I have a ganglionic cyst behind my left knee. It has been there for years without a problem. Some recent changes to my bike position and it has flared up twice and I have had it drained twice. At first there was immediate relief, but sure enough it would come back. Well, I hope I have figured out everything with my bike position and all but I can definitely feel the cyst behind my knee again (the immediate relief has worn off like it did last time after a couple weeks).
I know that cysts frequently come back even after being surgically removed. So what do you do about them then? Assuming I have fixed what was really causing it to flare up do I now just deal with it? Develop a pain killer addiction? Buy a big needle and drain it myself every 2 weeks?
Are you sure it is a ganglion cyst? A ganglion is usually related to the fraying of a tendon sheath and forms a small (pea sized fluid fill nodule.
A baker’s cyst on the other hand is a collection of fluid in the posterior of the knee. It is a bulge in the joint capsule or synovial lining of the knee and is commonly associated with injury to some other structure in the knee. Something like a meniscus tear or arthritis or some other inflammatory problem. The sca that forms aslo forms kind of a one way valve. Meaning fluid can go into the cyst but can’t get back out and stays there making the cyst grow larger.
Like you said, you’ve had it drained and it has come back. This is pretty common. The real treatment for this is to find what is causing it, i.e. meniscus tear etc. and get that fixed. Once the chronic swelling from the real injury goes away then typically the backer’s cyst will resolve as well.
Not trying to scare you about the meniscal injury or anything, it could be other things. It is just fairly common to have an underlying meniscal injury when dealing with a Baker’s cyst. For example if I see an athlete with a Baker’s cyst, I don’t stop at “Hey you’ve got a baker’s cyst.” I go looking for other things that might have caused it.
Thanks for the reply, I am guessing you are a doctor, or you enjoy doing research for random people online, so I will try to explain my situation and see what you think.
The cyst has been behind my knee for 4+ years. I had an MRI done on the knee and the ortho said it was very structurally sound and that my kneecap tracked well and all. He drained it the first time and there was immediate relief. I went back to hard training and it came back. I did some research online trying to be an informed patient and I thought it fit the description of a Baker’s Cyst. I went into him and said “Hey, this is a Baker’s Cyst.” He proceeded to explain the differences like you did about the one way valve and all and told me why it was a ganglion and not a Baker’s cyst. The doctor is great and always willing to listen, he treats a lot of atheletes, is a runner and triathlete himself and writes for Runner’s World so I trust him. He drained it for a second time that day and again I had the immediate relief.
I have done some very hard running and have had no issues. As soon as I put in a hard effort on the bike I could feel the cyst flaring up. I recently changed bike shoes and am discussing that in another thread on ST. I have been struggling with some tightness behind both knees and it seems from talking to some bike fit people that my new shoes might be the cause. As I said, that tightness is behind both knees, not just the one with the cyst. I am going to go back to my old shoes to see how I feel in them.
So, I guess I am asking, is it reasonable to believe that this might be a ganglion cyst and that whatever I am doing to cause the tightness behind both knees (possibly the new shoes) is also causing the cyst to flare up? At first I thought the cyst was the cause of the tightness, but as I said I have that behind both knees so I am now thinking the shoes might be the cause of the tightness and the cyst flaring up is an effect of that. If I switch shoes and resolve the tightness issue might the cyst subside back to the point where I hardly noticed it like it had been for the past 4 years or so?
I’m not a doctor. I am a Certified Athletic Trainer and work at the college level so I see sports injuries every day at work.
Posterior knee pain during cycling is usually attributed to the seat being too high. But since you have changed shoes, maybe it is a cleat placement issue or maybe stack height issue.
Could the new shoes be thinner in the cleat area, causing some minute difference in stack height?
or
Try moving your cleat back toward your heel just a little. This would maybe prevent you from over extending your knee.
If all else fails lower your seat 1 or 2 mm and see if that helps.
But only make one change at a time. That way you can do some trial and error testing and see what really works.
That being said, could my assumption be correct that the differences in my foot position are causing the tightness behind my knees which in turn is causing this cyst that has not flared up in 4 years to suddenly be acting up? I originally thought the cyst was the cause of the problem but now I think it might just be an effect. The theory I am working with right now is the new shoes are causing the tightness which is causing the cyst to flare up. Reasonable assumption?
I would say that is a fair assumption. And based on the info Fleck gave you I would say it is a good possiblity your shoe may be the problem. Specifically the thinner sole. you may nee to drop your seat height a couple mm to get things back to normal.
