One of the most reported knee complains is pain behind the knee or back of the knee pain. As always, the first warning is to always get your knee pain investigated properly by a physiotherapist or your doctor so that you don’t aggravate an existing injury.

Anatomy of the Knee

There are several structures at the back of the knee that could contribute to pain in the region.

Hamstring

The hamstring muscles consist of a group of muscles including: Semitendinosis, Semimembranosis and Biceps Femoris.
Their tendons attach to the top of the tibia and cross behind the knee joint.

Lateral & Medial Meniscus

The meniscus create a cushion between the Femur (bone in the thigh) and Tibia (bone in the shin).

Ligaments

There are 4 major knee ligaments that aim to protect the knee during movement.

1. Anterior Cruciate Ligament (ACL)
2. Posteror Cruciate Ligament (PCL)
3. Lateral Collateral Ligament (LCL)
4. Medial Collateral Ligament (MCL)

Common Diagnosis

Some common diagnosis that can stem from pain behind the knee

Arthritis

Osteoarthritis is a very common cause of knee pain at the back of the knee. Arthritis occurs as a result of the joint space being reduced between the femur and tibia. Usually, arthritis occurs due to weak/tight muscles and when left untreated can result in pain at the back of the knee usually due to meniscus damage from chronic friction and stress.
Symptom: Chronic dull ache – worsens in cold weather and after strenuous activity
Diagnosis: X-Ray, MRI or CT Scan
Treatment: If caught early, exercise can help reduce the forces impacting on the knee joint. If untreated, arthritis can result in major knee surgery.

Meniscus Tear or Damage

Meniscus tear is common in athletes or those who suffer from arthritis. Depending on the site of the damage, meniscus damage could result in persistent and sharp pain behind the knee.
Symptoms: Sharp, sporadic pain, knee locking, swelling and inability to fully bend or straighten the knee.
Diagnosis: MRI or Ultrasound
Treatment: Depending on the severity, meniscus tears can be treated conservatively with physiotherapy but may require surgical intervention.

Bakers Cyst

Bakers cyst is one of the most common causes of pain behind the knee and pain at the back of the knee. A Bakers cyst involves inflammation of the popliteal bursa
Symptoms: Local swelling (small bubble) at the back of the knee and pain behind the knee, pain on bending of the knee.
Diagnosis: Ultrasound, MRI or X-Ray
Treatment: Usually,  a Baker’s cyst can be treated conservatively with physiotherapy and medication. Often, Bakers cyst is secondary to another injury or condition (such as arthritis) and treatment may overlap into resolving other injuries.

Muscle Tear or Damage

It’s not very common for a muscle injury to cause pain at the back of the knee. In some circumstances, pain behind the knee can be caused by muscle damage to the hamstring or calf muscles, although usually these muscles are injured further away from the back of the knee.
Symptoms: Increased pain on knee, hip or ankle movement. Bruising or pain when touched.
Diagnosis: Ultrasound or MRI
Treatment: Treatment varies greatly for muscle injury depending on the severity and location of the damage. Usually, muscle damage requires rest, mobilisation and physiotherapy for recovery.

Ligament Tear or Sprain

Ligament injury is often caused by a severe trauma such as sport or fall. Usually an injured ligament will result in severe pain and may not be localised to pain at the back of the knee.
Symptoms: Severe pain even without exertion. Swelling, restricted range of motion.
Diagnosis: Ultrasound or MRI
Treatment: Treatment varies greatly for ligament injury depending on the severity and location of the damage. Usually, ligament damage requires rest, mobilisation and physiotherapy for recovery. Severe tears can result in surgical reconstruction.

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