Physical therapy for baker's cyst

A Bakers cyst is a swelling in the back of the knee that can cause a pressing sensation and pain at the back of the knee. This cyst always occurs as a result of an underlying cause such as osteoarthritis or meniscus injury. A baker's cyst by itself usually does not cause long-term difficulties but can cause pain, stiffness and limitation of movement. In this blog, we explain how a bakers cyst develops, how to diagnose it and what the treatment plan is.

Cause of a baker's cyst

The cause of a baker's cyst, or popliteal cyst, is always secondary. That is, another condition in the knee is responsible for this cyst. So for a cyst to be treated effectively, the underlying cause must be clear. This is to reduce the risk of a recurrent cyst. Some examples of these causes are: 

Osteoarthritis: osteoarthritis in the knee is a common condition where the quality of cartilage decreases. This is also called a degenerative condition. In response to the inflammation associated with the process of osteoarthritis, the synovial membrane starts to produce even more fluid and eventually leads to cyst formation in the knee compartment. 

Meniscus damage: a tear in the meniscus can cause inflammation in the knee and the formation of a cyst. 

Inflammation of the knee joint: conditions such as gout or rheumatism can lead to an overproduction of synovial fluid. This overproduction can lead to a baker's cyst in some cases. 

Synovial fluid

The synovium is a thin, mucous membrane filled with fluid. The function of this fluid is to allow smooth movement between joint surfaces. Through this fluid, the cartilage is supplied with oxygen and other nutrients. Other functions of the synovial fluid include absorbing shock loads and removing waste products and inflammatory mediators in the joint. In certain conditions such as rheumatoid arthritis, the synovium can become inflamed. This then causes pain and excess synovial fluid. When inflammation persists, the synovium can thicken, so to speak, and cause symptoms. Because of this inflammatory process, surrounding structures such as muscles and tendons around the knee can also become sensitive. Thus, the synovium generally maintains a healthy functioning joint but can also become inflamed and lead to symptoms. 

Diagnosis baker's cyst

When there is localized swelling in the hollow of the knee, there is a good chance that it is a cyst of the hollow of the knee. During the physical examination, we will see if the symptoms can be explained from another structure of the knee, such as the meniscus. Sometimes additional examination such as ultrasound can be of added value to get a good picture of the cyst. Ultrasound is an imaging technique where high-frequency sound waves can be used to take a picture of the knee. These sound waves are reflected off the various structures around the knee and are converted into images. In a baker's cyst, ultrasound allows us to make a statement about the location and size of the cyst, its shape and other features such as whether the cyst consists of a single or multiple compartments. It can also be used as an evaluative tool to check if the cyst is decreasing in size. 

Meniscus cyst

Meniscus cyst and bakers cyst are similar conditions. The only difference is the location. The bakers cyst is located at the back of the knee. Therefore, it is also called popliteal cyst in the English-language literature. This is because the popliteus is a muscle located in the hollow of the knee. A cyst of the meniscus can be located either on the inside or the outside.

When the tear/damage to the meniscus is more in the posterior horn of the meniscus or toward the menisco-capsular ligament, there seems to be a greater chance of forming a cyst of the meniscus. Thus, there is a lesion toward the capsule that allows synovial fluid to exit the capsule. There are different types of meniscus damage of which a cleavage tear where the meniscus is divided, so to speak, is often seen with cyst formation. When a tear is 12 mm or larger, the likelihood of a cyst also increases. Also, in people with more clearance of the knee joint(more than 3 mm) we more often see a cyst due to damage of the meniscus. 

A cyst of the meniscus need not always cause symptoms. But if symptomatic and thus causing pain, these are the most common symptoms: 

  • Pain on long standing 
  • Sensitivity to pressure pain 
  • A localized swelling, bump at the joint gap
  • Especially visible when stretched 
  • Varying in size 
  • Mild locking complaints of the knee 
Ganglion cyst anterior cruciate ligament

An anterior cruciate ligament ganglion cyst is located in the space close to the anterior cruciate ligament of the knee. This can cause movement restriction in both bending and stretching. The exact cause of a ganglion cyst is unknown. As with the other examples of cyst formation in the knee, it is usually a result of an irritation or inflammatory reaction in the knee joint.

    Physical therapy and bakers cyst

    The main goal in treatment for a bakers cyst is to reduce symptoms and improve knee function. This can be achieved by properly counseling people with a bakers cyst on how to manage the symptoms. This may include avoiding some activities that structurally trigger or exacerbate the symptoms. An important aspect of treatment is targeted exercise therapy to increase the function and stability of the knee joint. This is often done in conjunction with the use of anti-inflammatory medication or a local injection of corticosteroids. 

    Surgery and baker's cyst

    Surgery is very rare and almost never occurs. Only when the cyst causes severe symptoms and does not respond to other forms of treatment may surgery be considered. Surgery may involve removing the cyst or treating the underlying cause, such as removing a loose bone fragment or cartilage. It may also include repairing the tear in the meniscus, for example. 

      Conclusion

      A baker's cyst can cause considerable discomfort and is always the result of an underlying cause. Physical therapy can help reduce the complaints and symptoms associated with a cyst. It is important to work with a personalized treatment plan because the underlying cause and thus the personal situation should always be considered. 

        Ruben Luijkx

        Owner Physio Vital
        Physical therapist, MSC. Manuel therapy

        With a solid foundation in scientific knowledge, Ruben combines the latest insights with his practical experience to ensure the best results. As owner of Physio Fitaal, Ruben has created a patient-centered environment that works with innovative techniques and a data-driven approach. Whether you are an elite athlete looking to return to the field or someone recovering from knee surgery, Ruben will guide you to a full recovery, with attention to your individual needs and goals.

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