Anterior Knee Pain

Anterior knee pain can be grouped into several common types, based on the underlying condition:

• Patellofemoral pain syndrome (Runner’s knee) happens when the kneecap does not move smoothly over the thigh bone, often causing pain during running, climbing stairs , or sitting for long periods.
• Patellar tendonitis (Jumper’s knee) is irritation and inflammation of the tendon that connects the kneecap to the shin bone, usually from repeated jumping or running.
• Chondromalacia patella occurs when the cartilage behind the kneecap softens and breaks down, leading to pain and a grinding sensation.
• Patellar arthritis is worn and tear of the kneecap joint that develops with age or after injury.
• Osgood–Schlatter disease is common in teenagers who play sports, where repeated stress causes pain and swelling just below the kneecap.
• Iliotibial band syndrome causes pain on the outer side of the knee due to tightness of the band of tissue that runs along the thigh.

The most common symptom is pain behind or around the kneecap. This pain often becomes worse during certain activities such as: 

• When going down the stairs.
• Wearing high heels can make the discomfort worse.
• Sitting for long periods can cause knee pain and/or stiffness.
• Squatting can trigger or intensify the pain.
• Using a car clutch may worsen discomfort.
• Some people experience a sense of knee instability.
• A grating feeling or noise (crepitus) may occur when moving the knee.
• Weakness in the thigh muscles (quadriceps) may develop if pain persists over time.
   

Anterior knee pain may occur due to several underlying problems or contributing factors:

• Structural or anatomical differences in the knee may lead to uneven stress on the joint.
• Malalignment or instability of the kneecap can cause pain.
• Weak, tight, or imbalance muscles around the knee can increase the strain.
• Overuse or repetitive use of knee muscles, especially during sports, may trigger pain.
• A direct injury, such as kneecap fracture, can cause ongoing discomfort.
• Medical conditions like obesity can place extra stress on the knee joint.
• Women, teenagers, adolescents (affects 30% of adolescents), and young adults at higher risk.

Anterior knee pain is generally diagnosed via one or more of the following methods:

• Collection of a detailed medical history to understand symptoms and triggers.
• Physical examination to assess knee stability and movement.
• Imaging tests such as ultrasonography, radiography, or magnetic resonance imaging (MRI) to assess the structure of the joint.
• Assessment of core stability, muscle imbalances, and functional limitations to identify contributing factors.

Treatment usually starts with non-surgical options and only rarely requires surgery.

• Non-surgical treatment methods:
  • Resting and managing pain through activity changes.
  • Strengthening and stretching the thigh and buttock muscles to improve support.
  • Maintaining a healthy weight to reduce pressure on the knee.
  • Using shoe inserts if you have flat feet.
  • Applying taping techniques to help realign the kneecap.
  • Wearing proper, supportive footwear.
  • Using heat or ice to relieve pain and swelling.
  • Attending physical therapy sessions, which can help with malalignment and provides targeted strengthening programmes.
• Surgical treatment is considered only when non-surgical options do not provide relief and a quicker recovery is needed. 
   

It is recommended that patients visit their doctor if knee pain does not improve with rest and simple measures, if swelling or stiffness persists, if the knee feels unstable or gives way, or if pain interferes with their daily activities.

You can reduce the risk of anterior knee pain by:

• Keeping your thigh and hip muscles strong and flexible.
• Avoiding sudden increases in training intensity or duration.
• Wearing supportive footwear suited to your activity.
• Using proper techniques when running, squatting, or jumping.
• Maintaining a healthy weight to reduce stress on the knee.

If you have ongoing anterior knee pain, you should see an orthopaedic specialist. A physiotherapist can also help with exercises and rehabilitation.