Pain in the back of the knee or pain at the back of the knee can be caused by various factors. The complaints that may occur at the back of the knee depend on the cause. Common complaints are nagging, burning, stabbing pain, swelling and/or stiffness, i.e. the inability to move the knee (properly). Pain in the back of the knee can occur when stretching, bending, squatting, sitting, walking, cycling, standing up and other situations. Treatment of knee complaints depends on the cause. Most posterior knee complaints are the result of overloading certain structures due to trauma, accident or twisting, poor warm-up before exercising, structural overload (for example due to certain work), sagging of the feet or osteoarthritis of the knee. . If you have a painful knee joint, consult your doctor in a timely manner for a proper diagnosis and adequate treatment. The sooner the treatment starts, the more beneficial it is.
- Pain in the back of the knee or pain at the back of the knee
- Knee
- Popliteal fossa
- Causes of pain in the back of the knee
- Additional symptoms
- Damage to ligaments, tendons, muscles, bones or cartilage
- Popliteus tendinitis
- Torn meniscus
- Sprained or torn posterior cruciate ligament
- Plica syndrome
- Hamstring injury
- Muscle cramps in the leg
- Rheumatic conditions
- Knee osteoarthritis
- Rheumatoid arthritis
- Infectious knee arthritis
- Pain in the back of the knee in children
- Growing pains
- Sinding Larsen Johansson syndrome
- Osgood-Schlatter disease
- knee pit cyst (Baker’s cyst)
- Veins and blood vessels
- Thrombotic leg
- Varicose veins on the legs and back of the knee
- Nerve compression
- Other causes of a painful popliteus
- Examination and diagnosis
- Interview and physical examination
- Visual art investigation
- Treatment of pain at the back of the knee
Right knee seen from the right side / Source: BruceBlaus. When using this image in external sources it can be cited as: Blausen.com staff (2014). , Wikimedia Commons (CC BY-3.0)
Pain in the back of the knee or pain at the back of the knee
Knee
The knee is a complex hinge joint, meaning that the knee joint can move in one direction: extension and flexion. However, the knee can also make small rotational movements. This is because the joint cavity contains two wedge-shaped cartilage discs, which are attached to the top of the tibia. The knee is located between the femur, shinbone and kneecap. A fibrous capsule around the joint connects the three bones together.
Popliteal fossa
The hollow of the knee mainly contains attachments of muscles, nerves and blood vessels. The muscles at the back of the knee, those of the upper leg and the lower leg ensure that the knee bends. The attachment of the posterior cruciate ligament is located at the top of the back of the tibia.
Causes of pain in the back of the knee
Pain at the back of the knee or pain in the back of the knee can have various causes. Most posterior knee complaints are the result of overloading certain structures due to trauma, accident or twist, poor warm-up before exercising, structural overload, sagging of the feet or osteoarthritis of the knee.
Additional symptoms
There may be mild to severe pain in the back of the knee. This pain can be experienced as stabbing, dull, aching or throbbing. It depends on the cause whether you have any other symptoms. Pain in the back of the knee is often accompanied by swelling, a feeling of fullness, stiffness or pain when making certain movements and a limited range of motion. If there is a swollen and tender calf, it is important to consult a doctor because the swelling may also be the result of a blood clot in the leg (deep vein thrombosis), which needs to be treated urgently to avoid complications.
GP examines knee / Source: Denis Simonov/Shutterstock.com
Damage to ligaments, tendons, muscles, bones or cartilage
Excessive strain, damage or disease of muscles, ligaments, tendons, cartilage or bones can result in pain in the back of the knee.
Popliteus tendinitis
The popliteus muscle or knee pit muscle functions as a knee flexor, rotating the shin bone inward. This muscle can start to play tricks on you if it is overstretched. For example, you have walked up and down hills with a braced knee during a (long) walk or you have raised your leg with your foot on a stool for a longer period of time. Activities such as walking in loose sand and running downhill can irritate the popliteus tendon, which can cause inflammation. Complaints mainly occur on the outside of the knee, especially during rotational movements. The pain can also be located in the back of the knee. When the popliteus tendon is inflamed, it is called ‘popliteus tendonitis’.
Torn meniscus
There are two pieces of cartilage in the knee: the inner and outer meniscus. These also work as a kind of shock absorbers. When you twist with a bent knee while the lower leg bears the weight, a meniscus can tear. While a tear in the outer meniscus causes pain on the outside of the knee, a tear in the inner meniscus causes pain on the inside of the knee.
