Pain Behind The Knee: Common Causes And Treatments
Have you ever been standing at barbecue or party and felt you needed to sit down due to an aching pain behind your knee?
Have you ever been sitting at a movie theater and felt a sharp shooting pain behind your knee that distracted you from enjoying the movie?
Pain directly behind the knee is very common but can be misdiagnosed due to the amount of muscles, tendons, and tissues that reside there. Likely, you have searched the Google trying to find information on what could possibly be causing the pain behind your knee only to find scary and intimidating causes such as deep vein thrombosis or posterior cruciate ligament tear.
These are potential causes you want to pay attention to if you have had recent surgery, take blood thinners due to previous clotting, or had recent trauma to your knee. In these specific cases the course of action would be to call your doctor for a speedy appointment.
How about the majority of other cases though where the knee pain began without a know cause?
In this article we will explore the most common causes for pain in the back of the knee, but first lets peer into the anatomy of the back of the knee.
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Blood Clots Behind Knee
It is important to note that pain and swelling behind the knee may be associated with blood clots. Blood clots behind the knee are especially common for those on bed rest or prolonged laying down, recovering from surgery or who have experienced trauma to the knee. Age and weight may also be a factor in blood clots. If you are experiencing behind knee pain, see a doctor to diagnose your situation, especially as you may be experiencing a blood clot behind knee.
How Can You Prevent Knee Tendonitis
As processes such as increasing age cannot be changed, following certain preventive measures can be helpful in preventing knee tendonitis. Participation in sports is not a problem but following proper physiotherapy techniques and warm up procedures can prevent the occurrence of knee tendonitis.
Early identification of knee tendonitis and prompt treatment can prevent it from becoming severe enough to restrict day to day activities.
The muscles, tendons and other parts of the body need to be warmed up before beginning any activity that involves the continuous use of the joints. Simple warming and stretching exercises are necessary before getting started with any kind of sport activities. This helps to improve blood circulation and enables the muscles to get ready for the higher stresses associated with strenuous physical activity.
Stretching and squatting exercises are often beneficial in strengthening the knee joints and can thereby help prevent knee tendonitis.
Continuous sitting or standing for prolonged periods may also put undue pressures on the knees, making them prone to knee tendonitis. Intermittent walking or stretching the knee joint and the legs can be beneficial in improving the muscle health.
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Damage To The Ligaments Of The Knee
Ligaments are strong, flexible, fibrous and elastic connective tissue which connect one bone to another, provide stability and support joints. They do not connect muscles to joints, that is done by the tendons.
The ligaments of the knee comprise the medial and lateral collateral ligaments, on the inside and outside of the knee respectively, which give sideways stability to the knee joint, and the anterior and posterior cruciate ligament at the front and back of the knee. There is also a patellar tendon, which is really a ligament, which attaches the bottom of the patella to the top of the tibia.
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What Are Potential Complications
If you dont have medical treatment, patellar tendonitis can worsen. You may damage your tendon more severely, limiting your everyday functioning.
Resting your legs and stopping activity can be emotionally difficult for athletes, in particular. They may not want to stop playing, even though its painful. For professional athletes, patellar tendonitis can be a career-ender if left untreated.
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How Is Patella Tendinopathy Diagnosed
Your consultant will discuss your symptoms with you and examine your knee to check for tenderness, stiffness, swelling and any difficulties with movement. In most cases, they will arrange for you to have a magnetic resonance imaging or ultrasound scan to show the extent of the injury and any damage to the surrounding area.
Muscles And Tendons Of The Knee
Many muscles affect the knee, but the main muscles that allow for the knee to perform its main functions are:
- Quadriceps: A group of 4 muscles that sits on the front of the thigh. These muscles are responsible for allowing the knee to straighten. This movement is necessary for standing from a seated position, bringing your leg forward when walking, and kicking a ball! The two patellar tendons attach the quad to the patella. These tendons can also rupture during sports.
Quadriceps Muscle diagram
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What Do The Knee Ligaments Do
Knee ligaments have several important jobs. They:
- Absorb shock when the foot strikes a surface.
- Connect the thigh bone to the lower leg bones.
- Keep the bones in the proper position.
- Prevent the knee from twisting or collapsing.
- Stabilize the knee joint.
- Stop the knee from moving in any unsafe or unnatural directions.
Nagging Knee Pain Is No Fun
The problem is that knee pain is far too common: Research suggests about one in four adults will suffer frequent knee pain. Pay attention to the type of ache you experience since some causes for pain in the back of the knee warrant a trip to the emergency room. Miho Tanaka, MD, the director of the Womens Sports Medicine Program at Massachusetts General Hospital in Boston, says the things that warrant immediate medical attention are blood clotsthey can cause numbness and weakness in the legand fevers and redness associated with swelling. Although swelling in the knee has many causes, in rare cases, it could be a sign of an infection, so its a good idea to seek immediate care for that as well, says Steven Lyons, MD, an orthopedic surgeon at Florida Orthopaedic Institute in Tampa, Florida. He adds that knee pain experienced after a major trauma like a fall or a car accident means you need an ER visit. If the knee pain lingers longer than a week or two without any prior injury, Dr. Lyons recommends visiting a doctor instead.
