Pain in Back of Knee – Causes, Treatment & Prevention | Pain Care

Pain in Back of Knee – Causes, Treatment & Prevention

Pain behind the knee also called as posterior knee pain or pain in back of knees. This pain ranges in the severity from very mild to sharp pain at the back of the knee. 

The knee is considered one of the biggest joints in the body. It bears most of the body weight and much more susceptible to injuries and fractures.

As you might know, these knee pain can originate from various causes and not all of them damage the knee joints.

This pain usually manifests in form of discomfort, inflammation, redness, and hotness of the joint, stiffness, and eventually achy pain. Some of them heal spontaneously with rest and others require medications and surgical intervention.

As per the 2012 study, Published in Annals of Internal Medicine, the prevalence of the knee pain is increasing over the last 20 years. They also reported that obesity is a major cause of such increase in the prevalence of knee pain.

Here is a must watch video if you have the pain in back of knees. It explains the basic reason and do it yourself techniques to get rid of knee pains.

Causes of Pain in Back of Knees

Here we are going to review the most common causes of the pain behind the knee and how to fix it.


Baker's Cyst

Baker cyst, also known as a popliteal synovial cyst, is the most common cause of pain behind the knee. It is a fluid-filled sac that is formed behind the knee. It is made of synovial fluid in response to some form of cartilage damage. 

Bakers Cyst

Normally, the synovial fluid is a lubricant for the knee joint. However, if you had arthritis, cartilage tear or knee injury, your knee will secret so much synovial fluid that will accumulate and form a cyst behind the knee. Osteoarthritis represents 50% of cases developing a popliteal cyst. Baker's cysts are commonly affecting the women, especially older than 40.

Symptoms of Baker Cyst Include:

  • Pain and Swelling behind the knee.
  • Tightness and stiffness which get worse when flexing or extending the legs.
  • Sharp pain in the knee, especially if you are active. This is usually due to the cyst burst


Usually, Baker's cysts resolve spontaneously. You can use ice packs to reduce the inflammation along with Non-steroidal anti-inflammatory drugs (NSAIDs).

If your baker's cyst did not go away with ice or compression or it was big enough, here you might need steroid injection, cyst drainage and aspiration, and physical therapy.


You will also need to address the underlying conditions such as arthritis or cartilage tear. Furthermore, surgery might be needed if you have any cartilage problems needed to be addressed.


Meniscus Tear

​The meniscus is a wedge-shaped cartilage that helps to stabilize and reduce the fraction of your knee joint.

It also acts as a cushion between the femur above and the tibia below. Each knee joint has two menisci- one each side of the knee.

Meniscus Tear

Sometimes, Athletes tear the back of he menisci when they twist their knee. Moreover, the older people get their menisci degenerated and more likely to be torn.

When you tear your meniscus, you will hear "popping" sound. At the beginning, the tear will not hurt so much. However, you will feel the pain a few days later.

Symptoms of the meniscus tear include:

  • Pain, swelling, and stiffness behind the knee.
  • Instability and locking of the knee.
  • Difficulty to extend your knee

Those symptoms vary depending on the extent of the tear. They are aggravated by walking, squatting, running, and doing activities. The onset can be sudden during knee twisting or insidious through wear and tear.


PRICE " Protect, Rest, Ice, Compression, Elevation" of the leg, physical therapy, and meniscus bracing. If the tear did not improve on its own, surgery might be needed.


Hamstring Injury

The hamstring area is composed of three muscles that run down the back of your thigh:

  1. Biceps femoris muscle
  2. Semimembranosus muscle
  3. Semitendinosus muscle
Hamstring Injury

These muscles help you to bend your knee. Injury to the hamstring muscles happens when they are stretched beyond the normal range.

The tear can happen in any muscle of the three, however, biceps femoris muscle is the most commonly affected. That's why the hamstring injury is also called "biceps femoris tendonitis".

Athletes who run fast in sports such as basketball or soccer suffer from such types of knee injuries. Often, it happens when there are sudden acceleration and deceleration of your movement.

Symptoms of hamstring injury include

  • Sharp or achy pain behind the knee.
  • Swelling and bruising of the knee.
  • Weakness of the back of the leg


PRICE " Protect, Rest, Ice, Compression, Elevtion" of the leg, Physical therapy, exercise, and surgery in very rare cases. Usually, you will take from 1-3 months to be completely recovered from that injury


Anterior Cruciate Ligament (ACL) Injury

ACL is a tissue that connects your thigh and your shin anteriorly. ACL stabilizes your knee joint.

ACL is the most commonly affected ligament, especially when you suddenly stop or change your direction.

The symptoms include pain and swelling in the back of your knee, feeling a "pop" when the tear happens, and difficulty walking.

Treatment includes rest and physical therapy. However, if the ligament is completely torn, the surgery will be necessary.


Posterior Cruciate Ligament (PCL) Injury

PCL is a tissue that connects your thigh to your shin posteriorly.

PCL is less likely to be affected than ACL. PCL injury usually happens during forward hard extension of your knees such as in a car accident and sudden twisting of your knee.

This injury also results when the ligament is stretched too far beyond the normal pressure.

The symptoms of PCL injury include:

  • Pain, swelling, and stiffness of the back of the knee.
  • Weak and unstable knee.
  • Difficulty walking.


PRICE " Protect, Rest, Ice, Compression, Elevation" of the leg helps the PCL injury to heal in a short duration. Surgery might be needed if you have more than on ligament injured or have felt that your knee is unstable.


Deep Vein Thrombosis

DVT is the formation of a blood clot in the deep veins of the leg. This condition can be life-threatening if left untreated.

Deep Vein Thrombosis

This clot might leave your leg and get lodged in the vessels of your lung- This will be called " Pulmonary Embolism". That's why you have to seek an immediate medical care if you had DVT. 