As I mentioned before. Only change one thing at a time, record what you notice/observe about the effects of the change. Also record what changes were made. i.e. original cleat position etc so that if need be you can put it back where it started from without too much futzing around.
Thanks again for the input and advice. Assuming the switch back to my old shoes cures the tightness behind my knees that was causing the cyst to flare up, what can I expect from the cyst in the future? Will it just always be there? Might it go away on it’s own? Any long term effects I should look out for?
If you can get your set up figured out so that you aren’t having posterior knee pain then it might kind of go away. But from the sounds of your history it may never fully dissappear. Unfortunately there is probably no real way to know this. But as far as I know there are no long term effects of having something like that in your knee. It may just kind of give you troble from time to time.
Also one last thing. make sure your knee is feeling better beofre going and messing with your set up. If you start changing stuff with your knee still painful you might not be able to really tell if the change is working or not.
And a bit of preventative TLC might not be a bad idea either, in the form of 15-20 min of ice after you get done biking or running.
One last question about this cyst and the pain behind my knees. Will these cysts ever shrink on their own or are the only options to stay the same or grow? I took this weekend completely off other than a short run and was good about stretching, ice and massage. The pain behind my knees has decreased a fair amount and I am going to start some light cycling with my old shoes this week.
However, I can feel the cyst behind my knee sitting here at my desk. I can feel it more than I used to in years past when it wasn’t so irritated but less than I have recently when it was at its worst. I guess what I am saying is that right now it is tolerable but would be too irritating if it got much worse. If the issue was my shoes and switching back to my old shoes removes the irritating factor is there hope the cyst might begin to shrink? I would like to avoid having it drained again, but if there was no hope of it shrinking I would go and have it done just for the immediate relief. As I said, I could live with it like it is right now if there was hope it might shrink, however if it is only going to stay this size or possible grow I would probably go and get it redrained just for the immediate relief and then hope that riding with my old shoes would prevent it from growing again.
I did think of another possibility for your injury the other day. There is a bursa that sits in about the area you describe. It is the Gastronemius bursa. If that were inflammed it would give you similar symptoms. But anyway…
I haven’t ever worked with a ganglion cyst that big before and never one in the posterior knee, only Baker’s cysts. My experience with those is that over time they will sometimes reduce in size if left alone and the source of irritation is removed.
I think your best bet is to try out the old shoes and see what happens. If it goes away with the switch, then great, if not then think about having it drained again.
Thanks, I don’t know what the source of this pain is but it sure does suck. Here is how I described it in another post trying to figure out the cause:
I have been dealing with this for about 2 months now and still can’t get it figured out. I have a lot of tightness in the back of my knees. I don’t know much about anatomy but it’s behind both knees and slightly below the center of the knee so it might not even be part of the knees but something else entirely, I don’t know how far down is still considered the knee. Definitely above the calf but also below the middle of the knee joint (someone had mentioned the popliteus muscle?) When I stretch my hamstrings it doesn’t really seem to target it nor does stretching my calves.
It doesn’t hurt when I do any pushing motions, ie. standing up on my toes, squatting down, pushing down on the pedals or pushing off during my running stride. It seems to be more affected by pulling motions, the upstroke of my pedal stroke, the beginning of the recovery portion of my running stride. Doing one-legged drills on the trainer really used to fry it but once I realized the connection I stopped doing it.
It doesn’t really hurt, as much as it is very tight and tender and sometimes feels like it is spasming slightly. It almost feels like if your feet were anchored to the floor and someone was sitting in front of you and wrapped a belt behind your leg at your very upper calf just below the knee and was pulling forward. The pain goes horizontally across the back of the leg if that makes sense. It gets worse throughout the day sitting at my desk at work so I have tried to make an effort to sit with my feet propped up and to stretch and walk around as often as possible.
Anyway, for now I guess I will give the old shoes a shot. I would like the immediate relief of having it drained, but getting to the doctor is somewhat of a pain and I have tried that twice already and don’t want to do it again just to be back here in 2 weeks. I guess there are 3 possibilities here.
I ride with the old shoes, the cyst continues to get progressively worse as if I were still riding the new shoes and then I go back to the doctor and consider some serious time off.
I ride the old shoes and then pain behind the knees subsides and the cyst doesn’t get better or worse and at that point I consider having it redrained in hopes that after draining it again this time it won’t come back as I have eliminated the cause of the irritation (the shoes).
I ride the old shoes and the pain behind the knees subsides and the cyst follows suit.
