Posterior Knee Pain

Training Injuries
1

Over the past 3-4 months i have been developing some nagging pain behind my right knee.

My right leg is the dominant leg.

http://www.deeptissue.com/learn/knee/hamstings.jpg

-Pain will occur mostly during full knee flexion movements, be it either squatting below parallel, performing a quadricep stretch or even kneeling on the ground (sitting on your calves.)

From what ive read it could be a few different things :

-Bakers cyst ( i dont blatantly feel any swelling or anything unusual in the area)
-posterior meniscus damage (im assuming damaged menisci would hurt alot , this doesnt )
-some kind of wierd soft tissue problem. (im a little foggy on this )

Ive searched “posterior knee pain” here on the forums and on google but it hasnt provided any realy solid information as to the direct mechanical cause and what corrective action to take.

Ive mostly read stuff like “stretch your calves alot” and “dont overdo it on straight leg RDLs” and “it will heal on its own.”

For the past several months i have been doing minimal direct RDL or other stretched position hamstring exercises. Mostly double and single leg squatting type movements.

There is more i could say but i dont know how pertinent all of it would be to this topic.

If you have any ideas please help me out .

If you have any other questions which could help you internet diagnose, i will try to help you out and can also provide video or photo if needed.

Thanks

2

PT checked everything out and said its most likely just a small Baker’s Cyst.

Effected leg is tighter going into end range knee flexion , and there isnt any discomfort until im either sitting in a full deep squat or attempting to sit on my calves.

My right leg is slightly less flexible in the quadricep and (i think it was) the piriformis.

She said other than the little cyst i appear to be very sound.

So basically im being a wimpy/hypochondriac that doesnt really have much of a problem but its always good to make sure and determine that its nothing serious.

So ill probably just :

Not squat quite as deep.
Perform box squats more often.
Continue doing alot of single leg work

Im pretty sure this minor problem appeared due to leg strength discrepancy that i have slowly been improving.

3

Eh Fk. Its really only been getting worse. Im kind of irritated. Not really sure what i should be doing about this bullsh1t.

4

Hey Field. There are a number of ligaments and tendons in the region of the posterior knee. Firstly I would ask, whereabouts does it hurt posteriorly? Medially, Laterally? Is the pain coming from the enthesis (where tendons and ligaments attach to bone) attatchment on the Fibula/Tibia/Femur (the bones of the upper and lower leg)?

If you’re able to palpatate any painful area and list roughly where you think that is, it would be a help in figuring out what is going wrong. If the area isn’t palpable, and is a deep lying intra-articular structure (such as the medial and lateral menisci) then it’ll be harder to say realistically.

When performing a standing unweighted Hamstring curl, where does the pain originate from, where does it radiate to? Which harder to perform during a leg curl, the concentric or eccentric portion?

Are any muscles seemingly “tighter” in the bad leg as compared to the good leg?

Painful Baker’s Cysts are usually very visable and palpable. They are the result of a leaking of fluid, they don’t just spring up. So if there is one, something caused it. A tell tell sign is once it does flare up you will be unable to fully extend your leg, if this hasn’t happened, and you have no visible lump in the popliteofibular region then a cyst is unlikely. They are easily seen on Ultra-Sound also.

Get back to me with your thoughts, I’ll at the very least be able to tell you the relevant related anatomy.

5

Pain is probably more medial.
I definitely feel it more in the calf than in the hamstring.

It originates right up in the crook of the knee joint so i guess it would be where tenonds attach.

I am not able to palpate any painful areas. There isnt an actual fluid sack or cyst visible.

The concentric portion of a hamstring curl is more difficult do to restricted ROM. Discomfort is present when at full flexion, but not present otherwise.

PT said my quadricep and piriformis were tighter in my effected leg.

My right calve seems to be a little weaker than my left, it will just burn noticably easier than the left with the same workload such as doing single leg calf raises.

6

Hi,

So based on the information you’ve given me. First off, generally speaking when muscles tighten up for no apparent reason, such as what is happening with your Quadriceps, Piriformis, etc, they are protecting and compensating for soft tissue injury. The muscles haven’t suddenly lost sarcomeres so the response is purely neurological.

Structures located in the posterior medial corner are, the posterior capsule, directly above it lies the oblique popliteal ligament, insertions of the semimembranousus tendon runs through the oblique popliteal ligament as well as through the posterior oblique ligaments. The Gastrocnemius has a tendon insertion located medially (as well as laterally).

Medial Meniscus issues can also cause problems posteriomedially. Honestly I would consider this secondary, as studies have been performed showing people with no symptoms of pain or disability, and yet MRI reveals they have meniscal tears. The same thing as with the studies revealing disc buldges/protrusions in asymptomatic individuals.

Taking the above structures into account and assuming portential injury to any of them, the question is then what the hell can you do about it? Unfortunately posteriomedial dysfunction is one of the most under-researched areas of the knee at present.

If we’re talking about physical rehabilitation methods, I would start by researching Eccentric Training, for both your Calf and Hamstring.

