In this article you will find out everything you need to know about anterior knee pain and the most effective ways to treat it, including an advanced treatment called Prolotherapy.
Anterior Knee Pain – What Should You Know?
While anterior knee pain is a pretty common condition, it can be agonizing to the extent that it impacts daily life activities, such as walking. Adolescent anterior knee pain is especially prevalent among young athletes, often resulting from overuse, muscle imbalances, or biomechanical issues related to sports participation. Anterior knee pain is a condition of a painful knee that occurs circumferentially to the patellofemoral joint. This ailment is bilateral and deceptive in onset, having no overall macroscopic pathology. Most cases are not due to a physical abnormality but rather to overuse or muscle imbalance.
Anterior knee pain, also denoted as patellofemoral pain syndrome holds the need for further research about its causes of pain. This is because both malalignment and patellar cartilage deterioration does not necessarily be related to pain.
Anatomically, the patella (kneecap) is seated over the front of the knee joint. The patella’s base glides over the knee joint bones when the knee bends or straightens.
Resilient tendons play a role in attaching the kneecap to the surrounding muscles and bones. They are known as:
The quadriceps tendon attaches the thigh muscles that including the quadriceps muscles and hamstring muscles to the uppermost point of the kneecap. The patellar tendon attach the kneecap to the shin bone or tibia, highlighting the important relationship between the thigh and lower leg in maintaining knee movement and stability.
Introduction to Anterior Knee Pain
Anterior knee pain, often referred to as patellofemoral pain syndrome, is one of the most frequent complaints among individuals experiencing discomfort in the front of the knee. This type of knee pain typically presents as a dull, aching sensation around or behind the kneecap and can significantly impact daily activities, especially for young adults and those who are physically active. The causes of anterior knee pain are varied and may include overuse, muscle imbalance, and improper movement of the patella within the patellofemoral joint. Muscle weakness or imbalance in the thigh muscles, as well as issues with core stability, can contribute to the development of patellofemoral pain. Physical therapy and targeted exercise programs are often recommended to relieve anterior knee pain, improve muscle balance, and restore normal function. Understanding the underlying factors and seeking early intervention can help manage pain and prevent long-term complications.
Anatomy of the Knee
The knee joint is a complex anatomy that allows for both stability and mobility, making it essential for everyday movements like walking, running, and climbing stairs. The main bones that form the knee joint are the femur (thigh bone), tibia (shin bone), and patella (kneecap). The patella sits at the front of the knee and is embedded within the quadriceps tendon, which connects the powerful quadriceps muscles of the front thigh to the upper part of the kneecap. When you straighten your knee, the quadriceps muscles contract, pulling on the quadriceps tendon and moving the patella along a groove in the thigh bone. The hamstring muscles, located at the back of the thigh, are responsible for bending the knee. Ligaments and soft tissues, such as the anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL), provide additional support and stability to the knee joint. Understanding how these structures work together is crucial for identifying the sources of knee pain and developing effective treatment strategies for anterior knee pain.
What is the most common causes of anterior knee pain?
Have you been wondering why does the front of my knee hurt? Overuse of the knee creates a monotonous high pressure between the femoral groove and the kneecap. This continuous high pressure leads to overload, imbalance, and muscle fatigue that causes pain and happens to be the commonest reason for weakness and soreness surrounding the knee.
Hence, the anterior knee pain aetiology is multifactorial and ill-defined because of the diversity of symptoms, pain located in different areas, and pain level as per patients’ experiences. Identifying the specific pain located in or around the knee is important to guide diagnosis and treatment.
The underlying factors can be categorized as
- muscular imbalances
- patella abnormality
- patella malalignment due to weakness in flexion and extension
Anterior knee pain due to an overuse knee injury (includes injury to knee ligaments) can occur in the following conditions:
- patellar tendinopathy
- patellar instability
- insertional tendinopathy
- osteochondral and chondral damage
- Osgood-Schlatter disease (this condition causes pain located in the upper shinbone area, just below the kneecap)
- jumper’s knee (an overuse injury affecting the patella tendon, common in sports involving jumping)
- runner’s knee (patellofemoral pain syndrome, associated with repeated stress from running or jumping)
- knee bursitis (swelling and inflammation of the bursae around the kneecap, often from repetitive kneeling or overuse, also known as housemaid’s knee or clergyman’s knee)
The onset of anterior knee pain happens due to the improper movement of the kneecap leading to its brushing against the inferior portion of the thigh bone.
Comprehensively, the following causes are what you can consider:
- Patellofemoral joint, poor alignment, also called the abnormal position of the kneecap.
- Presence of tightness or weakness of anterior and posterior thigh muscles (quadriceps and hamstring, respectively).
- Excessive use or over-activity of the knee puts additional stress on the kneecap (for example, jumper’s knee, runner’s knee, skiing, twisting, or playing soccer).
- Too shallow thighbone groove (seat for the kneecap).
- Weaker core muscles and imbalance in muscles.
- Having flat feet.
The patella tendon plays a crucial role in knee stability and is commonly involved in overuse injuries such as jumper’s knee and patellar tendinopathy.
