Feb 26, 2010 6:56 PM
pain behind knee - how to get rid of it?
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thanks for reading my post!
start of the issue: I started running last september (2009) and I got this in october even though I wasn't doing much running yet back then. I have looked up many knee problems online and this problem fits the description of none of them! I hope someone can give advice, nobody so far has been able to.
main symptom: pain behind either knee (where it flexes) or in worst cases, both knees, it is not inside the knee, it feels like it is on the surface of the knee behind. or to say it in another way, it is this part between hamstring and calf, in the behind of your leg. I hope I explained this in a clear way, if not, let me know please.
the pain isn't awfully sharp but is a lot more sharp than dull. it's felt behind the knee, in the middle and below. I think I don't have swelling there, don't have anything visible there, don't feel anything when I touch it.
symptom details: it just started one day in october... a few days of rest didn't change it at all. it usually never hurts during a run or walking (maybe occasionally I feel the pain for 1 sec as if it was strained). then I noticed that it is usually the worst after getting up from a few mins of sitting with flexed knees or after getting up in the morning (I was sleeping with flexed legs/knees by default). so then I identified that a static flexing of the legs is what makes the pain come up and a few seconds of walking where your legs naturally extend-flex-extend, will make it go away fast. it did feel horrible in the first steps but then went away. when I say it felt horrible it was a different pain, not as sharp, it was more like my knee behind was totally rigid and needed warming up. the other pain that is more sharp can just come suddenly for 1 sec, maybe when I put my leg in an incorrect position.
temporary fix: so then after this realization, I started to pay attention not to keep my legs flexed ever. I even sleep with fully or partially extended legs. it seemed and still seems it is happy as long as the knees are not bent too much. if they were bent in 90 degrees or even more bent than that then it would come back.
after a while this temp fix worked so well that I was able to keep my legs flexed during sitting, for hours, and no pain. but sometimes it would lose the tolerance for being flexed and would come back and then I had to pay more attention to keep my legs extended or partially extended, again.
oh, one more note, I noticed that extending the legs too much can also make it hurt. so there is a fine balance. but most of the time it's happy with the extended state. but I think the best really is a partially extended-partially flexed state (but not reaching 90 degrees!!).
attempts at another fix: then I bought a knee support thing for my runs, to see if it will help. well, it seemed to somewhat help, because I hardly got the symptoms anymore, I could sin by keeping them flexed for very long and no problems... note, I still tend to sit with extended legs out of habit and out of cautiousness.
ok, so the knee support strap seemed to help BUT then it caused different knee pain (related to and) along with quads muscle pain after my workouts. this pain was worrying me too much so now I'm off the knee strap, I don't think it's a good fix if it causes another issue...?! the quads pain was pretty sh*t too. and it didn't 100% fix the original issue anyway.
current status: however it (the strap) did probably help with the original problem because now since I'm not using the strap anymore, my knee behinds (particularly behind the left knee) seem to be more sensitive again, though it is controllable most of the time. but not as controllable when seated on a bus where I don't have space to extend my legs. that led to me feeling the left knee behind in my last workout yesterday (not pain, just uncomfortable) when I started it but it went away. (I felt that because I was "sinning" too much with flexing the legs directly before going out for the workout.)
duh and I had to sprint after a bus the day before that, and my left knee behind was unhappy from sitting on another bus 5 mins before that, and it did hurt during the sprint too. ![]()
my real question: OK, so please can someone give me any idea what to do to fix this? I do not want this to become worse or chronic! so if you have ideas other than going to a doctor (I don't know of any good sport doctors here where I live but will keep looking!) that'd be so great.
I think the bottom line is this: Knees are not something you want to mess with. I'd go to a doctor (preferably sports-oriented doc, in my opinion) and see if there is anything major wrong. I think things that happen on both sides tend to be things like shoes, stride type, etc. When major things (stress fractures, torn tendons or ligaments, etc.) happen I they tend to be on one side. If it feels muscular and the doctor doesn't find major issues I'd bet you'll get referred to Physical Therapy.
There is a muscle where you describe and I've pulled it a couple of times. It's called Popliteus. You might Google that and see what images come back and see if it's location fits where you're having discomfort. When I had issues with this muscle I'd sit on the floor and bend my knee 90 degrees (foot on the floor) and use my thumbs to massage that muscle. If that is your issue that might loosen it up and increase circulation.
Good luck.
Jim
http://jimhaselmaier.blogspot.com/
"Kick off your high heel sneakers, it's party time."
-- From the song FM by Steely Dan
hi, thanks a lot for your reply!
yeah, you are right, I'm also sure it is not something torn, as it would probably limit functionality then. the weird thing is it doesn't always come up for both of my legs, lately it's the left one complaining, but there were times when it was the right leg.
good idea about this popliteus muscle. this is so far the closest guess I think
when you pulled yours how deep in your leg did you feel the pain?