Sprained or torn posterior cruciate ligament
There are two cruciate ligaments in the knee: the anterior and posterior cruciate ligaments. Damage to the posterior cruciate ligament is less common than damage to the anterior cruciate ligament. It often occurs when a lot of force is exerted on the knee, for example during a traffic accident.
Trauma to knee due to car accident / Source: Dmitry Kalinovsky/Shutterstock.com
Plica syndrome
There is a fibrous capsule surrounding the knee joint, which contains four folds. A Plica Syndrome indicates irritation of a capsular fold. This often involves the capsular fold on the inside of the knee, which runs from the bottom of the kneecap to the inside of the thigh. The main complaint of an irritated plica is pain, especially on the inside of the knee but it can also affect a larger area. The syndrome can gradually develop due to certain activities and movements that involve a lot of bending/stretching movements, such as cycling, climbing stairs and walking. However, it can also be caused by an acute injury, for example direct trauma to the inside of the knee due to a car accident or during sports.
Hamstring injury
Acute injuries to the hamstrings or hind thigh muscles often occur during exercise, where poor warm-up, poor fitness or over-fatigue of the muscle can play a role. It concerns a muscle tear of the rear thigh muscles on the inside of the leg. This injury is characterized by a sudden stabbing and sharp pain at the back of the thigh near the knee.
Muscle cramps in the leg
Muscle cramps or leg cramps can cause pain behind the knee. Cramps occur when muscles become too tight. This tightness may be because the muscle is being strained too much without being stretched. If it is stretched and cramps still occur, there may be an overexertion. Other possible reasons for leg cramps include:
- dehydration: loss of too much fluid and salts can cause dehydration and a lack of salts can cause muscle cramps
- liver disease or kidney disease, which causes excess toxins to build up in the blood and can affect the nerves
- With an accumulation of waste products, the muscles can contract quickly to accelerate the removal of waste products and in this way muscle cramps can also occur.
- deficiency of salts due to chronic kidney damage and this deficiency can cause cramps
- too high potassium levels in the blood due to kidney damage and too much potassium causes the muscles to contract
Women who are pregnant may also experience leg cramps which is a common pregnancy complaint.
Osteoarthritis of the knee / Source: Blausen.com staff, Wikimedia Commons (CC BY-SA-4.0)
Rheumatic conditions
Knee osteoarthritis
Osteoarthritis is not wear and tear, but a rheumatic condition in which the quality of the articular cartilage gradually decreases, with complaints such as stiffness and joint pain. With osteoarthritis in the knee, the cartilage in the knee joint changes. The complaints are pain and stiffness in the knee, especially in the morning when you get up. The complaints decrease through exercise. After fifteen minutes of exercise you will notice a clear improvement. The knee can also become inflamed. The knee becomes swollen and warm. In osteoarthritis of the knee, extra bone can also grow at the edges of the knee joint, causing the knee to become ‘bony’.
Rheumatoid arthritis
The most common inflammation of the joints is rheumatoid arthritis (RA). This is a chronic, inflammatory rheumatic joint disease based on a malfunction of the immune system. It is a so-called autoimmune disease. This means that the immune system turns against your own body. The immune system attacks harmless substances and structures in the body, in this case the knee. This leads to permanent inflammation, which damages and destroys the articular cartilage and ultimately the entire joint.
Rheumatoid arthritis in the knees is characterized by painful swelling of the knees, morning stiffness (stiff knees in the morning), weakness and a general feeling of illness, as just like in a ‘real’ disease, the immune system runs at full speed to combat the perceived destroy evil.
All treatments are aimed at inhibiting the inflammatory response in the knee. Physiotherapy can provide relief, but in severe cases immunosuppressants are also used. These are medications that suppress the body’s immune system and thus stop inflammation.
Infectious knee arthritis
Infection-related arthritis in the knee can be caused by bacteria (bacterial knee arthritis), viruses (viral knee arthritis) or fungi (fungal arthritis), which enter the knee joint via the bloodstream or during surgery. Possible bacterial pathogens of infection-related inflammation in the knee include staphylococci and streptococci. Viral inflammation in the knee can, for example, be caused by certain hepatitis viruses or the rubella (causing rubella) or mumps virus. Fungi that can cause inflammation in the knee are the yeast Candida parapsilosis and Candida krusei. Like rheumatoid knee arthritis, infection-related knee inflammation can lead to pathological and irreversible changes in the structures of the knee joint due to the inflammation-related damage to the cartilage.
Infectious arthritis is accompanied by severe pain, fatigue, headaches and body aches. Depending on the severity of the infection, fever may also occur. A bacterial infection can cause severe knee swelling.