The following people are more likely to develop anterior knee pain:
- Overweight people
- Individuals with a history of fracture, dislocation (subluxation), or any other kneecap injury
- Jumpers, Runners, bicyclists, skiers, and soccer players especially who exercise frequently
- Healthy young adults (adolescents) and teenagers, commonly females
- The young athlete is particularly at risk due to high activity levels
Other likely sources of anterior knee pain are the following ailments.
- Osteoarthritis
- Plica Syndrome or synovial impingement (the inner lining of the knee pinches during movement)
- Tendinitis – an inflammatory tendon causing pain during walking upstairs
- Bursitis – inflammation caused by overuse, including knee bursitis (inflammation of the bursae near the kneecap)
- Chondromalacia patella – damaged articular cartilage under the kneecap
Symptoms
Pain in the anterior knee portion pain is aching, dull pain. Patients often have a grinding or grating feeling with knee flexion (bringing the ankle close to the back of the thigh). Pain is most commonly felt in the following locations:
- Posterior to the kneecap
- Underneath the kneecap
- Medial and lateral to the kneecap
Sometimes, knee pain may actually be referred pain from another area, such as the hip, so it is important to consider other possible sources of discomfort.
The symptoms can be more manifest when:
- Having deep knee bends
- Going downstairs
- Standing upright after sitting for a short time
- Running downhill
- Performing exercises with a bent knee or straight leg, such as leg lifts or stretches, may also cause pain or discomfort
Diagnosis
The healthcare provider will do a thorough physical examination. You would have a mildly swollen and tender knee. Additionally, your kneecap might not be flawlessly in line with the femur (thigh bone). This may indicate patellofemoral instability, a condition that can cause pain and a sensation of the kneecap slipping or feeling loose.
Flexing your knee would give you a grinding feeling underneath the kneecap. Straightening the knee and pressing the kneecap would be painful.
Your doctor might want you to do a single leg squat to see the muscle imbalance as well as core stability.
X-rays are normally done for anterior knee cap pain diagnosis. However, signs of tilting or arthritis are shown on a special x-ray view of the kneecap.
Rarely MRI scans are needed.
Differential Diagnosis
When a patient presents with anterior knee pain, it is important for healthcare providers to perform a thorough differential diagnosis to determine the exact cause of the pain. This process involves a detailed physical examination, including an assessment of the thigh muscles, patellofemoral joint, and overall knee function. The clinician will review the patient’s medical history and may perform specific tests to evaluate muscle strength, flexibility, and alignment. Imaging studies, such as X-rays or magnetic resonance imaging (MRI), can be helpful in ruling out other conditions like meniscal tears, ligament injuries, or osteoarthritis that may also cause knee pain. By accurately identifying the underlying issue, healthcare professionals can develop a personalized treatment plan to relieve pain and restore function. This often includes exercise therapy and physical therapy focused on strengthening the thigh muscles and improving the stability of the patellofemoral joint, ensuring the best possible outcome for those experiencing anterior knee pain.
How do you treat anterior knee pain?
Prolozone Therapy
Many of the structures in the anterior knee have a poor blood supply, which is why they can struggle to heal on their own. It is the oxygen and nutrients in our blood supply that help to heal these structures.
Prolozone Therapy involves the injection of oxygen and nutrients into these structures to provide a direct supply of what is required to heal and repair.
As the treatment is helping to treat the root cause of the problem, it is deemed to be a permanent fix.
Conservative treatment is usually the first-line approach for anterior knee pain. Other less effective ways of treating anterior knee pain include:
- Resting your knee for short periods
- Consuming nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, aspirin, or naproxen, or using over the counter medication for pain relief
- Applying an ice pack after activity to reduce pain and swelling (do not apply directly to the skin)
- Modify your way of exercising, including adjusting your training routine to reduce knee stress
- Learn and do a tailored exercise program that includes strengthening exercises, adequate stretching, and activities to improve thigh muscle flexibility, especially for the quadriceps and hamstring muscles
- Learn and do exercises that strengthen and stabilize your core
- In case you are obese or overweight, try losing some pounds
- In case you have flat feet, make use of precise shoe inserts as well as support devices or orthotics
- Try taping your knee for realignment of your kneecap
- Use the right sports or running shoes
Most patients respond well to conservative treatment and do not require surgical intervention.
Surgery such as arthroscopy to relieve pain at the backend of the kneecap is necessitated in rare cases. However, the orthopaedic surgeon would suggest precisely when surgical intervention is needed. Surgical intervention is only considered when conservative treatment fails or is not suitable, and is reserved for cases that require surgical intervention. The following can be done during the surgery:
- Removal of damaged kneecap cartilage.
- Modifications to the tendons in order for the more even movement of the kneecap.
- Realignment of the kneecap for permitting enhanced joint movement.
Visit your physiotherapist regularly to make a routine of the right amount of physiotherapy needed to keep anterior knee pain at bay.
Takeaway
Healthy lifestyle selections and taking care of your body are the essence of reducing the severity and incidence of anterior knee pain. A healthful lifestyle includes avoiding alcohol, quitting smoking, making better dietary choices, keeping weight in check, exercising regularly, and sleeping on time.
Your doctor would help you identify the underlying source of your knee pain and advise you on the type of exercise you need and your future course of action. Visit your doctor regularly and determine how to beat the pain!