Wondering why you have anterior knee pain? Finding the cause often requires visiting a doctor or another health expert like a physical therapist.
Wondering why you have anterior knee pain? Finding the cause often requires visiting a doctor or another health expert like a physical therapist. Injury to many structures in the front of the knee can lead to pain, making it difficult to figure out exactly what’s going on.
Some knee conditions develop after a sudden injury, like a patellar tendon tear or kneecap fracture. Other conditions, like patellofemoral pain syndrome, may develop over time from repetitive stress.
Our guide examines potential reasons you might develop anterior knee pain, along with symptoms, risk factors, and treatment options.
Anterior knee pain is a general term referring to discomfort around the front of the knee. It can develop due to problems with several structures within the knee, such as the:
Patella (kneecap). Your kneecap helps protect your knee joint and supports your quadriceps.
Quadriceps. Your quadriceps (aka quads) is the large group of muscles at the front of your thigh that allows you to extend your leg. It’s made up of four smaller muscles.
Patellar tendon (ligament). Your patellar tendon connects your quadriceps to your shin bone just below your knee.
Quadriceps tendon. Your quadriceps tendon connects your quads to the top part of your knee.
Bursae. Bursae are small fluid-filled sacs surrounding joints that help structures smoothly rub over each other.
Pain in the front of your knee might be intense and start suddenly or develop slowly over time and cause a dull ache.
Common symptoms of anterior knee pain include:
A dull, aching pain at the front of the knee, especially during physical activity
Pain when walking down stairs, squatting, or sitting for long periods of time
Discomfort when performing activities that involve bending the knee or absorbing force, like running or jumping.
Swelling or inflammation around the kneecap
Popping or grinding sensations during knee movement
Visible bruising
Tenderness when touched
These symptoms may vary in intensity, often worsening with activities that put stress on your knee joint and surrounding structures.
Anterior knee pain may happen due to sudden injuries or injuries that develop slowly over time.
Here are some of the most common reasons people develop anterior knee pain.
Patellofemoral pain syndrome (PFPS) is also called runner’s knee since it’s common among runners and other people who perform repetitive lower-body exercises.
It’s a broad term that generally refers to pain in the front of the knee. PFPS can crop up from repetitive exercise that puts stress on the knee, especially if you suddenly increase the intensity or volume of exercise.
Other factors that can contribute to PFPS include:
Improper sports technique
Changing surfaces such as turf to track or pavement
Increasing exercise frequency (i.e., from twice a week to five days a week)
Biomechanical misalignment (when joints or muscles aren’t positioned right)
Muscle weakness
Patellofemoral pain syndrome symptoms generally start with a dull ache in the knee.
Patellar tendinitis is common, especially among young adults and adolescents. Sometimes called patellar tendinopathy or jumper’s knee, it’s characterized by inflammation or small tears in the patellar tendon (the thick band of tissue wrapping the front of the knee).
Jumper’s knee is commonly seen in athletes who engage in frequent jumping activities — think basketball, long jump, or hurdles. It causes sharp pain, especially during exercise.
As many as 45 percent of elite jumping athletes and 14 percent of recreational jumping athletes develop it.
Muscle imbalances such as a weak inner thigh muscle or biomechanic malalignment may contribute to patellar tendonitis.
Knee osteoarthritis gets more common with age. It happens when protective knee cartilage breaks down from years of wear and tear.
This condition is particularly common in people over the age of 60. It’s estimated to cause symptoms in 13 percent of women and 10 percent of men over this age.
Learn more in our guide to arthritis.
Bursitis is inflammation of a bursa in your knee — one of the fluid-filled sacs that help reduce friction when your muscles and tendons slide over the bone. You have bursae over your:
Kneecaps
Lower thigh bones
Upper shin bones
Bursitis generally starts with a dull ache and causes more severe pain with movement or pressure. Some people may have knee pain when walking.
A kneecap dislocation is when the kneecap is pushed out of its usual position, often due to a sudden traumatic injury such as a direct blow to the knee. It’s thought to account for two to three percent of knee injuries.
