Pain Behind The Knee: Common Causes and Treatments

Experiencing pain anywhere in your body is never pleasant, but if you are fit and active, it can be a real block to your progress and success. The back of the knee is a common area for many athletes and individuals to feel pain. The knee is a complex joint, and one that takes a lot of stress on a daily basis.

Even simple, non-strenuous everyday activities can place a lot of impact on the knee, and causes can range from serious injuries, requiring immediate medical attention, to more common, mundane sources.

Pain Behind The Knee: Common Causes and Treatments

Similarly, the range of treatment options available varies depending on the exact nature of the issue – in many cases, damage to the knee can be reduced, or even prevented entirely, simply by avoiding excess strain and impact around and on the joint.

In most cases, the earlier the treatment is received, the better the result, and the less likely it is that the injury will worsen and become more serious.

There are a number of potential causes of knee injuries, and we will explore some of these in greater detail below.

It is important to note, however, that you should seek advice from your doctor, or another medical professional if you are suffering from a knee injury, as some causes can require a course of long-term treatment if you want them to heal completely, and avoid future damage or injury. Some of the most common causes include:

Leg Cramp

In many cases, pain behind the knee can be caused by muscles being worked too hard, without being properly stretched – for example, if you fail to stretch properly before or after exercise.

This can result in cramp in the leg, displayed by cramp in the back of the knee, and a sudden, very painful muscle spasm that lasts for between a few seconds and several minutes.

If you have been stretching properly but still experience cramping pain, you may have simply overused the muscle – if this is the case, you may also experience cramp in the calf or thigh.

In some cases, leg cramp may also be the result of dehydration, or due to a more serious condition such as an infection, excess toxins in your blood, problems with the nerves, and, in some cases, liver disease.

This is why it is important to seek advice from your chosen medical professional if you experience cramping on a regular basis. You may also be able to alleviate the pain by stretching properly before exercises.

Shortening your stride when running or walking also reduces the strain on your knees, building muscle and reducing the risk of pain.

As a note, it is worth stating that pregnant women are more likely to experience leg cramps during their pregnancy, though you should consult your midwife if you have any concerns.

Fluid, or “Baker’s Cyst”

Another common cause of pain behind the knee is a condition known as “Baker’s Cyst”. This occurs when a pocket of fluid builds up in the back of the knee and can result in painful swelling.

These types of cysts tend to start small, and it can take a while for them to become noticeable – initially, you may feel a pressure on the back of the knee, and the area may feel as though it is tingling.

As the cyst grows in size, however, it can start to place excess pressure on the nerves and tendons, and can even cause the muscles surrounding the cyst to shift – this can be very painful. If left untreated, Baker’s cysts will continue to grow and can reach the size of a tennis ball.

While Baker’s cysts can be left without treatment, starting and completing a course of treatment can help to reduce your pain and alleviate any symptoms – this is important if you are a runner, or if the cyst is causing you serious problems in your daily life.

Runners Knee

Another common ailment in active individuals, runners knee occurs when the cartilage in the knee joint is worn down, causing the bones of the knee to rub together.

This can be very painful, and may also result in weakness or restricted movement throughout the knee and leg. You may also find your knee giving out from beneath you without warning, and even experience a grinding or cracking sensation whenever you bend the knee.

In most cases, the runner’s knee will recover on its own, but you will need to make sure that you rest the affected area as much as possible. You can also ice the knee for 20-30 minutes every 3-4 hours, for around 2-3 days – this reduces the swelling and can alleviate pain.

Keep the knee wrapped and supported, and elevate it whenever you are sitting or lying down. Painkillers can also help, as can strengthening and stretching exercises, focusing on the quads. In extreme, rare cases, runners’ knees may require surgery to replace damaged cartilage or correct the position of the kneecap.

Pain Behind The Knee: Common Causes and Treatments

Hamstring Injuries

Tearing or straining the muscles in the back of the thigh, such as the biceps femoris, the semitendinosus, or the semimembranosus, can cause pain in the knee.

This occurs when the muscle is pulled too far and can tear completely – this usually requires a lengthy recovery period of rest. In extreme cases, surgery may be recommended. Hamstring tears and injuries usually occur in athletes who move in short, fast bursts, such as football or tennis players.

Meniscus Tears

The meniscus refers to a piece of cartilage that is located on either side of the knee. This can be torn when you are bending or squatting, and you will typically hear a loud “pop” when this occurs.

While pain may not be apparent immediately, you may start to feel pain around the knee and joint over the next few days, and find that your knee is swollen and weak, without the usual range of motion.

You may also notice your knee locking up when you try to weight bear, or buckling from beneath you. While meniscus tears generally heal on their own with plenty of rest, a severe tear may require surgery.

