Why Am I Getting Pain At The Back Of My Knee
Published on: 4th February 2020
When it comes to knee pain, we often tend to think first of the front and sides. But pain that comes from the back of the knee is probably every bit as common.
It would be helpful if there was a single likely reason for this! But in fact the causes of back-of-knee pain can be very diverse. You could experience it as a sudden pain or a gradual ache. There may be swelling and inflammation or none at all. You might find it difficult to fully extend your leg.
In other words we need to do some narrowing down to find out whats going on. One useful starting point is to think in terms of problems inside or outside the knee joint: in medical-speak, intra- or extra-articular causes. Lets have a look at the most common ones.
Muscle Tendon Injuries Mcl And Lcl Injuries Acl Injuries And Meniscus Tears
Muscle Tendon Injuries
Almost all of these strains are treated with ice, elevation, and rest. Sometimes compression with an Ace wrap or knee sleeve is recommended, and crutches may be used for a short time to assist with walking. Ibuprofen or naproxen can be used as an anti-inflammatory medication.
The mechanism of injury is either hyperextension, in which the hamstring muscles can be stretched or torn, or hyperflexion, in which the quadriceps muscle is injured. Uncommonly, with a hyperflexion injury, the patellar or quadriceps tendon can be damaged and rupture. This injury is characterized by the inability to extend or straighten the knee and a defect that can be felt either above or below the patella . Surgery is usually required to repair this injury.
Except for elite athletes, tears of the hamstring muscle are treated conservatively without an operation, allowing time, exercise, and perhaps physical therapy to return the muscle to normal function.
MCL and LCL Injuries
There Is No Easy Surgical Solution For Anterior Knee Pain
The mere fact that there are likely to be ten or more described surgical techniques to try and treat pain in the front of your knee should give you pause. That usually means that none have been very successful, so we keep trying new ones. Surgery for anterior knee pain has not been proven to be more effective than a proper exercise program.
Some procedures have drilled holes into the patella, thinking that excess pressure may have been the cause of pain. Did it work for some people? Maybe but with that pesky placebo thing, we always hear about, we dont know because this procedure was never tested against control or sham. Besides having holes drilled through your patella might cause it to break if you fall on it or if you are hit in front of your knee.
One prolific Spanish author wrote about burning the tissues around the patella. We call that a denervation procedure. Thats because when you heat the tissues, you will fry the nerves to that region. The thought behind this procedure was that the patella is fed by nerves that could easily be burned using an arthroscopic approach. This procedure was also never evaluated against a control group or a sham group- so we just dont know if it works.
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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 don’t 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.
Symptoms Of Outer Knee Pain
Pain may be dull and aching, or sharp and localised. You may have swelling from fluid collecting or your knee may click or lock .
With iliotibial band syndrome, you may have pain all over the outside of your knee or the pain may be sharp and in one area. You may get pain when running and when doing anything that causes you to bend and straighten your leg repeatedly, such as cycling or going up and down stairs.
Lateral collateral ligament injury causes pain over the outside of the knee, which may focus on the mid-point of the knee joint. This ligament helps to keep the knee stable, so you may feel as if your knee is going to give way. You may have swelling around the knee or pins and needles in the foot. Some people find the pain worse when walking or running on uneven ground.
Symptoms of a torn meniscus cartilage generally come on up to a day after the initial injury. Pain and swelling may increase and you may have difficulty fully straightening your leg. Pain can come and go. Swelling may improve over days or weeks but get worse again after exercise. The knee may also feel stiff and lock or catch.
Pain from an anterior cruciate ligament injury will be sudden and you may hear a pop. The knee is likely to swell from internal bleeding and may feel as if it is going to give way.
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How Do You Treat Anterior Knee Pain
Pain in the front of the knee is usually treated successfully without surgery. This may take some time. It is not unusual for the pain to last for many months. Many of you will respond to physical therapy, which should focus on your hips, yes, your hips and pelvic muscles as much as it focuses on your thigh muscles. Runners who focus on a strengthening program might repeat might have a lower incidence of anterior knee pain.
Anatomy Of The Knee Joint
The large femur sits atop the tibia, much like two pillars stacked on top of each other. The smaller fibula bone is on the outside of the tibia in the lower leg. The fibula provides some weight bearing, but not nearly as much as the tibia does. At the end of the femur are two large condyles with rounded edges that allow for the rocking or hinging motion associated with knee movement.