As far as finding someone who can actually help you fix this. You can either get your MD to refer you to an orthopedic consultant, who may send you for MRI’s/ultrasound. Or you can find an MD who specialises in RIT (regenerative injection therapy), if it is indeed non-healing soft tissue he can stimulate new collagen growth for repair, no down time you can keep training, etc. Those two are probably your best bet.

Good luck with whatever you choose to do. Keep us up to date on how it turns out.

7

A few small things i might note :

  1. Up until this week i have done almost all of my lifting without shoes. I dug some old shoes out of the closet (Nike REAX) a bit ago and the slightly elevated heel seems to reduce irritation at the back of the knee when at the bottom position. obviously.

  2. Not sure if its that important but my knees naturally point outwards with feet straight ahead, which would mean externally rotated femurs. Probably pretty common but how should i know. It might warrant favoring a certain type of stance over another.

  3. My calf on my right (problem) leg feels weaker and seems to get fatiged easier. Just something i noticed. Not an insane difference or anything.

8

Started up doing some back squatting again, really trying to concentrate on squatting with the hips. This was just moving 225 and 265 around a bit.

I started using some shoes and am cutting my depth a bit shorter, using a shoulder or hip width stance. Squatting like this feels pretty easy.

My right leg still will try to shift under the center of gravity when i get fatigued and that hip/leg movement is probably part of the reason something happened with the back of my knee in the first place along with some nagging anterior hip pain on my right leg.

On recovery days where i might just come in and do alot of reps with just the bar i started getting some extra abduction stimulus in there by wrapping a resistance band around my legs in the poplieal area. Lol it actually feels kind of good for some reason like i am stimulating the proper muscles on my hip.

9

Hello,

I have just read a story of my knee, the only thing is my “problematic” knee was the left one. You have described step by step how the pain had been developing in my knee! I do have that Baker’s cyst, and median menisc tear. MRI did show that the menisc was completely torn. I could not walk, could not sit, could not train my strong beautiful legs. I am female, and my leg press was 410-430 lbs.
To make a long story short, I refused to do an operation last year, and did not trust PT’s prescribed exercises. I found some online, did them for a while, and stop doing them either. My body was asking me to allow it to relax, and I heard it, and did nothing for almost 2 months, and really felt much better. Came back to gym lately, and ordered Nucleo Immune and Osteo Ven supplements from Premium Research Labs. I drink Fish Oil and Flax Seed Oil.

I do EVERY DAY at least 100 all kind of squats (reversed squat is the best) with and without weight. Of course, Smith machine, and a lot of functional training. I sprint for 20-30 sec and walk very fast(80%of HR) 8 miles every second day. Oh well, I just don’t want to do knee operation!

I wish you good luck!

10

[quote]BellaDonna696 wrote:
Hello,

I have just read a story of my knee, the only thing is my “problematic” knee was the left one. You have described step by step how the pain had been developing in my knee! I do have that Baker’s cyst, and median menisc tear.
[/quote]

What exactly happened to cause your injury? Was there a specific event or did it happen over time ?

Glad you found this thread was a good read .

11

I believe it was a combination of overstretching, too much running on hard surfaces, and too many explosive excercises at the same time without enough time to recover. But, who really knows? I have been on my way to figure it out.

12

Ive noticed that the angle of my leg when flexed effects whether there is pain behind my knee .

When i put weight on my flexed leg up on a chair and externally rotate the leg the pain behind the knee diminishes

Part of this im pretty sure stems from not having my knees out enough when i squat .

I think the reason for the knees not coming out enough is more of a calf or foot problem. I have high-ish arches and my feet tend to underpronate. When i go into a squat and attempt to “show the crotch” i tend to roll onto the outsides of my feet.

Just speculating

13

Hello,
I actually have the same knee problem as you, only that I have in both knees.

Ok it was only in the left knees actually. I got it for about 3 months. Unknown reason.

The same symptoms as yours: I can run, jump, squat to max just fine, but the (nearly) full flexion hurt.

I can sit in the ATG position or kneeling without pain when relaxed, but resisted extension from full flexion (slowly descend to full squat or slowly kneeling down, or slowly stand up from that) hurt. The pain seems to be in the middle of the joint (top of the tibia/shin bone), on my left knee it feels more to the left side, while right knee more in the middle. Not palpable.

When the knee was only in my left knee, it seems to be gone after some stretching, warming up by light knee extension at that hurt position, then slowly increasing stress and eventually I could do bw ATG squat with no pain. Usually I would do all that (stretch, warm up, bw ATG squat) a few time a day and the pain kind of disappear. It only come back after a long time sitting or no activity.

Here’s how I got my right knee injured: because my left knee feel fine with enough warm up and I can squat ATG, I start doing ATG squat with barbell. One thing I didn’t realize was that unconsciously I was avoiding the painful left knee and did three silly things: 1/Dive bomb into rock bottom position and bounce up from the calves (since no resisted extension at that position = avoid pain) 2/Push the knees out a too much(to make up for lack of hamstring flexibility) 3/More weight distribution on my right leg to compensate for my weak left.

