Popliteus Trigger Points

Introduction

The popliteus is a small but essential knee muscle responsible for knee flexion, unlocking the knee joint, and stabilizing the lower leg. When trigger points develop in this muscle, they can cause posterior knee pain, stiffness, and difficulty fully straightening the knee, often mimicking meniscus injuries, hamstring strains, or ligament issues.

Name and Area

  • Name: Popliteus

  • Area: Located at the back of the knee, running from the lateral femur to the posterior tibia.

Indications

Popliteus trigger points may contribute to:

  • Pain Behind the Knee (Mistaken for Meniscus Injuries or Ligament Sprains)

  • Pain That Extends to the Upper Calf (Can Mimic Gastrocnemius Strain or Deep Vein Thrombosis (DVT))

  • Knee Stiffness and Difficulty Fully Extending the Leg (Feels Like the Knee Is "Locked")

  • Pain When Walking Down Stairs or Slopes (Common in Runners and Hikers)

  • Pain or Weakness When Rotating the Lower Leg (Can Affect Walking and Balance)

  • Discomfort After Prolonged Sitting or Sleeping with the Knee Bent

Pain from this muscle is often mistaken for meniscus tears, ligament injuries, or calf tightness.

Muscle Action

  • Unlocks the Knee: Initiates knee flexion by rotating the tibia inward.

  • Assists in Knee Stability: Prevents excessive forward movement of the tibia.

  • Supports Lower Leg Rotation: Works with other knee stabilizers to maintain proper gait mechanics.

The popliteus is crucial for knee function, movement control, and lower limb stabilization.

Signs and Symptoms

Individuals with popliteus trigger points often report:

  • Pain Behind the Knee That Feels Like a Deep Ache or Sharp Sensation

  • Pain That Increases When Walking Downhill or Descending Stairs

  • Tightness or Stiffness in the Knee That Limits Full Extension

  • Pain That Extends Into the Upper Calf (Can Be Mistaken for DVT or Gastrocnemius Strain)

  • Instability or Weakness When Rotating the Lower Leg (Can Affect Balance and Gait Mechanics)

  • Pain That Worsens After Prolonged Sitting, Sleeping with a Bent Knee, or Running Long Distances

Pain worsens with prolonged knee flexion, downhill walking, or sudden stops and pivots.

Perpetuating Factors

Common causes of popliteus trigger points include:

  • Running or Sprinting on Uneven Terrain (Forces the Knee to Work Harder to Stabilize the Body)

  • Frequent Squatting or Deep Knee Bends (Common in Weightlifters, Dancers, and Martial Artists)

  • Previous Knee Injuries (Ligament Tears, Meniscus Damage, or Post-Surgery Stiffness)

  • Prolonged Sitting with the Knees Bent (Can Cause Chronic Tightness in the Popliteus)

  • Weak Quadriceps or Hamstrings (Leads to Overuse of the Popliteus for Knee Stability)

Trigger Point Referral Pattern

Trigger points in the popliteus refer pain to:

  • The back of the knee and upper calf (Mistaken for Gastrocnemius or Soleus Strain)

  • The inner knee and tibia (Can Mimic Medial Meniscus or Ligament Issues)

  • The lateral knee (Mistaken for IT Band Syndrome or Fibular Nerve Compression)

Pain from this muscle is often confused with meniscus tears, ligament injuries, or nerve entrapment.

Differential Diagnosis

Popliteus trigger points may be mistaken for:

  • Meniscus Tear (Knee Pain with Locking, Clicking, or Swelling, Often from Twisting Movements)

  • Baker’s Cyst (Swelling and Pain Behind the Knee, Often Related to Knee Joint Inflammation)

  • Gastrocnemius Strain (Pain in the Calf and Behind the Knee, Worsens with Running or Jumping)

  • Deep Vein Thrombosis (DVT) (Calf Pain and Swelling, Can Be a Medical Emergency)

  • IT Band Syndrome (Outer Knee Pain That Worsens with Running or Repetitive Knee Flexion)

A thorough knee, lower leg, and gait examination is necessary to rule out these conditions.

Associated Trigger Points

Popliteus trigger points often co-exist with:

  • Gastrocnemius (Calf and Achilles Pain, Affects Ankle Stability and Running Mechanics)

  • Soleus (Deep Calf and Achilles Pain, Common in Runners and Walkers)

  • Hamstrings (Posterior Thigh and Knee Pain, Affects Hip and Knee Stability)

  • Quadriceps (Anterior Knee Pain, Can Contribute to Knee Instability and Movement Dysfunction)

Anatomy and Innervation

Muscle Origin Insertion Innervation
Popliteus Lateral condyle of femur, lateral meniscus Posterior tibia Tibial nerve (L4–S1)

The popliteus is innervated by the tibial nerve, which also controls knee function and lower leg stabilization.

Patient Examination

A comprehensive examination should include:

  • Palpation: Identify tender nodules along the posterior knee and upper calf.

  • Resisted Knee Flexion and Internal Rotation Testing: Assess pain and weakness when bending the knee and rotating the tibia inward against resistance.

  • Gait Analysis: Look for knee instability, excessive foot pronation, or difficulty maintaining balance on uneven surfaces.

  • Knee Stability Testing: Rule out ligament sprains, meniscus tears, or nerve compression.

Corrective Actions

Dry Needling

  • Dry needling can release trigger points in the popliteus, reducing posterior knee tightness and improving lower leg mobility.

Manual Therapy

  • Trigger Point Release: Apply deep sustained pressure to tight spots along the back of the knee and upper calf.

  • Massage Therapy: Helps improve circulation and reduce muscle tension in the posterior knee.

Stretching

  • Calf and Knee Stretch Against a Wall: Helps reduce tension in the popliteus and surrounding muscles.

  • Seated Hamstring Stretch: Loosens the posterior leg to improve knee mobility and function.

Strengthening Exercises

  • Heel Slides: Strengthens the popliteus and improves knee mobility.

  • Eccentric Knee Extensions: Enhances knee control and prevents excessive strain on the posterior knee.

  • Balance and Proprioception Drills: Helps stabilize the knee and prevent recurrent pain.

Postural and Footwear Adjustments

  • Avoid Wearing Shoes with Excessive Heel Lift (Prevents Overloading the Posterior Knee)

  • Ensure Proper Running Form and Stride Mechanics (Reduces Overuse of the Popliteus in Runners)

  • Gradually Increase Running or Activity Intensity (Prevents Sudden Overuse of the Posterior Knee Muscles)

Conclusion

The popliteus plays a crucial role in knee unlocking, stability, and lower leg function, but trigger points in this muscle can cause significant posterior knee, calf, and lower leg pain. By incorporating dry needling, manual therapy, stretching, and strengthening exercises, individuals can reduce pain, improve mobility, and prevent chronic knee dysfunction.

➡️ Learn more about Trigger Points

➡️ Explore our Trigger Point Index

Sources:

  • Travell, J. G., & Simons, D. G. (1983). Myofascial Pain and Dysfunction: The Trigger Point Manual (2nd ed.). Williams & Wilkins.

  • Simons, D., & Travell, J. (1999). The Trigger Point Manual, Volume 2: The Lower Extremities. Williams & Wilkins.