Anterior Cruciate Ligament Injuries

Another common area of injury is the anterior cruciate ligament, known as the ACL. This is a band of tissue running connecting the bones of the knee joint, running through the front of the knee to maintain stability in the joint.

Athletes who stop and start a lot, or who suddenly change direction, are more prone to this injury and, as before, you may hear a “pop” as the ligament tears, followed by later pain and swelling in the affected area.

Tearing this ligament is considered a serious injury, and has been known to bench pro athletes for a long time – in some cases, even putting them out of the game permanently. In most cases, you will require reconstructive surgery to fix the injury.

Posterior Cruciate Ligament Injury

The posterior cruciate ligament (PCL) is similar to the ACL, though its position behind the knee means that it is less prone to injury.

This is typically caused by falling directly onto the knee from a great height and can cause pain, swelling stiffness, and loss of mobility in and around the knee. Most PCL injuries will heal on their own, but a few may require surgery if the tear is particularly nasty.

Deep Vein Thrombosis

A lesser-known cause of knee pain can be deep vein thrombosis, also known as DVT. This occurs when blood clots form in the veins deep within the legs and can cause pain in the knee and wider leg when standing up.

If you notice that your knee and leg appear swollen, and bears prominent, clearly visible surface veins, you should seek medical assistance as soon as possible, as you will need immediate medication and care.

You may also notice that the skin feels warm to the touch, and is slightly red. Being older, overweight, and a smoker puts you at higher risk of developing DVT, as can a predominantly sedentary lifestyle.

Osteoarthritis

A slightly more serious cause of knee pain can come from osteoarthritis, a condition that gradually wears down the cartilage of the joints, causing pain over time.

The pain often comes alongside other symptoms, such as having trouble bending your knee to walk or run comfortably, and a reduced range of motion.

In some cases, you may lose motion altogether. Osteoarthritis typically comes with inflammation of the joint, leading to a “hot” feeling, as well as stiffness.

The symptoms are not usually restricted to the back of the knee; if you are suffering from osteoarthritis, then the chances are that you will also feel discomfort, and even pain, all around the knee and upper leg.

In some cases, osteoarthritis can be caused by a more serious underlying condition, such as rheumatoid arthritis or lupus, and this means that you should seek professional medical advice.

The bad news is that there is no cure for the condition, but it will not degenerate or grow worse over time. The main treatments include lifestyle changes, such as maintaining a healthy weight and getting plenty of exercise.

Carrying too much weight or being obese places additional strain on your joints, and this can increase your risk of osteoarthritis.

A good exercise plan is also important, and you should focus on improving your general, overall fitness, as well as focusing on exercises that strengthen your muscle – this will, in turn, strengthen your joints.

It is important to consult with your doctor or a physiotherapist prior to embarking on a diet or exercise plan, and make sure that any weight loss is safe and sustainable, and that further damage is not done to the joints.

You may also benefit from pain relief medication such as opioids, or from taking non-steroidal anti-inflammatory drugs (NSAIDs), which reduce inflammation and can be applied topically to your joints.

In some cases, your doctor may prescribe capsaicin cream – this works by blocking nerves that send pain signals to the brain in the affected area – or offering steroid injections, which can ease the pain for several weeks, or even months, at a time.

While medicines and changes to your lifestyle are important for limiting symptoms from osteoarthritis, you may also benefit from additional supportive treatments alongside these.

Transcutaneous electrical nerve stimulation (more commonly known as TENS) is a pain relief technique more commonly associated with childbirth, but can ease the pain of osteoarthritis.

The machines work by sending electrical impulses through sticky electrodes attached to the skin and can numb nerve endings located in your spinal cord, which are responsible for controlling pain.

Hot and cold packs are another way to alleviate pain, and you may also benefit from assistive devices such as insoles or special footwear.

Physiotherapy can also help to keep your joints supple and, in some cases, surgery may be recommended – this is usually after all other treatments have been exhausted, or the joint is severely damaged, such as a knee replacement, joint fusing, or an ostomy to add or remove bone around the knee, helping to realign the way weight is supported.

Final Thoughts

Knee pain can have a number of sources, and it is important to take a closer look at your symptoms to ensure that you receive the best care for your condition.

You can also prevent the chances of injury by ensuring that the muscles located around your knee are stretched properly every day – this includes the hamstrings, calves, and quads. This helps to build strength in the muscles and allows them to respond better to activity, reducing your chances of some of the more common injuries.

If you do find yourself suffering from knee pain, most medical professionals will recommend “RICE” as a first response – Rest, Ice, Compression, Elevation. This can reduce swelling and alleviate pain, as well as helping to prevent the injury from getting worse.

Painkillers and NSAIDs are also helpful. Ultimately, however, you should always consult a qualified medical professional; – they will be in the best position to assess your injury or condition and can set out a personalized, tailored plan to ensure that you make the best possible recovery.

Matt Williams