The right knee pain kind of developed over a few days/weeks. And I didn’t even realize that it is serious until my right leg’s normal ROM is actually now less than the left (meaning more ROM that cause pain). Now whenever I full squat down I have to stop a little bellow parallel, put my arm to the ground for support and slowly release down (feels tight and hurt).

After a lot of thinking I suspect the cause is too much Varus (bow-leg, knees out) because I’ve always focus too much on that, and especially when squat bellow parallel I can clearly feel the torque on knees. So even if most people advocate pushing knees out during squat as if Varus is not evil, I think overdo it does cause problem.

I cannot afford doctor, so I did read a lot about knees problem, and yes these symptoms doesn’t seems like it fit anywhere. The closest should be Meniscus tear (duck walk is painful), but it seems to be developed over time.

I hope you’ll have a chance to have it diagnose better. I’ve had it for more than 3 months, and now both knees. It really sucks since I can do squat to parallel just fine, and the pain doesn’t seems to get better or worse, but I’m still in doubt if I should squat or not. Please keep updating on the progress so it’ll help people with the same problem.

Thanks.

14

A couple things ive started doing which im fairly sure have helped :

  1. Doing some kind of calf work any time i go to the gym. Originally never did ANY calf stuff, now i do a few moderate sets of something 4-5 days a week.

  2. High rep light resistance band leg curls at the end of a workout. Try it out for a while and see what you think.

After reading this article i think i was headed in the right direction and maybe i(we) should just be doing some kind of good hamstring exercise at the beginning of a leg session.

I didnt keep track of everything but im pretty sure after i stopped doing RDLs or direct hamstring exercises i started to develope knee issues.

15

Hey, I just saw this thread and wanted to relay my experience. I’ve had posterior knee pain on the right, off and on, for about 15 years. Mostly off, thankfully. But when then condition is aggravated, it can be pretty damn uncomfortable.

It was initially diagnosed (by a GP) as Baker’s Cyst but that was never proven out. I should say I drive a lot in stop and go traffic, which does not help. So, having been to PT, ART, massage, etc. over the years, let me cut to the chase as to what I’ve figured out for MY condition.

After a few unsuccessful rounds of PT, the thing that helped the most was what I’ll call ‘decompression exercise’ off a step. I’d stand on a step with my good left leg and let the injured right leg dangle off the step. Then gently shake my leg around to stretch out the insides. I started with no weight and then progressed to doing this several times a day with an ankle weight. This was the ONLY time I got full pain relief so I knew I was on to something. Impression - I believe I ‘compressed’ something, somehow, which resulted in the pain and I literally had to untangle it. Over a course of a few days I started to see marked improvement and then finalty it was OK. Everytime I started to feel something ‘off’ behind my knee, I would do this and get relief.

Fast forward about 10 years and I found myself in PT again with an injury across the top of my right foot. I was starting to get better and I’m lifting with a trainer one day and bang!, the back of my right knee tightens up and starts hurting like hell. Totally couldn’t continue with whatever exercise I was doing at the time. So my trainer puts me on the mat and gives me a big foam roller to roll out my hamstrings. So, I’m rolling out my hams and moving into the back of my knees a bit and the weirdest thing happened. When the roller got to the back of my knee, I felt an electric shock go across the recovering injury on the top of my right foot! WTF?

If you look at a picture of the nerves in the leg, you’ll see the sciatic starting at the hip, goes down the glute and into the hamstring. Then right above the back of knee, it splits in two, one branch continuing down the calf and under the heel into your foot. And the other branch goes to the front of the leg and down inside the shin and then ACROSS THE TOP OF THE FOOT.

So, I believe, in my case, that that nerve gets a little jammed up or tangled, or something, right behind the knee where it splits in two. Could be from the compression forces of weighted squats. Could be overuse from driving in stop and go traffic every day. Whatever.

I would suggest that you try two things:
(1) The ‘dangle and shake’ decompression exercise off the step. Depending on how jammed up you are, start gently and then progress to ankle weights. Several times a day for a few minutes each.
(2) Foam rolling. Hams. Back of knee. Calves. (and shins and top of foot in my case). I’ve learned to never underestimate the power of foam rolling.

Hope that helps. Good luck!

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Posterior leg nerves

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Anterior leg nerves

18

I just want to say that this has been the only site that has exactly matched my symptoms. ie pain behind knee, duck walk pain, possible compressed nerve, only hurts in deep squatting or full flexion positions. I am getting an mri to rule out lateral meniscus tear and to just see exactly what the issue is. i will definitely try the dangle method and see how that works.
I was seeing a pt for over 2 months and seen some progress from not squatting at all. Now going back into my routine i have to stretch and do some stationary bike to feel good with my lifters on. seems that if i do not get to my squats in my workout, after 40 min. or so my leg will seem to tighten up again. Stretching as definitely helped.
thanks for the info