The symptoms of DVT include- Pain, warmth, swelling, and redness behind the knee. Those symptoms get worse if you dorsiflexed your leg. DVT usually starts after a period of inactivity, certain drugs such as oral contraceptive pills, pregnancy, surgery, obesity, and genetic causes as well.

Treatment include anti-coagulant medications "blood thinners", compression stocking, physical therapy, exercise, and thrombolytics if your clot was big and your condition needed immediate intervention.

DVT usually takes some time and long-term medication to fully recover and avoid any recurrence or emboli.


Calf Strain (Gastrocnemius Tendonitis)

Your calf is composed of two important muscles which are the gastrocnemius and the soleus muscle. Those muscles form the back of your lower leg. Those muscles function is primarily to bend your knee and point your toes.

Calf strain usually happens from overstretching of part of the gastrocnemius muscle.

Calf Muscles Anatomy

The onset might be gradual as a result of repetitive running or jumping or sudden change of position or speed. This will result into tear in the calf muscle.

The symptoms usually include pain, swelling, and bruising in the back of your lower leg, inability to walk, and difficulty standing on your toes. The pain severity varies according to the size of the tear.

Treatment: PRICE " Protect, Rest, Ice, Compression, Elevation" of the injured area, physical exercises, heel pads. Usually, It takes 2-3 months for complete recovery.


Knee Sprain

It usually happens as result of overstretching and tearing one of the ligaments in the knee.

Knee Pain Caused by Knee Sprain

There are different grades of knee sprain with various severity depending on the extent of the damage in the knee. That's why it might take from 2 weeks to 3 months for complete healing.

The symptoms of knee sprain include:

  • Pain and swelling of the leg.
  • Bruising behind the knee.
  • Weakness of the leg.
  • Inability to move.

Treatment includes PRICE " Protect, Rest, Ice, Compression, Elevation" of the leg, exercise, physical therapy, and knee bracing.


Knee Arthritis

Arthritis is an inflammation of the joints where the cartilages that support the knee are torn apart.

Knee Pain Caused By Arthritis

There are various kinds of arthritis that might affect your knee:
Osteoarthritis- This is the degenerative and most common type, especially if you are over 50 years old. The symptoms are gradual as you age.

Rheumatoid arthritis- This is the inflammatory type of arthritis in which the immune system attacks the joints.

Lupus arthritis- This is an autoimmune inflammation of the joints including the knee.

Psoriatic arthritis- This is another autoimmune disease associated with scaly patches of the skin.

Symptoms of arthritis include:

  • Pain and swelling in the knee.
  • Morning stiffness.
  • Clicking sound of the knee.
  • Painful leg movement.

These symptoms are worse in the morning, especially after prolonged rest and in the cold weather. They are getting better with exercise.

Treatment: Exercises, steroid injections, ice compressions, weight loss, and other pain medications. Patients with rheumatoid arthritis also take disease-modifying medications (DMARDs) that lower the immune system response and decrease the inflammation.


Jumper's Knee "Patellar Tendonitis"

Jumper's knee is an injury to the patellar tendon- a band that connects the patella to the shin bone from the front.

Basic Knee Straps for Jumpers Knee

The injury usually happens when you suddenly jump or change your direction such as in football.

The symptoms include pain, stiffness, and swelling of the tendon, and difficulty to flex or extend your knee.

The treatment includes rest, ice compression, elevation of the leg, and physical therapy.



Chondromalacia is a condition when the cartilage inside the knee joint tear down.


As we know that the cartilage is the cushion which prevents the fraction of the bone against each other during the movement.

Chondromalacia can result from aging, overuse, and arthritis. Patella is the most commonly affected site for cartilage break down.

The symptoms include dull aching pain behind the patella, weak knee, difficulty to move your knee, and cracking sensation when you flex or extend your knee. That pain is getting worse when you moving upstairs, or after sitting for a while

Treatment: Rest, ice compression, pain medication, physical therapy, and surgery in very rare conditions when the cartilage is completely damaged.


Leg Cramps

The leg cramp is a spasm of the muscles, especially in the calves. Other muscles might also tighten up such as the muscles in the back of the thigh near the knee.

Knee Pain Caused by Leg Cramps

Leg cramps often happen during exercise, pregnancy, nerve compression in your leg, infection, dehydration, and some diseases such as liver disease and mercury poisoning.

When your muscle cramp, you will feel the pain of the contracted muscles from few seconds to few minutes.

After that cramp disappears, the muscle will be painful for few hours. Treatment includes rest and re-hydration.

How to Prevent the Pain Behind the Knee?

Some of these tips are not only to prevent the knee problems. It can also help to treat them.

Doing regular exercise that will strengthen your leg muscles, help you to stay physically fit, and maintain a healthy body weight as well.

As we know, obesity is the major risk factor for knee osteoarthritis. That's why losing weight and regular exercise will help to alleviate that pain and keep your knee health. However, be cautious during exercise to avoid any sports Injuries.

  • Try to do some stretch before exercise and immediately cool down after it.
  • Do not overuse your knee by vigorous exercise. If you felt tired during exercise, stop and try again after a while.
  • Wear protective fitting shoes.
  • Avoid sudden twisting of your knee.
  • Avoid running on rough surfaces if possible.
  • Stop doing exercise if you had any tears in your knee and seek the appropriate medical attention.

In nutshell, Pain behind the knee might be excoriating. You must be able to differentiate between the minor injury and the life-threatening ones. You must seek medical help if you experience any of the following symptoms: your leg is red, very painful, swollen, and have a history of blood thrombi. Then you must go to the nearest medical facility to seek help

Dr. Sachin

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