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Anterior Knee Pain

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. 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.

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.

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, location, and pain level as per patients’ experiences.

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

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 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

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
  • Chondromalacia patella – damaged articular cartilage under the kneecap


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

The symptoms can be more manifest when:

  • Having deep knee bends
  • Going downstairs
  • Standing upright after sitting for a short time
  • Running downhill


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).

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.

How do you treat anterior knee pain?


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.

Prolotherapy 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.

Other less effective ways of treating anterior knee pain:

  • Resting your knee for short periods
  • Consuming nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, aspirin, or naproxen
  • Modify your way of exercising.
  • Learn and do exercises that strengthen as well as stretch your quadriceps muscles 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.

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 surgery is needed. 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.


A person with anterior knee pain


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!



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