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How Is Patellar Tendonitis Treated
Patellar tendonitis treatments mostly focus on managing your symptoms and strengthening the soft tissues in your knee. At first, your provider may ask you to try conservative therapies, such as rest. In minor cases, these measures may be enough to relieve your pain.
If the condition doesnt go away, your provider may recommend you:
- Take it easy: Avoid the activities or movements that trigger your symptoms. Pushing through pain may cause more damage to tendon tissues.
- Rest: Stay off your feet as much as you can. Rest gives your body time to heal.
- Apply ice: If you have swelling around your knee, placing an ice pack on the area for 15 minutes at a time, a few times a day, may reduce inflammation.
- Take pain relievers: Taking over-the-counter anti-inflammatory medicines as needed may be enough to relieve minor aches or knee pains.
- Support your knee: Your provider may recommend you wear a support device over the knee, such as a knee brace. Support devices may relieve the pain.
- Try physical therapy: A trained professional will guide you in doing special exercises and stretches. These motions slowly increase the strength and flexibility of injured tendon tissues. Physical therapy may also relieve some of your discomfort.
- Have surgery: Surgery to treat patellar tendonitis is rare. However, if imaging tests show a tendon tear, your provider may recommend surgery to repair the damaged tissues.
What Are The Types And Causes Of Knee Injuries
While direct blows to the knee will occur, the knee is more susceptible to twisting or stretching injuries , taking the joint through a greater range of motion than it was meant to tolerate.
If the knee is stressed from a specific direction, then the ligament trying to hold it in place against that force can stretch or tear. These injuries are called sprains. Sprains are graded as first, second, or third degree based upon how much damage has occurred. Grade-one sprains stretch the ligament but dont tear the fibers grade-two sprains partially tear the fibers, but the ligament remains intact and grade-three tears completely disrupt the ligament.
Twisting injuries to the knee put stress on the cartilage or meniscus and can pinch them between the tibial surface and the edges of the femoral condyle, potentially causing tears.
Injuries of the muscles and tendons surrounding the knee are caused by acute hyperflexion or hyperextension of the knee or by overuse. These injuries are called strains. Strains are graded similarly to sprains, with first-degree strains stretching muscle or tendon fibers but not tearing them, second-degree strains partially tearing the muscle tendon unit, and third-degree strains completely tearing it.
There can be inflammation of the bursas of the knee that can occur because of direct blows or chronic use and abuse.
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Popliteus Strain And/or Tendinopathy Causes
Popliteus muscle strains and tendinopathies most commonly occur in downhill skiers, and in runners and triathletes who compete on hills or uneven surfaces. The typical cause of injury is a direct blow to the inside of the knee, or a sudden forceful overextension/over straightening of the knee. Muscle weakness and poor dynamic stability can increase the risk of an injury during training.
How Can I Prevent Patellar Tendonitis
To reduce your risk of a sports injury, take these steps before you start any physical activity:
- Ensure a proper fit: Make sure all athletic gear fit your body type.
- Stretch it out: Give yourself at least five minutes before an activity to stretch major muscle groups. Regular stretching makes muscles and tendons more elastic. More elastic tissue is less likely to tear.
- Dont rush the warmup: Dont push your body to the max right away. A solid warmup gives your muscles time to wake up, which makes an injury less likely.
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When To See A Doctor
Without any pain, the tightness behind knee is probably not serious. If you cant immediately see a doctor, carry on with your normal activities, but be aware of any changes to your knee during and following exercise. If there is any increase in pain, stop what youre doing and seek medical attention straight away.
Knee Pain Caused By Nerve Aggravation
This is an incredibly common cause for pain in the back of your knee. As an official diagnosis, it refers to aggravation or compression of the sciatic nerve .
Most often, sciatica is caused by compression of the nerve roots in either your lower back or from soft tissue in the buttocks. People often describe the sensation as a pain that travels or shoots down their limbs, commonly hitting that tender spot behind the knee.
Sciatica is typically diagnosed in your 50s, though its possible for it to start as early as your 20s or 30s. Research estimates that, on average, you can have up to a 40% chance of experiencing sciatica at some point in your life.
Luckily, though, since its a common diagnosis that afflicts a wide population, theres plenty of research surrounding methods for alleviating that radiating pain.
The most effective solution is to seek physical therapy. Your treatment will likely focus on improving movement patterns that is, working on your movement during activities that compress or load the lower back. Depending on your general lifestyle habits, this could include anything from stretching to core strengthening, or lifting education and manual manipulation of the tissues.
