Pain Behind the Knee – Treatment for Pain Behind the Knee, Causes, and Exercises for Knee Pain and Discomfort

Knee pain is a very common problem; there’s hardly anyone who hasn’t experienced it at least once. This is due to the importance of the knee joint and the strain it undergoes in active people who walk upright.

Knee pain is not limited to any particular age group, gender, ethnic background, or other characteristics. 

Knee pain can affect anyone; it is not limited to any specific age group, gender, ethnicity, or other characteristics. 

In children, congenital abnormalities may be the cause, but more often it is simply due to overuse. Nevertheless, if a child experiences unusual or persistent knee pain, further evaluation should be conducted to rule out serious underlying causes. The same applies to knee pain in adolescents; here, too, overuse or injuries are the most common causes. Growth-related pain is also a possible cause, while serious underlying conditions such as rheumatism or bone tumors are, fortunately, rare.

In adults, in addition to accidents and overuse, degenerative diseases and signs of wear and tear also come into play, particularly with advancing age. Especially after accidents involving fractures near the knee joint, a misalignment can result, also known as bowlegs or knock-knees. This leads to increased stress on the joint surfaces—on the outer surfaces in the case of bowlegs and on the inner surfaces in the case of knock-knees. Over time, this often results in cartilage damage, which causes increasing pain.

The same applies to congenital misalignments, which—unlike acquired (post-accident) unilateral changes—occur almost without exception on both sides. Even elite athletes can suffer from knee pain and degenerative wear and tear at a young age, which can be attributed to the extraordinary strain placed on their knees. 

In older adults, however, signs of wear and tear are by far the most common cause of knee pain. Here, however, they are attributed to joint degeneration, also known as osteoarthritis.

Depending on its nature, the pain can be 

• sharp
• pressing, or 
• dull. 

A stabbing pain in the back of the knee is often caused by problems with the meniscus. The meniscus, also known as the articular disc, is a crescent-shaped cartilage pad in the knee joint.

A pressing pain, accompanied by a pronounced feeling of tightness, is often caused by joint effusion. Joint effusion can result from inflammation or an injury. Dull pain that radiates into the thigh or calves indicates excessive wear and tear on the knee joint.

The timeline is also important; here, a distinction is made between 

• acute and
• chronic pain

Acute pain arises suddenly, seemingly out of the blue. It is usually caused by injuries, particularly falls or overexertion. With proper treatment, pain management, rest, and immobilization, it typically subsides quickly.

Chronic pain persists over a longer period and can develop from acute pain if the joint is not rested or if treatment is not successful. For example, a meniscus tear can lead to chronic pain if it is not diagnosed and the joint is not properly immobilized or even treated surgically.

Causes of knee pain can include:

• Sports
• Accidents
• Growth spurts
• Misalignments
• Overuse
• Signs of wear and tear
• Joint wear
• Bone diseases
• Osteoporosis

Meniscus injuries, such as a meniscus tear, are common among athletes following accidents. In severe cases, surgery is necessary to repair the damage. If there is only a meniscus contusion without a tear, a 3- to 4-week break from physical activity is sufficient. Another of the most common sports injuries is a cruciate ligament tear, which results from hyperextension of the knee.

In cases of ligament and meniscus injuries, a period of rest is absolutely necessary to relieve pain and promote healing.

In children aged six and older, pain in the back of the knee occurs during growth spurts and is completely normal.

However, if the pain is caused by a fall and does not improve even after a prolonged period, it should be investigated more thoroughly. For example, after an accident, the growth plate in a child’s knee joint may become detached. This is called epiphysiolysis. This condition requires surgical treatment to prevent growth disorders and deformities. Prolonged pain accompanied by other symptoms such as fatigue, weight loss, fever, or loss of appetite should also prompt further evaluation. In very rare cases, a malignant bone disease may be the underlying cause.

Once the growth phase is complete, other causes of knee pain come to the fore:

• misalignments and
• overuse
• Cartilage wear
• Meniscus disorders

Knee misalignments such as bowlegs or knock-knees can cause pain under heavy strain. If pain frequently occurs on the inner or outer side of the back of the knee, this is an indication of a permanent misalignment and resulting meniscus damage.

Short-term overuse of the hamstring or the posterior thigh muscles can cause tendons in these muscles to become inflamed. Tendinitis usually manifests as pain when bending the knee or when pressure is applied to the tendon. 

