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Common Causes of Pain Behind Knee Injuries

back of knee painSuboptimal Muscle Function and Strenght

While it may seem like a no-brainer, suboptimal muscle function and strength are huge issues when discussing knee injuries. Believe me, I’m really glad to see more and more people hitting the iron to get into shape; however, a lot of people don’t understand how to design effective programs. Effective programs do a lot more than help you look great in swimsuit! An effective training program not only helps you attain strength or physique goals, but also optimizes your alignment, recruits and strengthens the appropriate musculature, and keeps you healthy over the long-term

Poor Mobility at Adjacent Joints

It may seem counterintuitive at first, but while improving mobility is generally a good thing, in the case of the knee joint, it may leave you at an increased risk of injury.

If you want to see for yourself, firmly put your foot on the ground and then move solely from the hip – try and turn it in and out. Did you notice what happened at your knee?

Now, try the same thing, but this time try and rotate and move your ankle.

MAKE SURE TO KEEP YOUR FEET ON THE GROUND! What happened at your knee this time?

As you are beginning to see, the knee doesn’t have a mind of its own; in fact, it’s slave to what’s going on at the joints above and below it. So what happens when we lose mobility at the hip and ankle? Chances are you’re going to try and get your mobility from your knee joint – and that’s NOT a good thing.

Poor Strength in Surrounding Musculature

Very simply, improving the strength of the muscles surrounding your knees will get you healthy knees over the long term. The stronger your active stabilizers are (i.e. your muscles), the less likely you are to rely on your passive structures (i.e. ligaments) to stabilize the knee! This is also true in the case of shock absorption; in an unhealthy body, shock absorption is transferred to the joints, increasing the rate of wear-and-tear.

Excessive Tension in Surrounding Muscle and Fascia

Have you ever heard someone complain of lateral pain behind knee? It’s quite common in running and cycling populations. However, unless they’ve had knee surgery or are arthritic, they generally don’t have a knee pain – they have a behind knee pain! The pain behind the knee may be felt, but the cause of the problem lies in the tissue above the joint.

Flat-Out Overuse

This may sound simplistic, but if you consistently overload a specific tissue, you’re probably going to suffer from an overuse knee injury. Patellar tendinosis is a great example; people perform too much volume and/or intensity of a certain exercise (whether it’s running, jumping or lifting weights) too soon, and exceed the tissues’ capacity for loading. The result is degeneration of the tendon and usually, pain to accompany it.


Why is the knee one of the most frequently injured joints in the body?

Pain Behind KneeThere are many reasons for behind knee pain and back of knee injuries, but here’s a short list of problem areas we will discuss:

  • Biomechanical alignment.
  • Suboptimal muscle function and strenght.
  • Poor mobility at adjacent joints.
  • Poor strenght in surrounding musculature.
  • Excessive tension in surrounding muscle and fascia.
  • Flat-out overuse!

Biomechanical alignment

If you look at the alignment of the human body, you’ll see that the knee is naturally in a position of slight valgus – in other words, the knee naturally caves in slightly. Serious issues arise when the relative angle between then hip and knee (also known as the “Q-angle”) is excessive in nature.


It’s often cited that female athletes are almost ten times more likely than their male counterparts to fall victim to an ACL injury! The Q-angle is often mentioned in discussions of female athletes, and for good reason. The natural biomechanical alignment of women, specifically a wider pelvis, increases the Q-angle and leaves them at an increased risk of knee injury when compared to men. A study by Moul showed that at 30 degrees of knee flexion, males averaged a 5.5 degree valgus angle, while women averaged 14 degrees! No wonder there’s such a discrepancy in ACL tears between men and women!

While we can’t change our genetics or bone structure, we can make most of what we have and optimize our strength and alignment to decrease the risk of injury.