Normally, the body is able to fight the infection successfully and the symptoms disappear on their own after a while. Anti-inflammatory medications can relieve symptoms. If bacteria or fungi are the cause of the infection, antibiotics or antifungal medications, respectively, may be prescribed to combat them.
Pain in the back of the knee in children
In children, pain in the back of the knee can have several causes. The most important are:
Growing pains
Children aged 4 to 12 years can suffer from so-called ‘growing pains’. A child complains of deep pain in both legs, usually around the knees, calves, shins or thighs. It mainly occurs at the end of the day and at night. A child often suffers from this during the day.
Sinding Larsen Johansson syndrome
Sinding Larsen Johansson syndrome is a relatively common condition in young people aged 10-15 years. This involves overloading the growth plate at the bottom of the kneecap. It occurs during the period when there is a growth spurt. The condition goes away on its own, although the symptoms can last for a long time: from a few months to more than a year.
Osgood-Schlatter disease
Osgood-Schlatter disease is an overuse injury of the knee during growth. The condition is mainly seen when a rapidly growing child participates in intensive sports. This then creates a temporary imbalance between the strength of the muscles at the front of the thigh and the quality of the tendon attachment. It mainly occurs in boys between the ages of 10 and 15 and girls between the ages of 8 and 13, more often in boys than in girls. This condition causes a visible and warm bump under the knee that is tender.
knee pit cyst / Source: Alila Medical media/Shutterstock.com
knee pit cyst (Baker’s cyst)
A knee pit cyst, also called ‘Baker’s cyst’, is a small, often painless swelling in the hollow of the knee, which is often caused by an underlying condition in the knee, for example osteoarthritis (see above). Someone with such a cyst often suffers from a tight feeling in the back of the knee and bending the knee is often difficult. In children, a knee pit cyst can develop for no apparent reason.
Veins and blood vessels
Thrombotic leg
Thrombosis refers to the development of a clot in a blood vessel. Such a clot can block a blood vessel in the leg. With a so-called leg thrombosis, a blood clot develops in the deep veins of your leg, usually the lower leg. A thrombosis often initially causes deep pain in the calf and at a later stage swelling of the lower leg and ultimately the upper leg may also occur. The leg then feels tense.
Varicose veins on the legs and back of the knee
Varicose veins are dilated veins and mainly form in the calf, back of the knee and the inside of the thigh. In rare cases this may be accompanied by pain or bleeding from a varicose vein. A large varicose vein can arise from the hollow of the knee at the back of the calf. This often causes complaints. It can also eventually damage the skin.
Nerve compression
The fibular nerve (peroneal nerve) divides in the hollow of the knee. This nerve can become pinched. This causes severe nerve pain in the back of the knee that radiates to the entire knee and lower leg. Such nerve compression is often the result of an accident and/or bone fracture.
A sprained knee / Source: Genus photographers (Tomas Gunnarsson), Wikimedia Commons (CC BY-SA-4.0)
Other causes of a painful popliteus
There are a number of other causes of a painful popliteus, such as:
- (rarely) a benign or malignant tumor
- a sprained knee or bruised knee
Examination and diagnosis
Interview and physical examination
The doctor takes your medical history into account and asks questions about complaints, such as:
- What kind of pain do you experience?
- When did the pain start?
- Does the pain come and go or is it constant?
- Is there a functional limitation?
- Do you suffer from other complaints?
After the interview, the doctor will perform a physical examination. Blood tests may follow if necessary.
Visual art investigation
An ultrasound or x-ray may also be necessary. For more serious injuries, doctors may use an MRI or CT scan to get a complete picture of the knee area.
Treatment of pain at the back of the knee
Resting, elevating and cooling the affected knee are important first aid measures. In many cases, this can help reduce symptoms, such as pain and swelling. Nonsteroidal anti-inflammatory drugs (NSAIDs) are another way to relieve pain and swelling while the knee heals. Some NSAIDs, such as ibuprofen, can be taken orally or applied topically in the form of a gel. In some cases, doctors may recommend a corticosteroid injection to reduce symptoms. An injection of corticosteroids into the joint, in the tendon sheath or around the nerve inhibits inflammation, which reduces swelling and pain and allows you to move better again. The doctor may also suggest treatment that includes physical therapy or surgery, depending on the severity.
read more
- Knee pain: stabbing, burning or aching knee pain
- Knee pit cyst or Baker’s cyst: symptoms and treatment
- Tendonitis: tendinitis in the shoulder, wrist, knee or thigh
- Knee pain or painful knee: pain inside or outside
- Joint pain, pain and stiffness of the hip and knee: osteoarthritis
