Pain Behind Knee: The ‘Ol Wallet-In-Door Syndrome

Pain Behind Knee: The ‘Ol Wallet-In-Door Syndrome Barefoot Rehabilitation Clinic

26 May Pain Behind Knee: The ‘Ol Wallet-In-Door Syndrome

Share this!

Author’s Gratitude: Big thanks to Dr. Ed House at New York Chiropractic College for sticking his wallet in the door during every Active Rehab meeting.  The vision of him, not saying a word, and doing this, has forever been engrained in my mind.

Do you have pain behind knee? (That’s how they said it back in the days when the Native Americans ran around this land.)

You probably have the ‘Ol Wallet-In-Door Syndrome.

“Pain” Behind Knee Is Most Commonly Not A “Problem” Behind Knee

Test yourself.

Stand up.TTT-2

Keep your knees straight and touch your toes.


If doing this provokes pain behind your knee, you have a sciatic nerve problem, either coming from an entrapment along the sciatic nerve’s course or from the spine.

This post is not about sciatic nerve “pain behind knee”.  That’s for another time.

Now, sit down.

Bend your knee, bringing your heel as close as you can to your butt cheek.  If it’s really painful, you can use your handy dandy friend to help you perform this test.  Notice in the below example, her knee flexion range of motion stops with her heel 4 finger-breadths away from her butt cheek.


If doing this provokes pain behind your knee, you have a wallet-stuck-in-your-knee-door.

Let me explain.

The wallet is medically speaking, a space-occupying-lesion.  It is something that takes up space in the door hinge, not allowing it to fully close.

Most often, the wallet is a meniscus pathology, but it could also be osteoarthritis.

What is causing the wallet in the knee door hinge?

As always in reducing pain and restoring range of motion, we have to determine a diagnosis (a name for which problem this is).

You know if your “wallet is stuck” when:

  • PAIN: you have pain behind the knee.
  • FLEXIBILITY: you cannot bring your heel to your butt (you have restricted knee flexion range of motion).


In the case of the wallet in the knee door hinge, below is a simplified version of the two major issues:


The more significant and more reducible block on our graph is the adhesion.

Removing the adhesion will slow the meniscus pathology’s growth over time.

If the meniscus pathology expresses its symptoms:

  • without any load (or activity).
  • often with load (or activity) despite having the adhesion reduced…

… then it may need to be reduced with surgery.

Note: Surgery, in this humble doctor’s experience, never completely resolves meniscus issues.  It only makes the block smaller, it doesn’t disappear it.

How do you fix this knee problem?

The first place to look for knee adhesion by a practitioner is addressing knee flexion range of motion.

Knee flexion will be restricted, causing pain behind the knee, and creating an excessive amount of tension that can be felt by a skilled practitioner in the:

  • knee capsule.
  • patellar tendon.
  • where the anterior, medial, and lateral meniscus touches the capsule.
  • between the LCL and MCL ligaments and the capsule.

This adhesion is present due to overload of the front of the knee.  This happened due to ankle and hip restriction and weakness.

Treatment to remove adhesion in the above named structures immediately increases the range of motion and causes permanent, sustainable improvement, even without further treatment.

If the pain goes away temporarily, then comes back, the meniscus pathology (and potential acute inflammation in the joint) is larger than desired.  : (

After knee flexion range of motion plateaus in its improvement, adhesion should be explored in the hip and ankles to restore those ranges of motion and increase strength.

speechbubblesTell us about your pain behind the knee? Who have you seen? Did it work?  How long have you had this problem?

If you know of a friend or family member with pain behind knee or restricted knee range of motion, please forward this information to them so they can get the help they need.  Fixing your adhesion matters because it improves flexibility, improves function, reduces pain, and restores normal movement to the body so you can enjoy the things you love. Call us at 862.205.4847.

Share this!

Dr. Chris Stepien, DC, Full-Body ID Certified, ART Certified, CSCS, and CrossFit Level 1 Certified, fixes your annoying and frustrating pains, even when it's been over 6 months and you've seen 3-5 other doctors or therapists without lasting relief Barefoot Rehab in Denville, NJ. And when you're sad, depressed, or not enjoying life, Dr. Chris wants to hug you. He invites you to reach out, no matter what your concern is. Barefoot Rehab is here to serve you.
Gravatar Image
  • Know Your Numbers: The Face-Up Heel to Butt Test
    Posted at 19:49h, 18 June Reply

    […] ability to differentiate a knee joint problem (the ‘ol wallet in the door syndrome) from a quadriceps muscle problem can save the knee from imminent […]

  • John Peterson
    Posted at 11:36h, 08 July Reply

    The knee joint is the most prone joint due to the fact that of its complicated structure and also commonly worry on it. Find out more concerning the causes as well as additional treatment at this resource It explains full photo of the illness.

    • Dr. Chris
      Posted at 16:00h, 09 July Reply

      Thanks for your comment John.

  • Lara Castanha
    Posted at 21:13h, 21 August Reply

    I am having pain on the left side and behind the left knee for more than a month. It makes me immovable suddenly. . Which Physiotherapy Center or medication can help me in Alameda or Oakland CA.

    • Dr. Chris
      Posted at 10:46h, 22 August Reply

      Hi Lara,

      First, with pain behind the knee, you almost definitely need an MRI. Have you had one? You have structural damage and it will be important for the treating doctor to know how much progress they can expect with you.

      I’d see this PT:

      They should be performing Graston on your knee capsule to improve your heel to butt ROM. You should notice improvement between 1-5 visits. If you don’t see and feel progress, it'[ll be time to find a different doctor.

      Here for you.

  • V Walsh
    Posted at 18:29h, 11 March Reply

    Hi! I have this exact pain and reduced joint movementin my right knee but my doctor is very disinclined to believe I have any issues with my meniscus and is even more disinclined to refer for an MRI! I have no pain when running, swimming or cycling just when kneeling on the floor and stiffness after a long drive (no swelling). When I tore my acetabular cartilage the docs were surprised they could not the induce pain they would normally expect when they finally scanned my hip and saw a large tear. I am mildly hypermobile, do you think this could explain the increased flexion with no pain? I am training to be a midwife and being able to kneel is imperative! Whilst I understand it is hard to comment without physical assessment I would be grateful for comment. Thanks.

    • Dr. Chris
      Posted at 11:01h, 12 April Reply

      If your doctor doesn’t give you an MRI, find a new doctor who does.

  • Sean Spraggett
    Posted at 15:44h, 15 February Reply

    The first bit of information that I have read which seems to explain my behind the knee pain. I had full rupture of my left achilles and had PARS surgery (Dec 8 2019). Nine weeks later I am walking in shoes, exercising and doing PT. However, I always have this numb pain behind my knee and tight hamstring. Did your test and I am four fingers. Was wondering what I can do to help alleviate the pain and get rid of it as it is disrupting my sleep significantly.

    • Dr. Chris
      Posted at 13:11h, 19 February Reply

      Hi Sean, the PARS surgery doesn’t explain the numb behind the knee and tight hamstring. However “sciatica” from the external rotators or low back does explain the overloaded achilles. Also sound like you have a knee problem, which is likely secondary to “sciatica”.

      I wouldn’t be able to offer you anything for relief except to find an adhesion removal specialist. It sounds like there is a lot of stuff going on. Anything you tried would be a diminishing return or temporary relief. LMK thoughts.

Post A Comment