Knee: Anterior Knee Pain

It was a breezy Saturday morning when I decided to catch up on some emails at a local park. I noticed Emma, a fitness enthusiast from the neighborhood, stretching her legs on a bench. Her usually cheerful demeanor seemed off. “Hey Emma, everything okay?” I asked, joining her on the bench.

She sighed, “Honestly, Dr. Priya, my knees have been killing me. It started with occasional discomfort during runs, but now even climbing stairs hurts.”

I listened carefully as she described her symptoms. Given her active lifestyle and the nature of her discomfort, I suspected she might be dealing with anterior knee pain, commonly known as patellofemoral pain syndrome.

What is Anterior Knee Pain?

Anterior knee pain is a variety of knee pain in which the discomfort is felt in the front of the knee and in and around the kneecap (called the patella). The usual cause is a relatively non-serious condition called chondromalacia patella, also known as the patellofemoral syndrome. There are other causes of anterior knee pain, but this is by far the most common and needs to be distinguished from arthritis of the knee joint. It is one of the most common problems in sports medicine and is sometimes referred to as ‘jogger’s knee,’ ‘runner’s knee,’ or ‘cyclist’s knee.’

Research published in the British Journal of Sports Medicine highlights that patellofemoral pain syndrome is responsible for nearly 25% of all knee complaints in sports medicine clinics.

How Does It Happen?

The basic cause is repeated flexion (bending) of the knee in activities such as sport, climbing stairs, and bushwalking, especially on uneven ground. Usually, there is no history of a preceding injury, but it can follow an accident such as falling directly and heavily onto the kneecap. It is a type of wear and tear on the surface under the patella that results in the smooth surface of cartilage becoming soft and stringy and sometimes inflamed. People who have an abnormal shape or position of the patella are more likely to develop the condition.

A study in the American Journal of Orthopedics found that individuals with anatomical abnormalities of the kneecap, such as patella alta (a high-riding patella), are at a higher risk of developing anterior knee pain.

Who Gets Anterior Knee Pain?

It may affect people at any age, but it is more common in adolescents or young adults. It is also more likely in athletes and those involved in activities requiring frequent knee bending.

Emma nodded, “That makes sense. I’ve been running more frequently and pushing myself harder.”

What Are the Symptoms?

The main symptom is pain or an ache in the front of the knee that sometimes can also be felt deep in the knee. The pain may come on slowly ‘out of the blue’ and then gradually get worse.

The pain is worse with:

• Walking up and down stairs
• Running (especially downhill)
• Walking on rough ground
• Squatting
• Prolonged sitting

A cracking sensation (called crepitus) or clicking or clunking on bending the knee is often heard. Occasionally, the knee may give way. Knee swelling is relatively uncommon.

Emma mentioned, “It’s especially bad when I sit for long periods. I even avoid watching movies at the theater now.”

“Ah, that’s known as ‘movie-goer’s knee,’” I explained. “It’s a diffuse ache felt when sitting for long periods with the knee bent.”

What is the Outlook?

The outlook is very good, and a steady recovery can be expected with attention to relatively simple guidelines. Elite athletes require more guidance from therapists if they wish to remain competitive. Surgery is rarely necessary. X-rays of the knee are usually normal.

A clinical review published in The Lancet emphasized that conservative treatments like physical therapy and lifestyle adjustments are highly effective for managing anterior knee pain.

What is the Management?

The key approach is to rest from aggravating activities such as running, cycling, or excessive climbing of stairs and to retrain muscles, especially the quadriceps. Correction of any biomechanical abnormalities of the patella or the feet with the use of taping, orthotics, or footwear will be important. Your doctor may refer you to a sports medicine therapist to supervise rehabilitation.

Acute Inflammation

This is relieved by rest and ice packs. Sometimes a short course of non-steroidal anti-inflammatory drugs will be necessary; otherwise, aspirin or paracetamol will control pain.

Taping

If the patella is ‘off-centre,’ taping of the patella will help relieve acute pain.

Muscle Retraining

Your doctor or therapist will advise on the most appropriate exercises. For straightforward cases of anterior knee pain, simple quadriceps exercises can be very effective.

A randomized controlled trial published in Physical Therapy in Sport showed that quadriceps strengthening exercises significantly reduce pain and improve function in patients with patellofemoral pain syndrome.

Quadriceps Exercise

Hold your hand over the lower quads to ensure that they are felt to tighten. Then relax as in position (b). This tightening and relaxing exercise should be performed at least six times every two hours or so until it becomes a habit. It can be done sitting, standing, or lying.

Emma seemed relieved to hear that surgery was rarely needed. “So, it’s all about managing it properly?”

“Exactly,” I assured her. “Let’s start with some gentle exercises and see how you progress. And remember, taking breaks during long periods of sitting will help too.”

FAQs About Anterior Knee Pain