In between the femur and the tibia are fibrocartilage shock absorbers, or meniscus. Several large stabilizing ligaments on the inside and outside of the knee prevent excessive forward and backwards movements. These stabilizing ligaments include the Anterior Cruciate Ligament and Posterior Cruciate Ligament .
The patella bone sits in front of the femur and slides in a groove. The backside of the patella is covered with hyaline cartilage along with the front side of the groove on the femur, which minimizes the friction as the patella slides. The patella is a large sesamoid bone, which means it is surrounded in muscle or tendon. Sesamoid bones act as a pulley system to change the direction of forces, in this case from the quadriceps muscle to the tibia.
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How Can I Manage Or Treat My Anterior Knee Pain
- It is most often caused by overuse so try and identify aggravating factors and reduce them
- Look at any lifestyle changes, have you changed job, have you put on weight or changed your shoes. Try and reverse what you may have identified as the cause, especially if the changes coincided with the onset of the knee pain
- Stretch the muscles that support the knee joint. Stretches should be held for 30 seconds. Please see lower limb stretching video
- Strengthen the muscles that support the knee please see lower limb strengthening video
- Gradually return to normal activity as pain improves
Most Common Knee Instability Causes
The most common causes of knee instability include the following.
- Ligament sprain: Sprain of the knee ligaments, which means these ligaments have had their fibers damaged due to wear and tear, sudden stress, or direct trauma.
- Ligament tear: Tear of the ligaments, meaning the fibers have been partially or completely torn through. This usually happens when you run and then make a sudden change of direction the knee stays pointing one way while the rest of you twists the other way.
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How Is Knee Pain In Teens Diagnosed
Your healthcare provider will ask about your teens knee pain:
- Is there a known cause for the knee pain does it happen with certain movements or is there no specific known event?
- How long has the pain been present?
- Where on or around your knee do you feel pain?
- Does the pain wake you up at night?
Your provider will perform a physical exam, checking:
- Kneecap and knee stability.
- Alignment of lower leg, kneecap and thigh.
- Range of motion of hips and knees.
- Thigh muscle strength, flexibility, firmness.
Your provider may order imaging tests including X-rays or a CT scan or MRI .
What’s The Outlook For Teenagers With Pain In Their Knees
Most knee pain in teenagers can be managed with simple treatments. However, many soft-tissue tears and bone breaks require surgery. Most teenagers recover without long-term problems if they follow the recover plan provided by their healthcare providers. Because there are many causes of knee pain, be sure to ask your healthcare provider for specific information on long-term prognosis for your teen’s knee condition.
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Who Gets Pfp Syndrome
Patellofemoral pain syndrome usually happens in people who do sports that involve a lot of knee bending and straightening, such as running, biking, and skiing. It also can happen to people, particularly young women, who do not do a lot of sports.
PFP syndrome is more common in women and happens most often to teens and young adults.
Tight or weak leg muscles or flat feet can make someone more likely to get PFP syndrome.
Other Causes Of A Swollen Knee
Usually, knee swelling remains inside the knee joint as the joint capsule acts like a barrier, preventing the fluid from escaping.
However, it can also occur outside the joint capsule, known as extra-articular swelling. The most common types of swelling outside the joint capsule are:
1. Knee Bursitis:Bursa are small fluid filled sacs that sit between bones and soft tissues to reduce friction. If there is excessive friction on them, they get inflamed. You tend to get pockets of swelling rather than general swelling of the whole knee.
Swelling in front of the knee cap of usually caused by Pre-Patellar Bursitis, aka Housemaids Knee.Swelling behind the knee, often like a squashy orange, is usually due to Popliteal Bursitis, aka Bakers Cyst. Swelling on the inner side of the knee may be due to Pes Anserine Bursitis. Visit the Bursitissection to find out more, including treatment information.
2. Haematoma: Blunt trauma to the soft tissues around the knee can cause bleeding. The blood collects around the muscles and can build up into a hard lump. If there is only a small amount of bleeding it is usually referred to as a contusion/bruise.
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What Are The Signs & Symptoms Of Pfp Syndrome
Patellofemoral pain syndrome causes pain under and around the knee. The pain often gets worse with walking, kneeling, squatting, going up or down stairs, or running. It may also hurt after sitting with a bent knee for a long time, such as in a long car ride or in a movie theater.