Chronic overuse also leads to knee pain. This includes athletic activities at a semi-professional or professional level. On the other hand, a strong muscle structure often protects joint function in athletes, so that sports can also have a protective (or gentle) effect.

Being overweight, on the other hand, is a major risk factor—currently the largest in industrialized countries—for joint and cartilage wear and tear in the legs (knees and ankles) as well as the hips. Our bodies are optimally designed for a normal weight; being overweight leads to serious problems and complications.

If the knee is subjected to particularly heavy strain, wear-and-tear-related meniscal pathology can occur, the likelihood of which increases with age. 

What is a Baker’s cyst?

When pressure on the knee joint increases suddenly (due to an accident) or chronically (due to sports or excess weight), an excess of synovial fluid often accumulates. In severe cases, this can lead to a bulge in the knee joint capsule, known as a Baker’s cyst.

A Baker’s cyst is noticeable as a distinct swelling in the back of the knee. Depending on its location and size, it can cause moderate pain when straightening or bending the knee.

If the back of the knee continues to be strained or irritated, a Baker’s cyst may rupture in rare cases. This results in sudden, severe pain and a noticeable inflammatory warmth in the back of the knee. A Baker’s cyst—whether painful with complications or chronic and asymptomatic—is always an indication of so-called “internal knee damage,” that is, pathological changes in structures such as the menisci or cruciate ligaments, and should be further evaluated. In the vast majority of cases, an MRI scan is the first recommended diagnostic test.

A Baker’s cyst can also compress the tibial nerve, which lies behind the knee joint. In such cases, the backs of the knees usually hurt when the legs are straightened. Pain after prolonged walking or running is also usually due to irritation of the tibial nerve. When the nerve is irritated, the pain usually manifests as a burning or tingling sensation.

Can a blood clot also cause knee pain?

In rare cases, thrombosis is the cause of pain in the backs of the knees. Thromboses are blood clots (thrombi) that can form in blood vessels due to an unhealthy lifestyle or lack of exercise.

If the clot breaks loose, it can lead to life-threatening pulmonary embolisms. Any suspicion of a thrombosis in the back of the knee should therefore always be further investigated. In addition to knee pain, signs may include swelling of the entire leg or the back of the knee, or a noticeably blue vein under the skin, similar to a varicose vein.

In most cases, resting the knee for a few days or weeks is sufficient to relieve pain in the back of the knee. If there is inflammation, you should apply cold to the knee. Muscle strain is best relieved with heat, for example, using an infrared lamp.

However, if the pain does not improve within a few days despite rest and immobilization, it is recommended that you see a doctor for further evaluation.

Pain in the knee—and particularly discomfort in the back of the knee—can have a wide variety of causes. Causes of pain in the back of the knee range from muscular problems and tendonitis in the back of the knee to a Baker’s cyst in the back of the knee or vascular diseases. The back of the knee can be affected by various types of strain, misalignments, or inflammation, which is why symptoms and causes of pain should always be evaluated on a case-by-case basis. If you experience stabbing pain in the back of the knee, a feeling of tightness in the back of the knee, or bluish veins in the back of the knee, you should see a doctor to rule out a possible blood clot.

Pain in the back of the knee is often accompanied by symptoms such as swelling, a pulling sensation in the back of the knee when walking, or pain in the rear area of the knee joint. Pain in the back of the knee when straightening the leg or walking may also indicate muscle strain or other possible causes. In some cases, a bulge in the back of the knee—such as a Baker’s cyst—can also cause pain. Pain in the back of the knee can manifest in many different ways and may occur suddenly or develop gradually.

Treatment for pain always depends on the specific cause. To relieve pain and improve symptoms in the long term, targeted exercises, stretching, and the best exercises for stabilizing the knee joint are often helpful. A support bandage can also provide relief and help manage pain in the back of the knee. Pain in the back of the knee can often be improved through movement, targeted exercises, and rest. It is particularly important to alleviate pain before chronic symptoms develop or severe pain sets in.

Pain in the back of the knee often depends on the strain placed on the joint and muscles, as well as possible inflammation. Pain can be triggered by conditions such as osteoarthritis, meniscus injuries, or a Baker’s cyst, which can radiate down into the back of the knee or the calf. Other causes can also lead to pain and should be evaluated by a doctor if symptoms persist. A diagnostic test to determine the cause of the pain, along with early medical treatment, helps establish the correct diagnosis and treat the underlying cause of pain in the back of the knee.