Baker’s Cysts - Non-invasive Suggestions

If you have pain behind the knee, and it’s limiting your flexion, there’s a good chance it’s a Baker’s cyst. These are benign collections of fluid. The build up of fluid is what prevents bending of the knee. Under normal circumstances, fluids come and go but when there is an inflammatory process such as a meniscus tear or arthritis, and it exceeds the rate of evacuation of fluid, you get a cyst.

The lymphatic system is the system of your body that handles swelling. If there is any inefficiency in that system from past surgeries or just stagnation of fluid, you’ll have more difficulty facilitating that system. It requires the pump action of muscle to get the lymph moving. That’s why the good ‘ol “walk it off” actually has merit. However if you have a blockage, getting manual lymphatic drainage can help. It’s kind of like having a boulder in a river; the water will flow around it, however it’ll create resistance. 

If you don’t have access to a therapist that does this, here is a way you can at least start to get some lymph moving:

Also, using a bike can be a great way to stimulate lymph. When you bend and straighten your knee, it’s like a mechanical pump and can really reduce the stiffness:

Sometimes the muscle behind the knee can contribute. You can use a ball in combination with some gapping like so:

Finally, one of my favorite tools is the Marc Pro. It’s a form of electric stimulation that pumps the muscle for you:

There are 6 main collection areas of the body. One large one is behind the knee. This is likely why Baker’s cysts are so common. They are exceptionally common following knee replacement due to the insult on the lymphatic system. If you’ve had a knee replacement, or plan on getting one, you’ll want to check out this program:

Baker’s Cysts

A baker’s cyst, or popliteal cyst, is a collection of fluid behind the knee. It is benign, and often asymptomatic. If it gets severe enough, it can cause pressure on the local nerves and vasculature which will provoke pain and stiffness in the knee. It will usually be difficult to fully flex the knee. 

There is a bursa behind the knee, namely the gastrocnemio-semimembranosus bursa. On the medial side there is a one way valve from the knee into the bursa. When there is any type of inflammatory process in the knee and the swelling builds faster than it can be evacuated, it accrues and pushes into the bursa. Because of this, baker’s cysts are associated with degenerative processes of the knee such as cartilage damage, meniscus tears, or rheumatoid arthritis. 

Sometimes the cyst can rupture which will initially cause some pain and swelling in the calf. It is important to note that a DVT (clot) be ruled out because this can be life threatening. A ruptured cyst can mimic the symptoms of a DVT. 

The bursa can be aspirated (drained) however, if the underlying issue is not addressed, it will just come back. This is not to say that surgery is necessary. The knee is about position and quality of movement. It is thought of as a hinge joint that just bends and straightens, but there is an element of rotation to the knee as well. If the knee is rotated internally (knee caved in) or externally (knee bowed out) it can change the relationship of the femur and tibia. If there is some defect such as a meniscus tear, this rotation can expose it and irritate it further provoking swelling. 

Where does this rotation come from? More often than not, the ankle. Stand barefoot, and slowly roll your ankle in and out. Watch what it does to your knee. If you are flat footed, it will lead to an internally rotated position of the knee and often cause pain when squatting. To fix this, you have to restore your arch and range of motion in dorsiflexion. Here is my favorite exercise for dorsiflexion:

And here is a way to train your arch with squatting:

Notice that the knee tracks slightly outward, this is the position you want. 

A general principle in rehab is that there are symptoms and dysfunctions. The dysfunction causes the symptom. You just have to look at the adjacent joint to find the dysfunction, as this is a prime example. Missing range of motion in the ankle changes how you squat, which provokes swelling and pain. Resolve the range of motion and work on technique, and you just might keep it from coming back.

Want to learn more? Check out https://www.restoreyourarch.com/