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What Does It Mean When the Back of Your Knee Hurts?

If the Back of Your Knee Hurts, Here Are the Likely Reasons

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If you've been experiencing pain at the back of your knee, it's important to inform yourself about all the possible reasons it might be occurring, whether it's due to a specific incident or not. By learning more about the causes of this body pain, you can make a thought-out plan for your next steps with your healthcare provider, as well as consider treatments or methods to relieve your discomfort. This kind of pain is actually quite common, so we spoke to three doctors about the causes behind back-of-knee pain, and what their recommendations are if you're dealing with this. Ahead, find all of the information you need to take the next steps.

What Does It Mean When the Back of Your Knee Hurts?

According to Dr. Jeremy James, DC, CSCS, and founder of the exercise program FitForever, pain at the back of your knee can be caused by a multitude of things. Dr. James advises to first ask this question: "If there was a recent incident in which you experienced a 'pop,' twist, fall, or painful incident in, or around, the knee." If the answer is yes, you could be dealing with a hamstring strain, or "a microscopic tear in the muscles on the back of the thigh," a meniscal tear, or "a tear in the c-shaped, shock-absorbing cartilage that lies between the upper and lower leg" (although pain is usually not felt behind the knee), or a posterior cruciate ligament (PCL) tear, which is the ligament on the back of the knee. However, if your pain is not a result of a specific accident, the answer becomes much more complex.

What Are the Possible Causes of Back-of-Knee Pain When It's Not Due to a Specific Incident?

If your back-of-knee pain is not due to any specific accident or incident, it could be caused by a wide array of factors. According to Dr. Celeste Holder, who holds a B.S. in behavioral neuroscience from Northeastern University, a doctorate in chiropractic medicine from the University of Bridgeport, and is a 1AND1 LIFE doctor, back-of-knee pain presents itself less often than other kinds of knee discomfort, but when it does appear, the "differential diagnosis is rather broad." Holder continues that diagnoses for this kind of pain can include "pathology to the bones, musculotendinous structures, ligaments, nerves, vascular components, and/or to the bursas," which makes pinning down the main reason quite challenging.

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Apart from musculotendinous injuries, one of the most common causes of posterior knee pain is a Baker's cyst. Dr. Patrick Jean-Pierre, board certified internal and nonoperative sports medicine doctor and part of the 1AND1 LIFE team, cites Baker's cysts as cysts that "develop from the breakdown of cartilage or arthritis in your knee, causing an out pocket of swelling and fluid. Sometimes this swelling can become very painful, resulting in the pain behind your knee joint." Dr. James adds that these cysts "can be caused by repeated irritation of structures in the knee. This also can be caused by poor movement habits or muscle imbalances."

Incredibly enough, Dr. Jean-Pierre points out that "one of the most common causes for pain behind the knee does not have anything to do with the knee joint at all. The tendons of the hamstring muscle insert behind the knee, often making people feel like they injured their knee — when instead they have a strain of the hamstring muscle." Want to see if this is the case for you? Dr. Jean Pierre instructs to "simply press on the middle of the hamstring muscle and down the muscle to where the tendons attach behind the knee to see if that is the cause of the pain." Dr. Holder adds that "when it comes to musculotendinous injuries, there are three sets of muscle complexes" that can cause back-of-knee pain, also citing the hamstrings. She further mentions the "gastrocnemius and popliteus tendon/muscle complexes," the latter of which is lesser known but can be a significant source of pain.

Another common cause of pain in the back of the knee can be tendonitis in the hamstring or gastrocnemius tendons, which Dr. James describes as "inflammation of the tendon, usually due to repeated irritation from bad posture or muscle imbalances during sports or repetitive movements." He adds bursal injury to the list, which involves "repetitive irritation of the bursae," or sacks of fluid that should allow smooth movement between tendons and muscles. This kind of injury is "due to faulty movement patterns around the knee and muscle imbalances."

Other prime suspects? According to Dr. Holder, it's very simple: overuse of the knee joint. "Running downhill, poor strength and flexibility, failure to warm-up properly before activity, flat feet, and improper knee alignment are examples that can contribute to the mechanism of [back-of-knee] injury." Moreover, if none of the above mentioned is relevant to your case, the cause can actually be something much more rare, like osteochondroma, a noncancerous overgrowth of cartilage and bone, or damage to the peroneal nerve.

What Should I Do If I'm Experiencing Pain at the Back of My Knee?

If you are dealing with back-of-knee pain, Dr. James makes the point that it is imperative to "see your healthcare provider to rule out some of these more serious causes." Dr. Holder agrees, recommending a "clinical assessment of the knee [that] is comprehensive and includes [assessing] for instability, edema, and clicking or popping along with pain." Dr. James mentions that if the diagnosis is related to overuse or muscle imbalances like tendonitis or bursitis, an exercise regimen that "focuses on proper form, good posture, and rebalancing the muscles around the knee" would be very helpful. Whether the pain is due to something more serious or not, Dr. Holder asserts that an orthopedic assessment and a physician evaluation are crucial to providing an accurate diagnosis, and that it's important to get treatment as soon as possible.

Image Source: Pexels / Ketut Subiyanto
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