Baker’s (Popliteal) Cyst in the Knee: Treatment Approaches

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Baker’s (Popliteal) Cyst in the Knee: Treatment Approaches

A Baker’s or Popliteal cyst can be described as a condition whereby the knee produces too much synovial fluid in an area in the back of the knee causing pain, inflammation and sometimes difficulty bending and extending your knee. When the pressure builds up, fluid is pushed into the back of the knee creating a lump or cyst.

It is a condition prevalent in those who have osteoarthritis, rheumatoid arthritis, andBaker's Cyst is also prevalent in children. In fact, a lot people with arthritis walk around with a Baker’s cyst and don’t even know it because they are symptom-free.  Sometimes, the cyst can break open though and rupture which can lead to significant swelling in the knee and calf as well as pain and bruising in back of the knee and calf.  An ultrasound or MRI may be indicated to rule out a blood clot or DVT (Deep Vein Thrombosis).

It is important to take the necessary steps to help reduce the swelling and symptoms once it is known that any serious condition has been ruled out like a DVT to make sure your quality of life is restored. Make sure to elevate your leg above the level of your heart and don’t do any strenuous activities or sports which could cause the swelling to get worse. It is also a good idea to do what’s called “ankle pumps” while elevating your leg. This  is moving your ankle up and down continuously which helps to reduce swelling. Then apply ice for 10-15 minutes at a time with your leg elevated. These steps should be done at least 3x/day. Initially the goal is to reduce the swelling in your leg which will make it more comfortable for you to bend and extend your knee and be more active again.

If your gait is abnormal and you feel you are limping it may also be necessary to use an assistive device like a cane or crutch to help take some pressure off the affected leg and possibly a brace to add compression. I always ask patients to make sure that when they do use a cane or crutch that it is being used with the hand of the opposite extremity or your “good” side.  When you walk the cane goes in sequence with your affected leg in order to take pressure off of it.

One other option that may be worthwhile is to take an over the counter anti-inflammatory medication, with the approval of your physician, in order to reduce swelling.

Anatomically the location of the cyst is in the back of the knee in an area called the popliteal fossa. There are key muscles there, primarily your calf and hamstring muscles that play an important role in allowing your knee to bend. When the pressure builds up there from the added fluid, it is critical that a physical therapist teach.  When a patient is suffering with baker’s cyst symptoms, it is important to perform exercises that includes stretching the gastrocnemius, soleus and hamstring muscles. This should be done daily at least 3x/day.

A doctor also may inject a corticosteroid such as cortisone into the area in order to reduce inflammation. The doctor may also aspirate or drain the knee if the swelling is large enough and all other measures have failed. In most cases though, a Baker’s cyst is very treatable and does not require surgery.

Author: Avi Bregman, PT, MPT

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