I'm going to try out this massaging tip, thanks a lot again! I'll be back in a few days to say if it helped.
about shoes - I used three so far, the first one wasn't exactly made for running and I think this started before I went out to buy proper running shoes. (then I bought another pair of running shoes because it was a special offer. but I'm not using that now because my achilles tendon didn't like it as much.)
hrm, about the doctor, I first have to find one who's good & sport oriented
that's why I preferred to solve this on my own first if possible.
A few additional thoughts.........
My recommendation about the doctor speaks to the point that, just because your pain is in the same spot as that muscle, doesn't mean the problem is the muscle. There can be other issues that might produce pain in that same location (ligaments? bursitis? something else?). I'm not saying the items just mentioned match your symptoms. I'm just saying there can be a variety of issues that only a medical professional can really figure out. I'd just be cautious about trying to figure it out too long on your own - in case it gets worse.
The shoes absolutely can be the problem, although they may not be. There are all sorts of stories associated with getting different shoes and problems either going away or showing up. It sounds like you ended up going to a local running store to get good shoes. That's good. It increases your chances of getting the right shoes however it, obviously, doesn't guarantee it. Unfortunately we sometimes just have to do some trial and error to see what works.
Jim
http://jimhaselmaier.blogspot.com/
"Kick off your high heel sneakers, it's party time."
-- From the song FM by Steely Dan
you are totally right about avoiding making it worse; I won't give it more than a few more days (trying out your massage suggestion, etc.) before trying to find a good doctor.
as for the shoes: I think it didn't really affect this knee issue (either for the better or the worse) when using the 2nd pair of running shoes as compared to my first shoes, but I had to stop using them anyway (as mentioned above, achilles stuff) so not 100% sure on that one. it may be just bad luck and getting a third pair of shoes would fix it. but who knows. btw, the 1st pair I bought is just fine in every other respect, so at least that's good.
This is a shot in the dark, but I wonder if you could have Bakers' cysts? There's no way to diagnose it without a doctor (who would probably order an ultrasound or MRI), but you might have had them before starting running, and they would't cause much problem other than pain.
Let us know what you find out.
Robin
I used to get the same thing. I was complaining one day about it to my buddy in the locker room in front of an "older" dude. He said "well no wonder your quads are puny". Turns out in a former life he was a soprts doc for the Ohio state Buckeyes. Apparently he was right. I began biking (stationary) and doing other quad strengthening excersises. It turns out that the quad can "give out" at some point in your run and allow the knee cap to "float" which scratches (could tear) the meniscus over the knee cap. Mine was mostly top of the left knee. I would try it. Can't hurt. a "go to" cross-training excersise is a must anyway since we all get hurt once in a while.
Good Luck!
P.S. I have seen the straps and things but I wouldn't want to make myself dependent on that. Just a personal thing. AND as painful as it is to think of running is not the only way to stay fit! Get yourself healthy!
I'm sitting here with the exact same problem. Mine has been going on for two months now. In early January I was running on icy ground and changed my gait to keep my footing and I think that is when I injured it. I believe this is hamstring tendonitis. My symptoms are almost identical to yours, mine is also right behind my knee where it bends.
This is weird, but I can usually run on it (once I'm warmed up) with only some twinges of discomfort. But when it REALLY hurts is in the middle of the night! During the day it isn't too bad other than being stiff. If I rest it 2-3 days it is always much better but then after a couple of runs I am waking up at night with it aching again. Is this how yours is?
I've also done icing and wrapping. It keeps getting better then worse again. From what I've read the answer is resting it for several weeks.
That is my last resort!
Just re-read the LOCATION. My diagnosis is "not helpful" sorry.
BAD Gatorman....
RobinfromMaine: thanks for the idea. I don't think it's that problem because, luckily, I cannot feel any bump when touching there. but certainly one more reason to go get it checked out if I can't fix it in the next few days!
gatorman10: yeah I started quad strengthening recently because of another problem with my quads, as mentioned above, but it was only caused by the stupid strap - you are right and I don't really recommend the straps to anyone anymore. that problem was exactly what you described. but the problem I write about here is probably not related to the knee cap (I *think* that anyway) because it's on the other side, in the back of the knee.
EDIT: I see you also realized it's not the same location but still thanks for trying to help!
Marykb: very interesting about your hamstring issue causing similar symptoms.. I didn't hear about hamstring tendonitis before, so this is a good idea.
I don't have problems at night but I have a tip for that: do you sleep with bent (bent more than 90 degrees) legs? for me it helped sleeping with more extended (or only slightly bent) legs. if I didn't, then I would wake up with a very stiff leg behind the knee. so, the question is, can the position of your legs (at rest) aggravate your symptoms?
another question, where it hurts, is it in the middle in the back of your knee, or more like on the sides in the back? for me it's mainly the middle or one side very slightly below the knee.
if I do have to go to a doctor I will definitely let you all know what the cause was. if not, then I'll describe the thing(s) that fixed it.
well, it's been a few days and no very big news. but I did find something that helped a lot. when I read about the popliteus I also read that hyperextending the knees is bad for it. I was keeping my legs extended to avoid problems with my knee back and yeah it did help but it seems that the few times when it came back was due to keeping them extended way too long (many long hours). so now I instead keep them half flexed and so far this seems best for whatever has the problem. (overflexing is the worst though so I'm careful to keep them only half bent, not more than 90 degrees). it also seems to like it when I don't keep my leg in front but slightly to the side (knee a little rotated, perhaps).
