Pain behind the knee and calf: what it usually means

Pain behind the knee or in the calf is usually something simple, like a pulled calf muscle or an irritated knee. Most of the time it settles with some rest and a little patience. Once in a while it's a blood clot, and that needs care the same day. Here's how to tell the difference, what you can do at home, and when to come see us.

When to get help right away

Get seen the same day if you notice any of these:

• Swelling, warmth or redness in the calf, especially if nothing happened to explain it
• A heavy, tight leg with no injury to explain it
• Chest pain, shortness of breath or coughing up blood (call 911)
• Fever along with a hot, swollen knee
• Numbness, weakness, or a foot that drags when you walk
• Numbness in both legs, numbness around your groin, buttocks or inner thighs, or trouble controlling your bladder or bowels (call 911 or go to the emergency room)
• Knee pain right after a fall, a car accident or a twist you couldn't walk off
• You can't put weight on the leg
• A snap or pop at the back of the lower calf or ankle, or you can't stand on tiptoe (possibly a torn Achilles tendon)

Why this matters: A blood clot in the leg can feel a lot like a pulled muscle. If your calf is swollen and you can't point to something that caused it, don't wait it out. Get it checked.

Common causes of pain behind the knee and calf

Where it hurts and how it started are the two best clues. Here's a simple guide:

Takeaway: Pain that starts suddenly during activity is usually a strain. Pain that builds up slowly is more often tendon irritation or wear inside the knee. If you're not sure which it is, that's exactly what an exam is for.

A lump behind the knee

A soft bulge in the crease behind your knee is usually a Baker's cyst. The cyst itself is harmless, just a pocket of joint fluid, but any new lump needs a check. A cyst is often a sign that something inside the knee, like arthritis or a meniscus tear, is making extra fluid. Treating that problem is usually what settles the cyst.

Now and then a cyst bursts and fluid leaks down into the calf. That can look just like a blood clot, with swelling and pain in the calf, so it always needs a proper check before anyone treats it.

Takeaway: A lump behind the knee usually isn't dangerous by itself, but it's worth letting us find out what's causing it.

Other causes we check for

We also check for these:

• A hamstring strain or sore tendon. The hamstring tendons cross the back of the knee. A strain often starts suddenly during a sprint, while a sore tendon usually builds up from overuse.
• Knee arthritis. This usually builds slowly, with stiffness that's often worse in the morning or after sitting.
• A pinched nerve in the lower back. Nerve pain (sciatica) can travel from the back or buttock down into the calf, sometimes with tingling.
• Muscle cramps. Common at night or after a hard workout, and gentle stretching usually eases them.

Takeaway: Several of these feel alike, so an exam looks beyond just the spot that hurts.

What you can do at home

If you have none of the warning signs above and you know what set it off, like a sprint, a jump or a long hike, simple care usually helps:

• Rest from the activity that hurt it, but keep walking gently
• Use ice and keep the leg raised to calm the swelling
• Skip hard stretching for the first few days
• Ask your doctor before taking anti-inflammatory medicine

Ice or heat? Start with ice, in short sessions with a cloth between the ice and your skin. Hold off on heat and massage for the first few days.

Give it about two weeks. If it isn't clearly better by then, come in for an exam. Get checked the same day if the pain gets worse, you can't put weight on the leg, the swelling grows or your calf turns warm.

Protecting your calf and knee

A few simple habits can lower your chances of a strain:

• Warm up before activity and stretch your calves regularly
• Build up new or harder workouts gradually
• Keep your calves and the backs of your thighs strong, with rest days between hard workouts

Know when a clot is more likely. Most calf pain isn't a clot, but the chances go up after surgery or a leg injury, on long trips, or when you have been laid up in bed or a cast. At those times, move around as much as your care team allows, and get a swollen, warm calf checked the same day.

What happens at your visit

We'll ask how and when the pain started, then examine your knee, your calf and the way you walk. Imaging isn't always needed. When we do want a closer look, we pick the test that answers the question: an X-ray for bone, or an ultrasound or MRI for muscles, tendons and cysts. Then we'll build a plan around what you want to get back to.

How long recovery takes

It depends on the cause. A mild calf strain often feels better within a few weeks, while a bigger tear can take a couple of months or longer. Physical therapy helps you rebuild strength step by step, so you can get back to walking, running or sports and lower the chance of hurting it again. We'll give you a realistic timeline after your exam.

Who to see for pain behind the knee and calf

Our team works together, and the right place to start depends on what's going on.

Schedule Exam

If the pain behind your knee or calf has lasted more than two weeks, keeps coming back or is changing the way you walk, come see us. You don't have to figure it out on your own; that's what the exam is for.

Are you suffering from pain?

Please contact us! We'd love to help.

If you have pain, please contact us and schedule an appointment. We have urgent care facilities all over New Jersey for your convenience.

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This blog post is meant to be informative and should not act as a self-diagnosis tool. If you’d like to see one of our doctors, please contact us here.