Some people with PFP syndrome feel a “popping” or creaking after getting up from sitting or when going up or down stairs.
Why Does My Knee Hurt When I Climb The Stairs
Self Care, Exercise, Arthritis, Knee
Joe asked himself that question every time he stood at the bottom of the steps and looked up at the landing. The stairs had become a physical endurance test. Each step caused searing pain in his knees no matter how slowly or carefully he climbed. The pain, which started in his right knee, now affected his left. Most of the time, Joe avoided the stairs by sleeping on the couch in the den and storing his clothes in the desk drawers. But, today he needed his suit from the bedroom closet.
Has knee pain ever caused you or a loved one to avoid activities?It may be due to damaged cartilage in your knee. The clinical name for the condition is chondromalacia patellae, also known as Runners Knee.
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Knee Pain When Standing Up From Sitting Position
Patellofemoral occurs when the nerves sense pain in the soft tissues and the bone around the kneecap. Soft tissues at the knee include the fat pad beneath the patella, the tendons, and the synovial tissue lining the knee joint.
Patellofemoral pain is sometimes associated with a condition called chondromalacia patella, which means the softening and consequent breakdown of the articular cartilage on the underside of the kneecap. Remember, the articular cartilage doesnt have nerves. Any damage to this structure doesnt cause pain but results in inflammation.
Why Does The Back Of My Knee Hurt When I Walk
A Bakers cyst is a pocket of fluid that builds up in the back of the knee, leading to pain and swelling. Bakers cysts may not be noticed at first, as small cysts do not typically cause pain. However, as the cyst grows, it may shift the surrounding muscles or put pressure on tendons and nerves, causing pain.
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Delayed Knee Swelling After An Injury
If a swollen knee develops anything from a few hours to a few days after an injury, it is most likely due to an increase in the synovial fluid in the joint a knee effusion.
This happens when something inside the knee is damaged slightly causing irritation and a resultant increase in synovial fluid. The amount of swelling varies but it tends not to be as much as with a haemarthrosis and the swollen knee doesnt usually feel tense.
The most common causes of a knee joint effusion are:
1. Meniscus Irritation: Compression or a small tear in the outer part of the cartilage lining the joint – the inner part of the meniscus has a poor blood supply so doesnt tend to bleed much when damaged.
2. Knee Sprain:Where one of the knee ligaments is overstretched, damaging a few fibres, but the ligament remains intact.
The amount of knee swelling may vary day to day and it may feel like it comes and goes as the injury is healing. It usually takes 6-12 weeks for soft tissues to heal, but cartilage injuries can take longer, as the cartilage has a very poor blood supply.
Visit the Knee Injuries section to find out more about these common causes of fluid on the knee, including symptoms and treatment options.
Knee Motions And Movements
Normally the knee goes through a hinge motion with a slight amount of rotation. When the muscles cannot properly stabilize and support the knee during these movements, the knee feels weak or wobbly. Weakness is more prevalent while going up or down stairs, or descending on a decline. These movements place increased stress on the knee and require greater stabilization from all the muscles.
There are several types of muscle dysfunctions that lead to knee injuries. Muscle strength is how much force we can generate, while endurance is how long those muscles can properly contract. Another dimension of muscle control is stabilization, which requires many muscles to work together to keep the knee in the proper position. With age and inactivity, we commonly lose strength, endurance, and stability.
Treatment improves strength, endurance, and stability to reduce the stress and strain on the knee. Treatment restores normal muscle function and movement patterns. A strong and stable knee does not buckle or wobble when walking on an unstable surface or going up and down stairs.
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Tips For Walking When You Have Sensitive Knees
Sensitive knees can be a challenge for walking, but it is a recommended way to maintain your function and reduce your symptoms. If you have knee pain due to osteoarthritis or other causes, you don’t have to let that keep you from starting a walking program.
A regular program of walking can reduce stiffness and inflammation and it won’t make most chronic knee conditions worse. Walking is the preferred exercise by people with arthritis, and can help you improve your arthritis symptoms, walking speed, and quality of life, according to the CDC.
Walking is part of a healthy lifestyle to keep your heart and bones strong and your joints functioning. Here are tips for walking when you have sensitive knees.