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Pain Behind The Knee

8th May 2021

Pain in the front of the knee is the most common type of knee pain which most people experience. But pain in the back of the knee is also an issue which many people can experience.

There are a few reasons why pain behind the knee develops and also different components of the knee which cause the pain.

Pain in your knee really does affects a lot of the components of your life.

It can make sitting and sleeping uncomfortable, and it can also hinder your movement as it is one of your main load bearing joints.

Knee pain is typically best dealt with by moving and exercising, but obviously this pain can stop you from doing that.

Knowing how to deal with it and how to get moving again is key – and this is what this Article is for!

Take a read to learn more about the knee, causes of pain behind the knee and what are the best ways to manage this problem!




To understand what causes pain in the back of the knee, we must first look at the anatomy of the knee to gain a greater understanding of the joint.

The knee is one of the more simple joints in the body to understand as it has less moving parts than others and moves in a more simple way.

The knee consists of 3 bones – the femur which your thigh bone. The shin which is your tibia and the kneecap, which is the patella.

The kneecap sits in to a small groove on the top of the femur and this slides up and down as the knee bends and extends. The main knee joint is made up of the shin meeting the thigh bone.

This is known anatomically as the tibiofemoral joint. For comfort the ends of these bones are covered in cartilage which helps to keep the knee lubricated and cushioned from impact.

The knee has 4 main ligaments which hold it together including the medial and lateral ligaments which sit on the inside and outside of the knee. The ACL and PCL help to connect the femur to the tibia.

The knee typically only moves in flexion and extension with only a small amount of tibial rotation at about 15 degrees.

The muscles that move the knee mostly are the thigh muscles known as the quadriceps which help to straighten the knee and the hamstrings which sit on the back of the thigh and help to bend the knee.

Within the knee there is a fluid called synovial fluid which is contained within the synovial membrane. This helps the knee to remain lubricated but it also helps to heal to the knee when it becomes injured. The synovial fluid is refreshed by movement – hence why movement and exercise is so important to recovery.

This is a simple overview of the knee anatomy but it gives an understanding of what is involved when we are talking about knee pain.


Top 3 Causes of Pain behind the Knee


The causes of pain behind the knee are not limited to these options but as a physiotherapist – these are the most common causes that come through clinic.

Obviously these issues will affect different people at different ages but we will outline why they are caused and what their symptoms can be like.


Hamstring Pain 


The muscles which sit on the back of the thigh attach via hamstring tendons which sit at the back of the knee. Commonly, pain in the back of the knee is caused by the attachments of the hamstrings. Tendons can become aggravated easily and this gives off pain and causes dysfunction.

If you trace to your hamstring attachments at the back of the knee and have a touch – they can be tender to touch if this is the cause of your pain. This type of problem does not cause swelling of the knee.

Problems associated with hamstring pain can be pain when sitting for long periods then going to move and also pain when using stairs. Hamstring insertion pain will typically affect people over 30 years of age without trauma but if you have had an accident or overstretched the hamstring – this can cause damage to the attachment point.


Joint Pain


Where the thigh bone meets the shin bone can often be a cause of pain. This will typically occur in people who are older as their joints become irritated due to onset of problems such as arthritis.

However, this doesn’t rule out the younger generations from pain behind the knee. A big factor in knee joint pain can be due to increased sitting. With an increase in studying, sitting and driving based jobs, knee pain is becoming more of an issue because we are not as active as we could be.

Denying the knee of regular movement increases the amount of irritation within the joint and this can cause pain.


Bakers Cyst


A bakers cysts is a small sac of fluid that can develop at the back of the knee joint when osteoarthritis problems become more advanced. This will almost always happen in people over 50 years of age.

As the knee joint becomes progressively more aggravated and degenerative, this will cause the bakers cyst to develop. It is a fluid filled sac which will cause a visible swelling and pain in the back of the knee. The swelling can often lead in to the lower leg but also affect function.

