Why Is There Swelling Behind The Knee – Baker’s Cyst

Do you know anybody that has swelling behind the knee? I’m talking about the type of swelling that is right behind the knee, right where the knee bends, and usually gets puffy. Sometimes it can be almost like a ball back there that’s kind of soft and squishy. It’s often called the baker cyst. There are other things that could cause that kind of swelling back there.

In today’s video, I’m going to tell you all about it and what to do about it. My name is Dr. David Middaugh and I’m a specialist physical therapist over at El Paso Manual Physical Therapy, I’ve been helping people out with knee problems for years. And we see Baker cysts here in the clinic from time to time. They’re just not that common. They don’t happen super often. But we know exactly why they are there and why they happen and how to treat them.

In fact, we had a client come in just this week with a baker cyst that had ruptured, in fact. So I want to explain all this to you. But real quick, a baker cyst, let me just tell you about that. A cyst is a pocket of fluid that develops inside of the body somewhere, usually the ones that we know about the famous ones or the ones that are close to the skin. So behind the knee, the baker cyst is what they’re talking about.

The reason why they are called a baker cyst is because the surgeon that named it first his name was Baker, Dr. Baker, so they call it a baker cyst. But it’s on the back of the knee, there’s a the joint lining, the capsule, as they call it, the stuff that holds all the fluid inside, it stretches out backwards on the knee. Because it’s finished there, there is an kneecap like on the front, and on the sides, you have a bunch of dense ligaments and tendons.

On the back, there is it’s a little thinner membrane wall, it’s called the synovial membrane effect. And it has it’s kind of the weakest point in the knee joint. So the fluid that accumulates inside, if there’s excessive fluid accumulation, in some people, depending on everybody’s genetics, everybody’s different. In some people, it’ll expand backwards into the back of the knee. And that’s what causes that puffiness and that discomfort back there. That doesn’t allow proper knee bending, that’s the baker cyst.

In some cases, like this patient that we saw this week, it ruptures. It’ll be there almost painlessly just kind of a nuisance more so than something that is aggravating day in and day out. And some people it is definitely a very painful thing. But once it ruptures that’s almost always painful, and it causes swelling down into the leg.
Now the baker cyst itself, there are all kinds of treatment options out there, and getting to the root problem is a big deal. When it’s not treated at the root problem. Treatments that are commonly done are taking pain medication for the pain, obviously, that’s just masking the pain. Some surgeons will go in and aspirate it, meaning they put a needle in there and drain it. They take the fluid out, and that does reduce the size of the cyst.

But what often happens is the fluid regenerates and it comes back it grows back. And the root problem hasn’t been addressed. They just dealt with it one of the symptoms swelling, the root problems that physicians will also often label as being the root problem for Baker’s cyst is a cartilage injury, like a meniscus injury, or ligament injury.

If those injuries are present within the joint, it can definitely set off inflammation and excessive fluid being built up inside the joint which can cause a baker cyst. But here at this clinic, we got to go deeper than that, because we can’t surgically correct a meniscus tear. And a lot of times you don’t want to they sometimes are painless. In fact, we get people running and being active going up and down stairs with a torn meniscus as evidence on an MRI.

But what’s most important is making sure that the forces going through the knee in other words, the muscle balance the weighted motions occurring. It’s kind of things that are hard to explain on the video, you have to kind of have to go through treatment to fully understand it. But the best way I can put it to you as the forces going through the knee needs to be normalized. When there’s a muscle imbalance.

If you think about the muscles in the front of the leg and the muscles in the back of the leg, they’re usually stronger on one side than they are on the other and that can cause the knee joint to have excessive forces in certain parts of the joint. When that happens, the joint doesn’t like it, it gets irritated and as a response to that it starts to generate more fluid inside the neat and in an effort to cushion the surfaces on each other.

A great analogy is if you think about getting blisters, like if you go with weightlifter, do a bunch of yard work or housework and you get a blister somewhere on your hand. You get a blister because it’s excessively rubbing against your skin. And if it happens too much, too soon, a little pocket of fluid develops, like assist, that is protective so that you’re not going to hurt the tissues below.

Same thing inside the knee, you don’t necessarily get a cyst inside the knee, you get that that fluid pouch on the back of the knee. But the joint lining inside the joint develops more joint fluid, that’s its purpose is to develop joint fluid and protect the surfaces, and it cushions the joint. But if it’s excessively developing fluid, and it’s been going on for a while, because those forces have been there for a while the muscle imbalance has been there for a while. That fluid doesn’t have many places to go. And it tends to go out the back where the joint lining is the weakest. So that’s how you get the Baker’s cyst.

