Knee Pain from Front to Back

June 2021

Anterior knee pain is experienced by many people in all walks of life, from adolescents to senior citizens. It is the most common knee pain diagnosis we make. The pain occurs at the front and center of the knee and can refer (travel) to the back of the knee. This means a patient can feel pain in the back of the knee, but the pain is actually generated from the structures in the front of the knee.

Related Conditions

Multiple conditions that cause knee pain in this area include:

  • Chondromalacia of the patellae: softening and breakdown of the tissue (cartilage) on the underside of the kneecap (patella)
  • Runner’s Knee: sometimes called patellar tendonitis
  • Lateral Compression Syndrome: the patella, during range of motion, moves or tracks more to the outside part of the knee
  • Quadriceps tendonitis: pain and tenderness at the quadriceps tendon attachment to the patella
  • Patellar arthritis: cartilage breakdown and erosion underneath your kneecap (patella) until all the cartilage on the bone is gone
  • Instability of the patella: when the kneecap pops “out of place”/out of joint

Causes

To understand the causes of anterior knee pain, it helps to know how things are supposed to work. The kneecap sits over the front of your knee joint. As you bend or straighten your knee, the underside of the patella glides over the thigh bone that makes up the upper part of the knee joint. Strong tendons help attach the kneecap to the bones and muscles that surround the knee. These tendons are called:

  • Patellar tendon, where the kneecap attaches to the shin bone
  • Quadriceps tendon, where the thigh muscles attach to the kneecap

Anterior knee pain begins when the kneecap does not move properly and rubs against the lower part of the thigh bone. This may occur because:

  • Kneecap is in an abnormal position—also called poor alignment of the patellofemoral joint
  • There is tightness or weakness of the muscles on the front and back of your thigh
  • You are doing too much activity that places extra stress on the kneecap, such as running, jumping, twisting, skiing, or playing soccer, basketball, tennis, etc.
  • Muscles are not balanced and your core muscles might be weaker—the core muscles consist of abdominal, pelvic, and lower back muscles
  • The groove in the thigh bone where the kneecap normally rests is too shallow which produces instability of the patella
  • You have flat feet

Anterior knee pain is more common in:

  • People who are overweight
  • People who have had a dislocation, fracture, or other injury to the kneecap
  • Runners, jumpers, skiers, bicyclists, and soccer players who exercise often
  • Teenagers and healthy young adults
  • Women, who are more susceptible because they are often knock kneed (their thighbones tend to curve inward from the hip to the knee) and this alignment can create added stress on the joints. Women are also more prone to have loose ligaments due to hormones—and if their thigh and core muscles are weak, that further predisposes them to anterior knee pain.

Symptoms

Kneecap pain is a dull, aching pain that is most often felt:

  • Behind the kneecap
  • Below the kneecap
  • On the sides of the kneecap
  • When bending the knee, creating a grating or grinding feeling

Activities that usually cause the pain include:

  • Deep knee bends or squatting down
  • Going down the stairs or less often up the stairs
  • Running down hill
  • Standing up after sitting for a while

Our Recommendations

Most people will initiate Activity Modification (stop activities that cause increased pain) and over-the-counter NSAID’s (Advil, Aleve, etc.) and some people use Tylenol as a pain reliever.
If these initial treatments fail, then we recommend you come to our office for an orthopaedic evaluation. This will include X-rays and a meticulous physical examination. From this, your doctor can determine:

  • If further diagnostic testing (MRI) is needed
  • If a brace is indicated
  • The proper choice of NSAID (over-the-counter vs. prescription)
  • A home exercise program
  • If surgery may at some point be needed

If you’re experiencing knee pain, please reach out so that we can address your concerns and get you on the path to better health.

Visit our website to learn more about pain management and our expertise in hip and knee diagnoses and treatments.