What is Popliteus Tendinopathy?
Popliteus tendinopathy is a rare overuse injury affecting the popliteus tendon, located at the back and outside of the knee. The popliteus muscle helps unlock the knee during flexion and stabilises the knee during rotation. Tendinopathy of this structure causes posterior-lateral knee pain.
What happens in Popliteus Tendinopathy?
The tendon becomes irritated due to overuse or repetitive rotational stress on the knee. Pain is typically localised to the outer back aspect of the knee and worsens with running, downhill walking, or twisting movements.
Common causes
- Overuse from running (especially downhill)
- Repetitive cutting or twisting sports (football, rugby, basketball)
- Previous ligament injury altering knee mechanics
- Sudden increases in training load
- Poor biomechanics or muscle imbalances
Who is most affected?
- Runners and trail runners
- Athletes in football, rugby, basketball, and skiing
- Less common in the general population due to its sport-specific demands
- In Australia, posterior-lateral knee pain is often linked to football and rugby players with high rotational loads
Symptoms of Popliteus Tendinopathy
- Localised pain in the back and outside of the knee
- Pain worsens when running downhill or twisting
- Tenderness over the lateral posterior knee
- Mild swelling in chronic cases
📞 If you have persistent pain in the back of your knee, book an assessment at Spinal and Sports Care Bella Vista or Parramatta.
Diagnosis of Popliteus Tendinopathy
Clinical Tests:
- Palpation of the popliteus tendon at the lateral knee
- Resisted knee flexion in internal rotation reproduces pain
Imaging:
- MRI: Best for visualising tendon pathology and ruling out meniscus tears
- Ultrasound: Can sometimes detect tendon irritation
Treatment options
Popliteus tendinopathy is nearly always treated non-surgically.
Non-surgical:
- Load modification and temporary reduction in aggravating activities
- Isometric and eccentric strengthening of hamstrings and popliteus
- Strengthening of glutes and quads to reduce rotational load on the knee
- Soft tissue therapy to the surrounding muscles
Surgical:
- Very rare, considered only in severe chronic unresponsive cases
Role of physiotherapy
- Provide progressive strengthening of the popliteus and supporting muscles
- Correct biomechanics and gait mechanics
- Guide graded return-to-sport program
- Use manual therapy for associated tightness
Recovery timeline
- Mild: 4–6 weeks
- Moderate: 6–12 weeks
- Severe: 3–6 months with progressive rehab
Injury grading
- Mild: Pain only after activity
- Moderate: Pain during sport and twisting movements
- Severe: Persistent pain interfering with daily and athletic activities
Prevention of Popliteus Tendinopathy
- Strengthen hamstrings, glutes, and quads
- Avoid sudden increases in training volume
- Include rotational stability drills
- Proper footwear for running and sport surfaces
Taping and bracing
- Kinesiology taping may reduce stress on the tendon
- Bracing is rarely needed but may be used temporarily in high-level sport
When to see a physiotherapist or chiropractor
📞 If pain in the back or outside of your knee has persisted for more than 2 weeks, book an assessment at Spinal and Sports Care for diagnosis and treatment.