Fixing the root problem of the excessive pressures is a process and it happens over time. It’s not something that’s instantly done, there isn’t a surgery for that, you’ve got to learn how to move better, you’ve got to learn how to exercise better, there’s a whole learning process that needs to develop. Because if it’s a quick fix,

I don’t know if there’s any surgeries out there for Baker cysts, honestly.
Besides getting the joint aspirator, where they take the fluid out, I don’t know if any other procedures are out there, what surgeons are likely to do is say, well, let’s go in there and fix that torn meniscus or let’s go in there and clean up the joint because you’ve got arthritis, and that’s likely what’s causing the excessive fluid.

But what we often see is that people still get the fluid to return back because the muscle imbalance, the movement patterns are not fixed, which is exactly what we fix here in our manual therapy clinic. And just to make sure you fully understand how the baker cysts work, if the fluid develops gradually, the tissues that are holding it in, have a chance to adapt and hold it pretty well.

And we do see some people that have had Baker cysts for years, and they just kind of live with it, their knee aches and hurts from time to time. But it’s decently manageable. Besides they can’t bend their knee all the way, it does set the person up to begin to get arthritis to progress faster and that knee because they’re not going to the normal motion, and they probably baby that knee a bit more than their other side.

But in other cases, if the fluid develops faster than what the tissues can adapt to, that that cysts can rupture, and the back of the of the joint where the where the membrane is, can possibly be leaky after that it may never develop into a normal cyst. But what will happen is fluid will accumulate in the cafeteria all the way into the foot. In some cases, there’s little crevices where fluid can seep into in the leg, and it can stay in there and it can be painful because of swelling can press up against the nerves and other tissues. And it is very uncomfortable, you do not want to have a recurrent swelling problem.

A lot of people think that they have a blood clot in your leg, which is very dangerous. And you want to get that checked out as soon as possible and get it ruled out make sure that your heart is going to be okay your lungs going to be okay. But it is a ruptured Baker’s cyst, the best thing to do is to start addressing the root of the problem. And it’s rarely ever a torn meniscus or the ligament or the arthritis, there’s a deeper problem than that.

So look to get a muscle imbalance fix or some other mechanical problem that isn’t putting that isn’t allowing you to put normal pressures through your knee joint. And some other things that could mask as a baker cyst, or some people come into the clinic thinking that they have a baker cyst, but it really isn’t. And the meniscus itself is a big, big structure, you have a pair of minnisky in each knee. And it would maybe people don’t realize is the meniscus is a chunk of cartilage that goes all the way to the front of the back of the knee and on the outsides of the knee joint. And if it becomes injured on the backside of the knee, it can cause swelling in that direction.

It may not literally be a baker cyst, but it may just be the inflammation from the meniscus itself. Other things it can become injured, there’s tendons back there from your hamstrings. And if those get injured, if you have a torn tendon or a pulled hamstring that’s low behind the knee, it can also cause swelling, but usually a meniscus injury or a tendon injury will cause swelling off to the sides, not right in the middle.

If you’ve got swelling right in the middle, and it just doesn’t go away. It’s likely a baker cyst. The one other thing that could happen that’s right in the middle is a PCL injury, the posterior cruciate ligament, which is rare to have that that happens in traumatic cases, most people that have a baker cyst, maybe have a history of knee problems that are small in the thing that was a big deal, but they haven’t had a traumatic incident that caused them to then begin getting the baker system. The baker cyst is usually a gradual development over time. That is a nuisance.

Hey there, if you think that you’ve got a baker’s cyst and you want to address the root problem, so that the swelling isn’t coming back, and you’re not just getting a band aid fix by getting a meniscus repaired or the ligament address or the cartilage cleaned up. Because of arthritis, you want to get to the root of the problem.

If you’re considering hiring us to help you with your Baker cyst and the root of it. And here’s what I recommend that you do. Go up to the top of the website here where it says cost and availability, hit that button right there. And you’ll get taken to a page where you can leave us your details, so that we might call you back as fast as we can, and have a conversation with you about your knee issue, the baker cyst, the swelling behind the knee.

Once we talk with you, if it’s the type of problem that we can help out, then we’ll tell you the next steps and see if it’s appropriate for you to come in and get checked out for your knee problem. And you can also just call us directly at 915-503-1314 so that we can begin that conversation right away over the phone. I hope that we can be a part of your successor real soon so that this swelling behind the knee is gone and you’re back to being healthy, active and mobile again. Have a wonderful day.