Pain in the tendons behind the knee, physical therapy: Focus Fizikal✓

Pain in the tendons at the back of the knee represents a common functional problem that directly affects the stability of the leg and the mechanics of walking. The back of the knee, known as the popliteal fossa, is where the strong tendons of the hamstring muscles and calf muscles attach. These tendons play a crucial role in controlling knee flexion and preventing excessive knee extension, which is why they are under constant dynamic load during daily and sports activities.

The anatomy of the tendons behind the knee includes the medial tendons (semitendinosus and semimembranosus) on the inner side and the lateral tendon (biceps femoris) on the outer side. Deep in the popliteal fossa, there is the tendon of the popliteal muscle, which is responsible for the initial phase of leg flexion. When chronic overuse or sudden movements occur, microtraumas can develop in these tendons, which the body fails to heal in time, leading to degenerative changes and thickening of the tendon tissue. Understanding the connection between thigh muscle tension and the load on the tendons behind the knee is crucial for determining the exact source of the pain. Timely physiotherapeutic diagnostics and targeted procedures prevent the development of permanent shortening and rupture of tendon fibers.

The symptoms of tendon pain behind the knee vary from a feeling of tightness and stiffness during the first steps in the morning to sharp stabbing pain when attempting to run or squat. Patients often report that the discomfort worsens with activities that require strong pushing off the foot from the ground or sudden braking movements. The clinical presentation is specific, as the pain is usually localized to the tendons themselves, which can be palpated as firm, painful bands behind the knee.

The most common symptoms associated with pain in the tendons behind the knee include:

• Sharp pain on palpation (touch) of the back of the knee: Clearly localized tenderness along the medial or lateral tendinous structures behind the knee.
• Pain and tightness during full knee extension: Inability to fully straighten the knee without discomfort or pain in the hamstring region.
• Increased pain during resisted knee flexion: Marked pain during running, squatting, or hamstring-strengthening exercises.
• Morning stiffness and a “wooden” feeling behind the knee: Pronounced stiffness upon waking that gradually improves after a few minutes of light walking.
• Localized swelling or tightness in the popliteal fossa: Sometimes accompanied by a palpable, elastic swelling (Baker’s cyst) that can make deep squatting difficult.

These signs are clear indicators that the tendon structures at the back of the knee are under excessive load, which requires professional evaluation. Recognizing these symptoms early allows a physiotherapist to prevent the development of chronic tendinopathy, which significantly prolongs the recovery process.

• Tendonitis
• Bursitis
• Osteoarthritis
• Joint injuries

The etiology of pain in the tendons behind the knee is most commonly associated with overuse syndromes due to sports activities or improper biomechanics of the entire lower extremity. Factors such as weakness of the front thigh muscles, poor flexibility of the hamstrings, or sudden changes in training intensity directly contribute to tendon damage. Although the pain is felt directly behind the knee, the underlying cause is often related to muscle imbalance between the hip and the knee.

The main causes of pain in the tendons behind the knee are:

• Biceps femoris tendinitis: Inflammation of the outer tendon behind the knee due to sudden sprints or changes in direction.
• Medial hamstring tendinopathy: Inflammation of the inner tendons behind the knee associated with prolonged running or cycling.
• Popliteal tendinitis: Irritation of the deep tendon, commonly occurring when running downhill or due to excessive rotation of the lower leg.
• Hamstring muscle shortening: This leads to constant tension at the tendon attachment sites and increases the risk of micro-ruptures.
• Compensatory pain due to meniscus injury: Muscles behind the knee remain in spasm to protect the interior of the joint.

Accurate identification of the location and extent of fiber damage allows for the creation of an individualized treatment plan that will permanently eliminate pain and restore elasticity to the tendons. Each of the mentioned causes requires a specific rehabilitation approach to achieve long-term relief.

At Focus Physical Therapy, our approach to treating tendon pain behind the knee is strictly individualized and focused on permanently eliminating the causes – from chronic inflammation due to overuse to micro-tears in the fibers. We use the most advanced medical technology that stimulates collagen regeneration and breaks down fibrous knots, restoring maximum strength, elasticity, and full functionality to your legs, all without pain.

The process includes:

• Physiatric Examination and Functional Assessment: Detailed diagnosis of the hamstring tension, precise testing of flexor strength, and joint stability check of the knee before beginning therapy. We identify the exact degree of tendon fiber damage to create the fastest plan for a safe return to activities.
• Shockwave Therapy (Acoustic Waves): The most powerful method for treating chronic tendinopathies behind the knee. High-energy acoustic waves directly stimulate tissue regeneration, break down calcifications and adhesions, and significantly accelerate the formation of new collagen fibers in the tendon.
• HILT Laser (High-Intensity Laser Therapy): Powerful biostimulation that penetrates deeply into the area behind the knee, eliminating pain at the cellular level. The HILT laser quickly soothes the inflammatory process and accelerates the metabolism of damaged tissue, providing fast analgesia and regeneration.
• Tecar Therapy: Radiofrequency therapy that dramatically improves microcirculation and nutrition of tendons through deep heat. Tecar relaxes the hamstring muscle spasms and improves the elasticity of soft tissues, preparing them for kinesitherapy.
• Manual Therapy and Soft Tissue Mobilization: Special techniques used by our specialists to manually break down fibrous knots and adhesions. This phase is key for restoring normal mobility to the tendons and improving local circulation.
• Kinesiotherapy and Eccentric Exercises: An individualized program of specific eccentric exercises, which are scientifically proven to be the most effective for the permanent treatment of tendinitis. These exercises strengthen the tendon apparatus and make it resistant to heavy loads.
• Kinesiotaping and Education: The application of kinesiology tapes for mechanical offloading of tendon attachments, along with education on proper warm-up and stretching techniques. Our goal is to make your tendons strong and prepared for all sports and everyday challenges without the risk of injury.

The comprehensive application of these advanced methods guarantees maximum therapeutic effectiveness, even for the most persistent pain behind the knee. With the personalized approach at Focus Physical Therapy, you will regain the necessary strength and elasticity in your legs, with permanently improved movement mechanics.