A subluxation is when the kneecap briefly moves out of its normal location.
Osgood-Schlatter disease is commonly seen in adolescents who play sports, particularly those who do lots of running and jumping. Repetitive stress can cause pain at the front of the knee where the patellar tendon attaches to the tibia (shinbone). It’s most common during growth spurts.
A bruise is caused by ruptured blood vessels underneath the skin. Discoloration seen on the outside of the skin happens when blood leaks from the broken blood vessels.
Bruising is common if you hit your knee on a hard surface or after a traumatic accident like a car accident.
A fractured kneecap is a break in the knee bone. It might develop after a sudden traumatic injury to the knee, such as a sports injury or a motor vehicle accident.
Chondromalacia patellae is a condition characterized by the softening and breakdown of cartilage beneath the kneecap. It often leads to pain during activities that put pressure on the knee, like squatting or climbing stairs.
Chondromalacia patellae is common in athletes but may also occur in older adults.
Some people have an increased risk of developing knee pain.
General risk factors for developing knee pain include:
Malalignment. Abnormal positioning and tracking of the kneecap can cause uneven pressure and extra stress in the front of the knee.
Weak or imbalanced muscles. Weak quadriceps, hips, or glutes, along with tight hamstrings, can potentially contribute to improper knee function and increased stress on the knee joint.
Flat feet (pes planus): Flat feet can cause misalignment and improper distribution of force through the lower legs and knees, increasing the risk of anterior knee pain.
Previous injuries. Previous injuries or trauma to the knee joint or patellar tendon, including dislocations, can contribute to chronic knee pain.
Specific risk factors for knee injuries include:
Patellofemoral pain syndrome. Patellofemoral pain syndrome is more common in women and folks who frequently run or jump.
Patellar tendonitis. Patellar tendonitis is particularly common in athletes who do lots of jumping. It can occur at the recreational or professional level.
Osteoarthritis. Osteoarthritis is most common in adults over age 60.
Osgood Schlatter disease. Osgood Schlatter disease most commonly develops in adolescents in growth spurts.
Bursitis. More than 80 percent of cases of patellar bursitis in the front of the knee are men between 40 and 60 years old.
Kneecap dislocation or subluxation. Folks who play contact sports such as rugby or ice hockey can risk a dislocation or subluxation.
Bruising. Bruises are common in people of all ages, but you might be more susceptible as you get older or if you’re taking blood thinners.
Fractured kneecap. Women over 65 have the highest risk of developing a fractured kneecap.
Chondromalacia patellae. People assigned female at birth and young athletes have an elevated risk of this condition.
Medical providers may order various tests to help diagnose anterior knee pain, like imaging and a physical exam.
A proper diagnosis is essential for identifying the specific cause of anterior knee pain and creating an appropriate treatment plan. The diagnostic process often starts by visiting your primary healthcare provider or another health expert like a physical therapist.
They’ll likely:
Review your personal and family medical history
Consider your symptoms
Perform a physical exam
During a physical exam, they’ll move your knee through various ranges of motion to see if these motions trigger pain. They’ll also probably press on different parts of your knee to see where you’re tender.
Your healthcare provider may want to assess your gait (how you walk) or posture to look for contributing factors such as foot misalignment.
They might also order imaging tests. X-rays are often used to check for bone abnormalities, while MRI (magnetic resonance imaging) scans can provide detailed images of soft tissues, including the patellar tendon and cartilage.
The best treatment for anterior knee pain depends on the underlying cause.
Treatment for anterior knee pain focuses on:
Pain relief
Restoring normal joint function
Preventing recurrence
Common treatment methods include:
Rest and activity modification. Reducing activities that trigger pain, such as running or climbing stairs, can help alleviate symptoms.
Physical therapy. A physical therapist can guide you through targeted strengthening exercises and stretching for your quadriceps, hip muscles, and hamstrings to improve knee stability and alignment. They may also use an ultrasound, massage tool, or electrical stimulation to reduce discomfort.