They can unfortunately be difficult to deal with as consultants do not typically like to perform a surgical correction on them. They will with time disappear and reabsorb.

General symptoms of pain behind the knee can be as follows:


  • Swelling – as mentioned above, baker’s cysts can swell the back of the knee and also present with quite a specific lump of swelling. Swelling of the front of the knee is also common with pain behind the knee for the simple reason that the knee joint space fills up with swelling. The swelling can often make the knee feel tight and restricted. As a safety note – it is worth noting that if the knee becomes extremely red hot and swollen it may be a sign of infection and this should get checked by an emergency service, especially if you are developing any system illness.


  • Loss of knee range of movement – due to a combination of pain and swelling, this can hinder the amount of movement available within the knee. If the joint of the knee itself is sore then this will impact the knee movement as it may be uncomfortable to fully bend or straighten the knee.


  • Reduced function – you may not be able to do the same exercise or activities you were able to when you didn’t have the knee pain. If you have a sore knee joint or if the hamstrings are painful and weak, this may prevent you from moving at any great intensity or speed.




Treatment of pain behind the knee depends solely on the exact cause and also the individual themselves.

Without giving specific and exact medical advice – the next few options are great ways of dealing with knee pain in a more generalised way.

If you are struggling to deal with you knee pain or you simply don’t know what’s causing it, then seek help from a medical professional to get to the bottom of your problem.

One thing that can’t be denied is the effect of movement and exercise on your knee pain.


  • Physiotherapy – getting an assessment off a good physio will help towards diagnosing what exactly what is causing your knee pain is a good start. This will help you to understand the problem you are experiencing and provide you a plan to get it better. Physiotherapy is not one method but a combination of treatment, education and exercise to resolve your problem.


  • Mobility Exercise – improving the mobility of your knee and increasing its movement can help to reduce pain within the knee. Often pain can be caused by reduced movement, stiffness and pain – movement is nearly always the answer. Moving the knee slowly and gradually without any weight can help to start your recovery and progress your symptoms.


  • Yoga – is a great way to progress your recovery from knee pain as it is a gentle combination of stretching and strengthening which does not involve any impact on the knee joint but does involve plenty of movement and mobility. Yoga improves balance, stability and also helps to work both knees equally when performing flows, this can be helpful in the recovery phase to balance your knee function and capability.


  • Walking – is as good as exercise as any for knee pain. Even when the knee is painful – walking is recommended. Bearing your bodyweight through the knee joint helps to regain function within the knee and also it strengthens the muscles of the lower limb. If you are struggling to walk due to knee pain then slow the pace and length of your steps.


  • Cycling – is a closed chain exercise which does not involve any impact for a painful knee. This is a great way to get the quads firing and the knee joint moving and lubricated. Quadriceps strength is a big indicator of knee pain – the weaker the quad, the more likely you are to have knee pain. This is due to the quad helping to lock the knee out and generate force. If this mechanism is weak, it puts a lot of pressure on the knee joint.


  • Swimming – and even moving your body in a swimming pool is a great way to reduce knee pain. In the weather, there is no weight on you and the pool has an almost anti-gravity like effect. Performing squats, lunges and jogging in the water is a highly recommended way of returning your knee to normal.


  • Pain Relief – knee pain can often just be sensitivity of the tissues within and around the knee. Using pain relief to make you more comfortable and restore normal movement is advised.


  • Knee Supports – use of a knee support in the short term to provide support for the lower limb is a great idea. If you have swelling on the knee, compressing it with a knee support can help. If your knee pain is causing discomfort or dysfunction then a brace can help you to keep moving. Movement is key for reducing knee pain so whatever it takes to help you move – do it!


That’s concludes our article on pain behind the knee – if this has helped you or you know someone suffering from pain in the back of the knee, please share this with them.

As ever – this is general advice and if you are struggling with a knee problem, seeking the help of a medical professional is always advised.

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