I will see if it totally goes away which for me means a month without any issues.
just a follow-up. nothing new, same status as last time I posted. i.e. avoiding hyperextending and avoiding full flexing of my legs for more than a few mins helps. seems to be better than when I first posted here, though. on most days I can keep my legs fully bent (ouch!) for a long time (such as sitting on a bus with not enough space for my legs) and no problem.
I suspect sometimes while running sometimes I somehow move my leg around in an incorrect way, perhaps for just 1 single step at a time because then it will complain instantly and then pain goes away quickly. and probably that incorrect movement is what places some stress on it. happens maybe once a week. once happened during power walking. so now trying to figure out what it is that I'm not doing correctly at those times.
by the way, I found out there is a very good sports doctor in my area who deals with your body as a whole in these issues and so prefers to find the cause instead of treating the symptoms - if I cannot figure out the answer on my own to this question (what movements I'm doing wrong) I will just have to sacrifice some money to visit the doctor (I'm told not cheap but good). though I prefer finding out myself because it could teach me a lot. ![]()
Just joined this thread, but I agree with Jim's assessment and strategy.
I need to add that the Popliteus muscle is used to initiate the action of unlocking the knee, and it can become ischemic (deprived of blood flow) when the knee is straight (locked), particularly if your knee is prone to hyperextension, which could be another reason why this muscle would be sore. Its job as a medial rotator can sometiimes point to excess motion in your footstrike, either due to surface slippage, footwear, or foot structure. Have someone run behind you to look for this action. Lateral movement of the foot would also be a clue to the tiring of Popliteus.
There is another muscle in the back of the knee (Plantaris) that acts via a long skinny tendon as a knee and plantar flexor, but it does not even exist in some people, and has been found to be so tiny and vestigial in others to be mistaken for a nerve. Still could register pain, though.
BTW, be careful massaging in this cavity, because there are nerves and arteries with little protection in there. This is why self-massage of the area may be better, so you can monitor pain and pulse.
Meanwhile, there are muscles that work with the above two to flex the knee. The hamstrings are obvious, and the upper rear-calf muscle Gastrocnemius can be strengthened by toe raises while the knee is locked straight. The stronger these larger muscles get, the less work for the little guys.
Take a look...
http://www.getbodysmart.com/ap/muscularsystem/legmuscles/popliteus/tutorial.html
thanks for your great tips on this!
as for knee hyperextension - by default I'm not prone to that, but yes I used to force static extension of the knee for a while because initially that was what helped with the symptoms, before finding out that it was only helpful in preventing me from keeping my knees bent too deep, i.e. too deeply flexed knee is what sometimes gives a lot of stress for whatever it is that can get sore in the back of my knee. and the other thing that causes stress for it is probably some movement I inadvertently seem to make when power walking/running (so, weak muscle theory is good too) so yeah it will be useful to have a friend look at it/record it, that's a good idea!
A couple things I ran across in my studies for another thread...
MaryKB mentioned "hamstring tendonitis" as a possible cause for her similar pain, and I found that both back-of-knee pain (more dull than sharp), as well as misdiagnoses of hamstring tendonitis, can be due to trigger points in the Biceps Femoris (outer hamstring) you can find at tab #5 in the link I supplied earlier. You can get a better look in this link (click on #14)...
http://www.getbodysmart.com/ap/muscularsystem/legmuscles/bicepslong/tutorial.html
This is because the outer hamstring pain is sometimes mapped to this area by the brain, although it can range from outer thigh pain to top-of-calf pain. There is a possibility that the location of the Biceps Femoris tendon is the reason for this - because it crosses over the tiny Plantaris muscle. To find the most common trigger point on the long head of Biceps Femoris, see on the link where the muscle diagonally crosses the Femur bone. Consistent short sets of circular massage at this point may or may not reproduce your back of knee pain, but a few times a day may reduce it after a few days or weeks.
On your Popliteus, another interesting tidbit is the tendency for this muscle to compensate for weakness in the Posterior Cruciate Ligament, the function of which is to prevent hyperextension and keep the Femur from slipping forward on the supporting Tibia bone. If you ever had an accident to this area (I had a nasty ski accident when the binding did not release after impaling a mogul - ouch), there might be some hyperflexibility in the ligament that forces both Popliteus and Biceps Femoris to tire from compensation. If that were the case, tightening ligaments is not an easy thing to do.
In case things don't stabilize as your running inevitably matures, there are relatively inexpensive options down the line should such a problem be diagnosed. One would be prolotherapy, an injection technique that induces inflammation in semi-hard tissues like ligaments in order to toughen them.
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