Stretching and strengthening exercises. Regularly stretching your hamstring and quadriceps muscles, as well as doing lower-body strengthening exercises, may help you maintain flexibility and reduce stress on your knee joint.
Orthotics and shoe inserts. Custom orthotics or shoe inserts can potentially help correct flat feet, pronation, or supination and improve knee alignment.
Taping and bracing. Using supportive taping techniques or braces can provide stability and reduce pain during certain activities.
Medications. Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen can help manage inflammation and pain.
Heat and ice. Applying ice and heat to the front of the knee may help reduce swelling and offer pain relief.
Now let’s go over treatment options for the specific conditions that cause anterior knee pain.
Treatment for patellofemoral pain syndrome may include:
Decreasing physical activity
Improving sports form
Training on a softer surface
RICE (rest, ice, compression, elevation)
Medications like NSAIDs
Losing weight might also be recommended for those with overweight or obesity.
Patellar tendonitis may respond to conservative treatment, such as:
Reduction of aggravating activity
RICE
Eccentric exercise
Eccentric exercise involves slow, downward movements to control body weight as it lowers — a physiotherapist can help you develop a rehab program.
Surgery is sometimes used as a last-resort treatment.
Treatment for knee osteoarthritis may include:
Weight loss
NSAIDs
Corticosteroid injections
If conservative treatments aren’t effective, you may require surgery. Surgery might include:
Minimally invasive arthroscopic procedures
Total knee replacement
Partial knee replacement
Your provider will let you know if or when a surgical operation is something you should be considering.
Bursitis is often treatable with:
NSAIDs
RICE
Rest from aggravating activities
Antibiotics if you have a bacterial infection
Steroid injections
In some cases, a medical provider may remove fluid with a needle to relieve symptoms.
If it’s your first kneecap subluxation, your healthcare provider will likely recommend treating it conservatively with RICE. Repeated subluxation or dislocations might need to be treated with surgical repair.
Most bruises don’t need any particular treatment. They often heal on their own within a few days to a few weeks.
If you don’t have any bones out of position, you may only need a cast to give your kneecap time to heal from a fracture. But you might not be able to put weight on your leg for six to eight weeks.
More serious fractures will need surgery to set bones back into their proper positions.
Treatment for Osgood Schlatter disease involves minimizing pain and swelling with:
Hamstring stretching
NSAIDs
Ice
Patellar tendon strap
Taking it easy with exercise is also recommended in most cases.
Managing chondromalacia patellar involves reducing activities that worsen symptoms, along with strengthening the quadriceps and improving patellar tracking.
Arthroscopic surgery may be needed to see if you have knee misalignment.
Many knee injuries can be prevented with good lifestyle and training habits.
Preventing anterior knee pain involves proactive measures to maintain knee health, such as:
Strength training. Regularly strengthening your quadriceps, hamstring muscles, and hip muscles ensures proper support for your knee joints. It can also help maintain bone density as you age.
Flexibility exercises. Stretching your quadriceps and hamstring muscles can help you maintain a healthy range of motion and reduce stiffness, which can put stress on your knee.
Proper footwear. Wearing supportive shoes and using orthotics if needed can help prevent misalignment and overuse injuries.
Gradual increase in activity levels. It’s best to avoid abrupt increases in physical activity intensity or volume.
Maintaining a healthy weight. Reducing excess pressure on your knee joint can help prevent pain associated with increased body weight. We have some home workout ideas for weight loss if you’re interested.
Attention to form. Ensuring proper technique during physical activities, such as running or weightlifting, may help minimize stress on your knee.
Eat a well-rounded diet. Eating a balanced diet high in protein and essential nutrients like calcium and vitamin D can help you optimize your muscle and bone health.
If your healthcare provider recommends weight loss as part of your treatment for anterior knee pain, you might consider weight loss medication. Take our free online assessment to start exploring your options.
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