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“Bury me standing because I have lived my life on my knees”  (old Romany proverb)

It is not unusual for a person to come into a movement class complaining of tightness or restriction behind the knee, with the pain increasing when they fully flex or bends the knee. The physiotherapist or doctor tells them it is a Baker’s cyst and may tell them it is nothing to be concerned about. Needless to say, some people are alarmed and it is important to be able to accommodate them and inform them in a class, helping them to understand what can be done.

What are Baker’s cysts?

A Baker’s cyst, also called a popliteal cyst, sits within the popliteal fossa (the back of the knee) where there is a large collection of lymph nodes. The cyst sits under the popliteus muscle which is the only muscle of the posterior compartment of the lower leg that acts just on the knee and not on the ankle.

The Baker’s cyst forms from a posterior bulge of the sac containing synovial fluid at the knee, often associated with conditions like rheumatoid or psoriatic arthritis, fibromyalgia and other autoimmune conditions. In these conditions excessive synovial fluid is produced and builds up behind the knee and can’t be moved away.  

The Baker’s cysts can burst and the fluid will then leak into the calf area, leading to:

//   Swelling in the calf.

//   Sharp pain in your knee.

//   Redness in the calf and feeling of water running down the leg.

It is important to remember that these symptoms are similar to a blood clot and therefore needs to be checked by a doctor very quickly to make sure that it is not something more sinister.

The Baker’s cyst can be aspirated by a doctor if it is causing problems.

Exercise considerations for Baker’s cysts

//   Understand the underlying autoimmune condition and address that as well as you can with your movement programming.

//   Keep the joints moving; remember that in many cases pain and stiffness needs movement.

//   The lymphatic system may be under a fair bit of load because the popliteal fossa and the lymph nodes in that area are compressed. Remember the lymphatic system is our body’s immune garbage clean up system. If a person has Baker’s cysts because of autoimmune conditions then their lymphatic system is also compromised. Remember the principles for working with lymphatic issues.

//   Be careful not to compress the knee too much, e.g. putting the roll up bar under the knee can cause compression and irritation for Baker’s cysts.

//   Strengthen the whole leg so that movement in the gait cycle is improved, e.g. unload the knee joint by strengthening quads and hamstrings in progressively loaded squats. Remember to respect pain tolerance.

//   Work on alignment and decompression of the joints. Be careful of the placement of the balls and other props so that it is not directly compressing the Baker’s cyst.

Body Organics runs the Anatomy Dimensions courses around the world providing movement teachers with detailed courses empowering them to provide anatomy inspired movement for clients with different levels of health and strength. Body Organics also produces comprehensive repertoire manuals for pilates and CoreAlign.

Carla Mullins is co-director and co-owner of Body Organics, a multidisciplinary health and body movement practice with studios in Brisbane, Australia. Carla is a Level 4 Professional Practitioner with the APMA and has also studied pilates with APMA, PITC as well as Polestar. She also has a LLB (QUT), M. Soc Sc & Policy (UNSW), Advanced Diploma of Pilates Movement Therapy (APMA), Diploma of Pilates Movement Therapy (APMA), Diploma Pilates Professional Practice (PITC), Gyrotonic Level 1, Gyrotonic JSB, Gyrotoner, CoreAlign Level 1, 2 and 3 and Certificate IV in Training and Assessment. Carla also has returned to University to complete an Occupational Therapy Degree.