Pain in the back of the knee: causes and treatments

What causes pain in the back of the knee?

Knee pain is most commonly caused by low-grade, non-severe issues like muscle strain, says Mary Kimbrough, PT, DPT, a physical therapist at Hinge Health. Here are other causes of knee pain that could lead to pain in the back of the knee.

• Overworked muscles. When your muscles work harder than usual, they become stronger and more resilient. But sometimes, if you do too much too often, you can overdo it. The hamstring, the calf, and a small stabilizing muscle known as the popliteus muscle are top sources of muscle strain behind the knee, resulting in an aching, tender feeling. 

• Runner's knee. Patellofemoral pain syndrome, or runner’s knee, is one of the most common overuse injuries affecting the knee. It feels like a dull ache behind or around the kneecap (patella) that gets worse with movement or prolonged sitting. 

• Ligament injuries. Ligaments are thick, fibrous tissues that connect your bones to each other. The PCL (posterior cruciate ligament) is a common culprit in pain behind the knee. The PCL works with its cousin the ACL (anterior cruciate ligament) to keep the knee stable during front-to-back motion. PCL tendons may be injured if the knee suffers a significant blow while bent. 

• Osteoarthritis. The cartilage that cushions your knee naturally changes as you age, which can lead to pain, stiffness, and tightness behind the knee. One study found the back of the knee was one of the top pain zones for knee osteoarthritis. 

• Meniscus tear. The meniscus is a rubbery C-shaped disc of cartilage that helps to cushion your knee joint — you have two in each knee. When you tear this particular piece of cartilage, it’s called a torn meniscus. This can be the result of an injury or normal, age-related changes that can happen to cartilage, leading to pain, stiffness, and a sense of the knee catching or locking. 

• Bursitis. Knee bursitis occurs when a bursa in your knee becomes irritated or inflamed, causing pain that can limit mobility. These fluid-filled sacs in your knee joint act like tiny pillows to reduce friction and cushion bones, tendons, and muscles, which helps you bend and straighten your knees. Sometimes inflammatory diseases such as rheumatoid arthritis and gout can affect the bursae in the knee, causing bursitis.

• Baker’s cyst. If there’s been swelling in the knee, it will sometimes collect as a fluid-filled cyst.  “You might touch the back of your knee and notice a little bump or firm nodule, which is causing discomfort,” says Dr. Kimbrough. Baker’s cysts are common and often occur when another irritating condition, like osteoarthritis, is present. 

Treatments for Pain in the Back of the Knee

Knee pain often gets better on its own or with active pain treatment methods like exercise, movement, and physical therapy. Effective treatment options include: 

• Physical therapy. A physical therapist (PT) can design customized exercises to improve strength, flexibility, and mobility where you need it. Physical therapy exercises typically target the injured area (the knee), as well as structures that support it from above and below, like the hip and ankle. You can see a physical therapist in person or use a program like Hinge Health to access a PT via telehealth/video visit.

• Activity modification. If you’re experiencing an uptick in acute knee pain, avoid putting weight on the knee or moving around more than necessary. But remember that healing happens mostly from moving, not resting. Physical movement helps your joint heal, so ease back into your routine as soon as you can, advises Dr. Kimbrough. 

• Ice or heat therapy. Apply cold packs for 20 minutes several times a day to help ease discomfort and swelling. While ice tends to be better for acute injuries, ice or heat is okay depending on your preference.

• Taping. Athletes recovering from runner’s knee experienced less pain while stepping down when athletic tape was applied above and below the knee, forming a supportive “X” behind the knee, according to one study.  A physical therapist can help you determine if taping is right for your knee pain.

• Take over-the-counter (OTC) medication. Pain relievers such as ibuprofen (Advil, Motrin), naproxen (Aleve), and acetaminophen (Tylenol) can be helpful for pain in the back of the knee. It’s important to make sure that you are safely able to take these medications, based on your medical history.

• Surgery. Some treatments for serious injuries, like an ACL or meniscus tear, may involve surgery.

Knee Pain: A Hinge Health Perspective

We know knee pain can feel scary and debilitating. If there’s one thing we want you to know, it’s this: There are always things you can do to get back to doing what you love and get pain relief.

You may have some muscle strain. You may have arthritis or ligament or meniscus injuries. You'll read about these possible causes below but remember: No matter what's involved in your knee pain, you're not stuck. Your condition is not impossible to change. How do we know this? Studies show that less than 50% of people with osteoarthritis on X-rays have knee pain. Same goes for a majority of people who had meniscus tears on an MRI: They didn’t have any pain, stiffness, or aching.

This means your imaging findings do not always correlate with your symptoms. It's a possible contribution to your pain, but it's often not the only factor. You may not be able to control every issue involved in your knee pain, but you do have the power to change some important things. You can always do something to improve your knee pain, and that often starts with moving more. As our Hinge Health care team says, movement is medicine.

How Hinge Health can help you

If you have joint or muscle pain that makes it hard to move, you can get the relief you’ve been looking for with Hinge Health’s online exercise therapy program.

The best part: You don’t have to leave your home because our program is digital. That means you can easily get the care you need through our app, when and where it works for you.

Through our program, you’ll have access to therapeutic exercises and stretches for your condition. Additionally, you’ll have a personal care team to guide, support, and tailor our program to you.

See if you qualify for Hinge Health and confirm free coverage through your employer or benefit plan here.

This article and its contents are provided for educational and informational purposes only and do not constitute medical advice or professional services specific to you or your medical condition.