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Baker's Cyst Knee Physiotherapy

Baker's Cyst is one of the most common cause of behind the knee

At the back of our knee is the popliteal bursa - it is a small fluid filled sac that sits between the hamstring muscle tendons and knee bones, and its primary function is to reduce friction.

Inflammation of this bursa was first discovered in the 19th century by Dr William Morrant Baker, which is where it gets its name "Baker's Cyst". It is also known as semimembranosus bursitis or a popliteal cyst.

Popliteal cysts typically affect patients who are over the age of 40 and has a tendency to affect women more than men.

first of all, What Causes A Bakers Cyst?

A Baker's cyst develops when there is excess fluid in the knee joint and there is number of things can cause this swelling of or in the knee.

The most common cause is knee osteoarthritis, where wear and tear of the knee bones and cartilage leads to increased fluid in the knee joint. In fact, 50% of arthritis sufferers develop a popliteal cyst at some point.

Other conditions, such as knee gout, or any injury to the knee which produces swelling, e.g. a cartilage or knee meniscal tear, can increase the risk of developing bursitis in the knee.

What happens is then this excess synovial fluid seeps backwards out of the joint and into the semimembranosus bursa. As the fluid enters the bursa it starts to swell resulting in knee bursitis.

Symptoms of a Bakers Cyst

The first symptom people tend to feel with a bakers cyst is a small bulge behind the knee, a bit like

  • a small water balloon or
  • squashy orange or fruit

There may only be minor swelling and often a popliteal cyst can be so small you don’t even notice anything.

That being said, in some cases, the cyst can get quite large, that can cause

  • pain behind the knee
  • knee tightness and
  • knee stiffness

especially when you bend and straighten the knee. The average size of a Baker's cyst is about 3 cm.

The pain associated with a popliteal cyst tends to get worse with activity or when standing for long periods, easing with rest.

Diagnosing A Bakers Cyst

Diagnosis of a popliteal cyst is usually made by your doctor from what you tell him or her and what they can

  • see
  • palpate and touch

If there is any doubt the doctor can confirm the diagnosis of a Baker's Knee Cyst by performing an ultrasound or MRI scan.

The symptoms of a ruptured popliteal cyst can be similar to those of a DVT (a blood clot in the leg) so if you experience pain in your calf accompanied by any swelling, redness or heat, see your doctor immediately. 

Treatment Options

There are a number of things that can help to treat a bakers cyst including:

1) Ice / Cold Therapy

Ice treatment helps to reduce the swelling in the knee and the bursa, which will help to reduce the pain.

2) Medication

Non-steroidal anti-inflammatory Drugs (NSAIDs) e.g. ibuprofen can help to reduce pain and swelling with popliteal bursitis, but they should only ever be taken on advice of the doctor due to the potential side effects.

3) Stretching Exercises

Tightness in the muscles around the knee can aggravate a popliteal cyst by squashing it which can lead to further inflammation. Knee stretches can therefore be a very effective way of resolving the condition.

4) Aspiration

If a bakers cyst is particularly large or is causing pain behind the knee, then the excess fluid can be drained with a needle by your orthopedic doctor or GP.

It is a fairly straight forward and simple procedure and usually provides instant relief.

However, that being said...it is very common for the fluid to re-accumulate in the bursa if the underlying cause of the bursitis is not address.

5) Injections

Knee bursitis often responds well to cortisone injections.

This is where your doctor injects a mixture of steroid and local anaesthetic into the knee which works to reduce the swelling and reduce the pain behind the knee. Again, the benefits are usually fairly instant but are often short lived as the swelling behind the knee will return after some time.

6) Surgery

Whilst not usually necessary, in a minority of cases, surgery may be recommended. This is usually the case if the popliteal cyst is a result of long-term damage in the knee e.g.

Preventing baker's cyst from coming back

Bakers Cysts frequently return, especially in people suffering from knee arthritis due to the continued production of excess fluid in the knee joint. 

Knee strengthening exercises and knee stretches can often help to prevent a popliteal cyst returning - what happens is that the stronger the muscles get, the less force goes through the bones making it less likely that the knee will swell which therefore prevents another knee cyst from developing.

This is especially the case when the popliteal cyst has developed due to arthritis.

Possible baker cyst Complications

Sometimes...a Bakers Knee Cyst can burst.

If that happens, then the fluid from inside the bursa typically will leak and travel down the back of the leg and into the calf area.This can cause swelling and/or a sharp pain in the calf.

This free fluid will fortunately and gradually be reabsorbed into the body but this can take up to a month, give or take another 1-2 weeks.

During this time, your doctor may prescribe you pain medication to alleviate any discomfort after the cyst bursts.

baker's cyst knee physiotherapy

We can also provide to ease the pain and accelerate soft tissue healing and knee strength and range of motion:

Reference Sources

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