or jumping
Symptoms: Pain in back of knee or calf, bruising, swelling & difficulty walking. Worse when running or on tiptoes
Full Article: Calf Strains
Knee Arthritis
Erosion of the knee bones and cartilage, bone spur formation, loss of joint space. Most common in the over 50's
Causes: Aging, obesity, previous knee injury or surgery, genes, gender
Symptoms: Knee stiffness, pain, clicking, grinding, reduced leg movements. Worse with prolonged rest, activity, cold weather
Full Article: Knee Arthritis
Hyperextended Knee
An injury where the knee bends back too far damaging the structures at the back of the knee
Causes: Sporting injury where knee is pushed backwards e.g. awkward tackle or skiing
Symptoms: Sharp or aching pain behind the knee, swelling, bruising and instability. Worse standing, walking, going down stairs
Full Article: Hyperextended Knee
Deep Vein Thrombosis (DVT)
A DVT is a blood clot in one of the deep leg veins. If it breaks off it can lead to a heart attack or stroke
Causes: prolonged inactivity, certain medical conditions, pregnancy, obesity, genetics
Symptoms: Pain behind the knee or in the calf, swelling, redness, warmth, usually only on one leg
Self-Test: Pull your toes up towards you (your foot doing the work, not your hands) - an increase the pain behind the knee/calf indicates possible DVT
Safety Warning: A DVT is a potentially life-threatening condition. If you are showing symptoms of a DVT seek immediate medical attention
Hamstring Injuries
Overstretching the hamstring muscles on the back of the thigh beyond their elastic limit so they tear
Causes: Sudden, fast movements e.g. sprinting, lunging & jumping
Symptoms: aching behind knee/thigh, sharp pain behind the knee. Worse when bending knee or with sudden acceleration or deceleration
Common Pain Behind The Knee Questions
Here, you can find answers to the questions we are most commonly asked regarding symptoms associated with pain at the back of the knee.
What Causes Pain Behind The Kneecap?
Pain behind the kneecap is usually caused by a problem with the cartilage that lines the back of the kneecap. It may be Runners Knee, where a problem with how the kneecap glides causes friction and pain behind the kneecap.
In teenagers, pain behind the kneecap is often caused by Chondromalacia Patella, a condition where there is thinning of the cartilage on the back of the kneecap.
What Causes Tightness Behind The Knee?
Tightness behind the knee is often caused by tightness in the hamstring or calf muscles. The hamstring muscles run down the back of the thigh attaching behind the knee, and one of the calf muscles, gastrocnemius, arises from the back of the knee and travels down to the heel.
Tightness in these muscles is a common problem, particularly in men, and makes the back of the knee feel very tight. Simple knee stretches are the best way to treat the tightness.
What Causes Swelling Behind The Knee?
Swelling behind the knee is most commonly caused by a Baker's Cyst. Excess fluid in the knee joint, usually from an injury or knee arthritis, leaks out of the back of the joint.
This fluid fills the semimembranosus bursa and causing swelling behind the knee. It often feels like there is a squashy orange behind the knee.
What Causes Sharp Pain Behind The Knee?
If you are a runner, then sharp pain at the back of the knee often indicates a problem with the hamstring tendons, such as tendonitis. If you do a lot of cycling, then a sharp pain behind your knee is usually caused by tendonitis in one of the calf muscles, gastrocnemius.
If you have recently twisted your knee or had a fall, then a meniscus tear is probably causing the sharp pain.
What Causes Pain Behind The Knee When Bending?
The most common cause of pain behind the knee when bending is a Bakers Cyst. This is when there is inflammation of the semimembranosus bursa, a small sac filled with fluid that sits at the back of the knee.
If the bursa gets inflamed, then any time you bend your knee, the bursa gets squashed, causing posterior knee pain.
What Causes Pain Behind The Knee When Straightening The Leg?
The most common cause of knee pain when you straighten the leg is a meniscus tear, particularly if you've been sitting down or squatting for a while.
As the knee straightens out from a bent position, the torn, inflamed portion of cartilage gets squashed in the joint, causing pain in the back of the knee.
What Causes Pain Behind The Knee After Sitting?
Pain behind the knee after sitting for prolonged periods is often caused by arthritis. When we sit still, the fluid that lubricates the knee joint dries out slightly so when we then stand up, there is less cushioning.
The wear and tear associated with arthritis mean you can end up with the knee bones rubbing together, causing pain. Once you are up and moving about, the joint produces more synovial fluid so, after a few minutes of moving around, the pain eases off.
What's The Best Back Of Knee Pain Treatment?
The best treatment for back of knee pain will depend on what's causing the pain. Generally, the first step is to reduce any swelling, then work on exercises to improve the strength and stability of the knee to reduce the force that goes through the knee joint.
Want to Know More?
Just because there is pain in the back of the knee, doesn’t necessarily mean the problem is there. Pain can refer to different places so a problem around the front of the knee can produce a feeling of posterior knee pain.
Remember, the best way to accurately diagnose the cause of your pain behind the knee is to see your doctor.
Page Last Updated: 9/05/19
Next Review Due: 09/05/21
Related Articles
References
Posterior Knee Pain by S. English & D. Perret. Journal of Current Reviews in Musculoskeletal Medicine, Oct 2010
Pain Behind Knee? Injury vs. Disease-Related Causes from University Health News, March 2018
Bakers Cyst - NHS UK June 2018
Meniscus Tears - OrthoInfo. American Academy of Orthopedic Surgeons
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