Posterior Knee Pain


If you live a physically active lifestyle, you are bound to have a some aches and pains from time to time. Most exercise related pain resolves itself with rest, but persistent pain that lingers beyond a few days may indicate an injury that should not be ignored.

Posterior knee pain is often seen in runners and other athletes, and it may originate from a variety of causes. Following are four common causes of knee pain, and recommendations for treatment:

  • Popliteal cyst, also known as Bakerтs cyst: A popliteal cyst is a golf-ball sized fluid-filled swelling behind the knee. Symptoms include pressure and pain at the back of the knee and upper calf. Baker’s cyst arises when a bursa fills with synovial fluid. Treatment includes rest, compression and a change of activities until the swelling goes away. If swelling persists, seek medical attention.
  • Meniscus tear: Menisci are tough, rubbery horseshoe-shaped bits of cartilage located between your femur and tibia that provide stability and shock absorption during physical activity. Sports that demand pivoting and rapid changes of direction cause torque at the knee joint that can lead to a meniscus tear. Walking may be possible, but the knee may become swollen and painful. Rest, ice and physical therapy are recommended treatments.
  • Hamstring tendinopathy: Posterior knee pain originating from the hamstrings most often involves the biceps femoris muscle and tendon. Pain manifests behind the knee near the outside, with pain and tenderness upon bending the knee against resistance, and stiffness after exercise. Ice and compression may help alleviate pain. Running gait retraining and physical therapy may provide a long-term solution to prevent future injury.
  • Gastrocnemeus tendinopathy: Tendinopathy of the upper calf muscle is a common overuse injury in runners and sprinters. The condition is marked by pain from an inflamed calf tendon at the back of the knee. Modified training, ice and compression may help reduce initial symptoms. Physical therapy is recommended to correct faulty gait mechanics that may be the root cause of tendinopathy.

Knee Pain Diagnosis and Treatment in NYC


The sports medicine specialists at NYDNRehab are experts in diagnostic musculoskeletal ultrasonography. Diagnostic Ultrasound not only enables the doctor to identify the structural causes of knee pain, but it allows your clinician to view the knee region in real time, with the knee in motion. In addition to ultrasound, video gait analysis can help us identify faulty movement mechanics that contribute to hip and groin pain. Once the exact cause is determined, an effective treatment plan can be initiated.

A knee injury can be devastating if you are physically active, keeping you from participating in your favorite activities. If you are experiencing persistent posterior knee pain that does not get better with rest, you may have a serious injury that needs professional attention. The knee pain specialists at NYDNRehab are dedicated to resolving your knee pain at its source, so you can get back to your active lifestyle. Our cutting edge technologies and innovative treatment methods are unique to our clinic. We are dedicated to accurately diagnosing and treating your knee pain so you can get back to enjoying the activities you love, pain-free.


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In this instance, an athlete was originally diagnosed with minor quadriceps muscle strain and was treated for four weeks, with unsatisfactory results. When he came to our clinic, the muscle was not healing, and the patients’ muscle tissue had already begun to atrophy.

Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider. To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected.

The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. Using dynamic MSUS, we can see what happens when patients contract their muscles, something that cannot be done with MRI. From a diagnostic perspective, this interaction is invaluable.

Dynamic ultrasonography examination demonstrating
the full thickness tear and already occurring muscle atrophy
due to misdiagnosis and not referring the patient
to proper diagnostic workup

Demonstration of how very small muscle defect is made and revealed
to be a complete tear with muscle contraction
under diagnostic sonography (not possible with MRI)


Complete tear of rectus femoris
with large hematoma (blood)


Separation of muscle ends due to tear elicited
on dynamic sonography examination

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