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How Do The Anatomy Of Knee And Lower Leg Affect Movement
The knee is a hinge joint that sits between the thigh and the shin. It functions the same as a hinge on a door and sometimes gets a creaky as a hinge can. This joint allows the legs to bend and straighten, necessary for walking, going up and downstairs, going from sitting to standing, running, and jumping. The knee’s anatomy consists of many structures from the bones, tendons, and ligaments to the cartilage and muscles to help the knee function.
If you want to learn more about knee anatomy, please watch this knee anatomy video or this article Knee JOINT Anatomy.
Why Does The Back Of My Knee Hurt When I Straighten
The back of the knee may hurt when a person straightens their leg because of a variety of issues, including blood clots, muscle or tendon injuries, arthritis, or cysts. Physical therapy, rest, and pain medications are common treatments for many of these causes, but sometimes a person will need surgery treat the issue.
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What Causes Patellar Tendonitis
Patellar tendonitis happens when someone pushes knee tendon tissues too far, or too fast, over and over again. Repeated jumping and sprinting motions stress and strain the bands of patellar tendon tissues. Over time, lots of minor strains and tiny tears make the tendon tissues weak and sore.
This injury happens slowly over a long time. Medical experts still have unanswered questions about how or why patellar tendonitis occurs. Healthcare providers believe two main types of activities damage tendon tissues:
- Sudden, sizeable increase in activity .
- Returning to play at full strength after a break instead of slowly getting back into your regular routine.
How Is A Kneecap Tendon Tear Treated
- Non-surgical treatment includes wearing a knee brace to immobilise the knee for three to six weeks along with a course of physiotherapy. Your consultant may also advise that you have a course of shockwave therapy, a painless procedure where shockwaves are passed into the injured part of the knee to help speed up the healing process. In some cases, Activated Mesenchymal Pericyte Plasma injections can also help with healing
- Surgery: most people need to have tendon repair surgery in order to regain their normal range of movement and stability. This involves reattaching the torn tendon to the kneecap. The sooner this is carried out after an injury, the higher the success rate. Most people can return to their previous activities after surgery, although complete recovery can take 6-12 months
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How Are Knee Sprains And Tears Classified
A healthcare provider will grade your injury by how severe it is and what symptoms you have:
- Grade 1: A grade 1 injury to a knee ligament is a minor sprain. The ligament is overstretched or just slightly torn. With a grade 1 knee strain, youll have minimal pain, swelling or bruising. Youll still be able to put weight on the affected leg and bend the knee.
- Grade 2: A grade 2 knee sprain is a moderate tear of the ligament. Signs include bruising, swelling and some pain. With a grade 2 injury, youll have some difficulty putting weight on the leg or bending the knee.
- Grade 3: A grade 3 injury is a complete tear or rupture of the knee ligament. Grade 3 injuries often involve more than one knee ligament. With this level of injury, you will experience severe bruising, swelling and pain. You wont be able to put weight on the leg or bend the knee.
Tendon And Muscle Injuries Causing Pain Behind Knee
Tendon injuries often occur in runners due to overload. The tendons most likely to be affected include the hamstring on the inside or outside . Rarely, a small tendon called the popliteus wrapping around the outside of the knee joint can become swollen and painful.
In addition, hamstring muscle tears can occur close to the outside of the knee. Usually, these tears occur about 5cm above the knee joint. It is important to define the exact location of the tear, as location determines the time to return to sport.
Finally, a pulled calf muscle near the knee can also cause pain in this area.
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What Is The Prognosis For A Knee Injury
The goal for treating knee injuries is to return the patient to their previous level of activity. The prognosis for an individual injury depends upon the type of injury, the underlying health of the patient, and their willingness to work with their care provider and therapist to maximize their outcome.
Torn Anterior Cruciate Ligament
You hear a pop and can’t move after you suddenly change direction — often while playing soccer, football, or basketball. You may have torn your ACL, which connects the femur and the tibia and prevents the tibia from moving too far forward. Your knee will hurt and swell and feel unstable.
You can tear or strain any of the tissues that hold your knee together: Ligaments connect bones to each other tendons connect muscle to bone. Irritated tendons from using them too much? That’s tendinitis.
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Anatomy Of The Posterior Knee
Okay, before we get ahead of ourselves, lets first review the anatomy for the back of the knee.
Lets start by looking at the large muscle anatomy of the posterior knee. In the image above, you can visualize the two heads of the calf muscle and the multiple muscles that make up the hamstrings.
Another feature of the posterior knee is the gap behind the knee, where theres a distinct lack of soft tissue this is known as the popliteal fossa. In the deeper muscle layer of the posterior knee, youll find the popliteus and plantaris muscles.
Deeper still, youll find the posterior capsule of the knee joint and some important nerves that run along the back of the knee.
Alright! With that brief overview of the anatomy of the back of the knee, we can explore some of the most common diagnoses for posterior knee pain.