Pain in the Back of the Knee? These Muscles Could be to Blame

After a week of vacationing and hiking in the mountains, Ryan returned home with an unexpected issue—sharp pain in the back of his knee. At first, he assumed it was just soreness, but as the days passed, the discomfort persisted, making daily movements like walking downstairs or going for a run difficult and painful. As an active individual who ran regularly and loved to go hiking, Ryan was surprised by the pain. He had no history of knee injuries and couldn’t recall a specific moment when he hurt himself—his knee just started aching near the end of the trip. Was it something serious, or would it eventually go away?

Ryan figured he could push through the pain and see what happened, but his wife was concerned and scheduled an appointment with a local therapist. After an assessment, the therapist determined that the issue wasn’t in the knee itself but was caused by trigger points in his leg muscles. The prolonged uphill climbs and steep descents had overworked these muscles, causing them to tighten and refer pain to the back of his knee. After a session of targeted massage to release the tension, the therapist prescribed corrective exercises to strengthen and balance his leg muscles. Ryan felt almost immediate relief, and within a few weeks, the pain had completely disappeared.

Could overworked muscles be causing your knee pain too? Let’s explore how muscles become overused and which ones might be responsible for your symptoms.

How Overused Muscles can Cause Pain in the Back of the Knee

Before exploring how muscles could be contributing to your pain, it's important to acknowledge that knee pain can stem from various causes, some of which may be serious. While massage and exercise can often provide relief regardless of the source, it's always a good idea to consult a professional who can assess your condition and determine if further medical attention is necessary.

When a muscle is overused—kept in a tight or constricted state for too long—it becomes fatigued and tense, much like you might feel after a stressful, overbooked week. Over time, or after a traumatic overload event, the muscle can lock into this tight position, forming painful knots known as trigger points. These knots don’t just cause localized pain; they can pull on surrounding muscles, restrict movement, and even contribute to joint dysfunction.

Pain in the back of the knee can be caused by triggered muscles in the hamstrings, calves, or even in the muscles at the back of the knee itself. Various activities can lead to this discomfort, such as wearing high heels, playing high-intensity sports like basketball or football, sitting for prolonged periods, hiking, cycling, or experiencing a traumatic injury. While the knee may be the primary area of pain, the discomfort can sometimes radiate up or down the leg. You may also notice the knee feeling prone to locking or being unable to lock properly. These symptoms can be concerning, but the good news is that they are often easy to resolve. At the end of this article, you'll find helpful tips on how to address and relieve triggered muscles.

My exploration into how overused and triggered muscles impact daily life has been deeply influenced by Myofascial Pain and Dysfunction: The Trigger Point Therapy Manual by Dr. Janet G. Travell and Dr. David G. Simons. This comprehensive two-volume set transformed my approach to massage, allowing me to provide lasting relief to my clients. For a more accessible, hands-on resource, I highly recommend The Trigger Point Therapy Workbook by Clair Davies, NCTMB, which breaks down these concepts into a practical, easy-to-follow guide for self-treatment.

Muscles the can Create Pain in the Back of the Knee

Now that we've explored how muscles can contribute to or even cause pain in the back of the knee, let's take a closer look at the specific muscles that may be responsible. While there's much more to say about each one, I've highlighted the key points that you should know. If any of these symptoms sound familiar, be sure to check out the section below on what you can do to find relief.

1. Gastrocnemius

This muscle shapes the calves and extends from the back of the knee to the Achilles tendon. It plays a crucial role in generating power for movements like jumping, climbing, and pushing off while walking or running. Additionally, it helps control the descent of the body when navigating stairs or downhill surfaces.

Symptoms it can Cause:

• Pain in the back of the knee, thigh, and down to the inner ankle

How it can be Overused:

• Leaning forward while standing for an extended period of time

• Climbing or walking uphill

• Wearing high heels

• Cycling

2. Biceps Femoris

This muscle is the largest of the hamstring group, extending from the sit bone (ischial tuberosity) to the top of the fibula. Its primary functions are to bend the knee and extend the hip, playing a crucial role in movements like walking, running, and squatting. Additionally, it helps stabilize the body and prevents forward collapse when standing or moving.

Symptoms it can Cause:

• Dull aching behind the knee

• Stiffness in the back of the legs

How it can be Overused:

• Keeping the legs bent at the hip or knees for long periods

• Playing football, basketball, or soccer

• Cycling

3. Popliteus

This small muscle is located at the back of the knee, extending from the outer side of the lower femur to the upper back of the tibia. Its primary function is to "unlock" the knee, allowing it to bend by initiating knee flexion and rotating the tibia slightly inward.

Symptoms it can Cause:

• Pain right below the knee when straightening the leg

• Abnormal locking of the knee

• Pain when running or walking that gets worse when going downhill or down stairs

How it can be Overused:

• Quickly changing direction while running

• Downhill skiing or hiking

• Wearing a knee brace

4. Plantaris

This small muscle crosses the back of the knee and features a long tendon that assists the calf muscles in plantar flexing the ankle, allowing the toes to point downward.

Symptoms it can Cause:

• Pain in the back of the knee

How it can be Overused:

• Extreme extension in the knee and ankle at the same time

How Do We Fix Triggered Muscles?

The good news is that triggered muscles can often be relatively quick and easy to "un-trigger." However, if you continue the activity that caused the issue in the first place, the muscle will likely become triggered again. Consider how you can modify or mediate these triggers—for example, wearing high heels less often or not at all. For activities that cannot be adjusted, consistently applying the following two steps can help keep your pain significantly reduced.

Step 1: Relax the Muscle

The first step in releasing a triggered muscle is to relax it. Whether through using self-massage of your legs with a tennis ball or your hands, or seeking the help of a professional massage therapist, massage is the most effective way to ease muscle tension and restore movement. If you're interested in learning more about self-massage, I highly recommend The Trigger Point Therapy Workbook by Clair Davies, NCTMB.

Step 2: Strengthen and Stabilize

Relaxing the muscle alone is not enough. The reason it became overworked in the first place is often due to weakness—either in the muscle itself or in surrounding muscles that failed to provide adequate support. Developing a targeted corrective exercise routine to strengthen and stabilize your legs is essential for long-term relief. These exercises normally don’t require a gym and usually take just a few minutes each day, but the benefits will be well worth the effort!

If you are currently dealing with pain in the back of your knee, schedule a consultation with me today to see how we can work together to help you feel and move better!

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