Posterior Knee Pain

If you lead 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. In many cases, back-of-knee pain while running is cause by inefficient running gait. Pain while running is not normal, and ignoring it can lead to more pain and injury down the road.

Common Causes of Posterior Knee Pain

Sports and exercise are common causes of knee pain in people of all ages. Repetitive use injuries occur when your body does not have time to recover and heal between activity bouts. Acute trauma from impact with another athlete or a simple error in skills execution can also cause knee pain.

Runners are particularly prone to knee injuries due to repetitive impact that overloads the knee joints. Athletes in sports that require rapid directional changes like soccer, tennis and basketball also have a high incidence of knee injuries.

Following are four common causes of posterior knee pain, and recommendations for treatment:

  • Popliteal cyst: Also known as Baker’s 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. Manual therapy and local cryotherapy can help relieve bursa swelling.
  • 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 after a meniscus tear, 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 when bending the knee against resistance, and stiffness after exercise. Ice and compression may help alleviate pain. Running gait retraining and physical therapy may provide long-term solutions to prevent future injury. Extracorporeal shock wave therapy (ESWT) can help stimulate cell neogenesis to accelerate healing. Eccentric loading is a popular treatment for tendon injuries.
  • Gastrocnemius 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 and gait retraining are recommended to correct faulty gait mechanics that may be the root cause of calf tendinopathy. ESWT and eccentric loading can speed up the healing process.

Knee Pain Diagnosis and Treatment in NYC


Medical history and clinical exam are standard procedures for knee pain, along with assessments that test for strength, stability and range of motion. Imaging may be recommended if the clinical exam warrants it.

At NYDNRehab, we use high-resolution diagnostic musculoskeletal ultrasonography (MSUS) to visualize the structures surrounding the knee. Ultrasound lets us see muscles, connective tissues, joints and nerves in real time, with the patient in motion, for a fast and accurate diagnosis.

Diagnostic MSUS also enables us to conduct sonoelastography and superior microvascular imaging, to evaluate the progress of tissue healing.


Explore more advanced diagnostic tools available only at NYDNRehab:


Knee testing

Knee pain and dysfunction cannot be effectively resolved using only subjective clinical analysis. Without objective quantifiable data, physical therapy often addresses the symptoms without resolving the underlying cause.

At NYDNRehab, our groundbreaking motion analysis technology and high resolution diagnostic ultrasonography have enabled us to develop a battery of tests that perfectly reveal the dynamic functional pathology of the knee joint.

Treatment Options for Posterior Knee Pain

The state-of-the-art human movement lab at NYDNRehab has a growing array of high-tech tools for knee injury rehabilitation and return to sport. In addition to rehabilitating muscles and healing damaged tissues, our sports medicine team emphasizes brain retraining, to restore neuromotor pathways that have been disrupted by injury.

Some of our favorite treatment technologies include:

  • 3D running gait analysis and retraining
  • SEMG (surface electromyography)
  • Force plate technology
  • Motion capture video
  • Alter-G antigravity treadmill
  • Kineo intelligent load system
  • Proteus training system
  • DD Robotech AI trainer
  • C.A.R.E.N (computer assisted rehab environment)

Other corrective therapies include:

  • Red Cord therapy
  • DNS (Dynamic neuromuscular stabilization)
  • AIM (Anatomy in motion)
  • IMA (Integrative motion analysis)

Conditions Treated with DDR

Conditions Treated with DDR image 1

Single leg squat stability test with C.A.R.E.N. using perturbation and 3D motion analysis

Conditions Treated with DDR image 1

Knee joint stability test using DLEST methodology on C.A.R.E.N.

ACL stability testing and training


3D SEBT ( star excursion banner test) for assessing the involvement of the knee joint and musculature in postural stability


3D gait or running analysis


3D kinematic joint angle analysis during a squat, lunge, drop jump and pelvic-on-hip rotation

Neuromotor brain-muscle testing with DD Robotech for:

  • Proprioception
  • Tracking ability
  • Force sense
  • Critical power
  • Reactive power
  • Flexibility

KINEO Intelligent load muscle strength assessment

Rehabilitative ultrasonography of intrinsic knee stabilizing muscle activation

Surface electromyography (SEMG) can be added to any of the above tests when needed.

Based on our experience and on evidence-based information, we believe that physical therapy and rehabilitation should be based on objective quantifiable data.

KINEO Intelligent load muscle strength assessment

At NYDNR, we are always learning and adding the latest therapies and high-tech tools to our growing menu of treatment options. We are the most advanced private rehab and therapy clinic in the United States, featuring equipment rarely seen outside research settings.


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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