Pain at the Front of the Knee

This page has been designed to provide you with the right information about pain at the front of the knee and the rehabilitation that may help you in your recovery.

What is pain at the front of the knee and what causes it?

Pain at the front of the knee (often called ‘anterior knee pain’) is a collective term for a number of complaints that may cause you to feel discomfort at the front of your knee.

There are a number of things that can cause pain to present around the front of your knee, ranging from kneecap (patella) issues, tendon complaints and even issues arising from the hip.

The following information page will focus on one of the more common causes of pain at the front of the knee, the patello-femoral joint area (kneecap joint area), however, most of the information you will read will still be relevant even if your patella is not the cause of the issue/s.

What is the patella-femoral joint?

Your knee is made up of a number of joints, with one of them being the joint between your patella (kneecap) and your femur (thigh bone).

What does the patella do?

Firstly, as you may have already guessed, patella is the name for your kneecap. For the rest of this article, we will use the name patella.

Your patella is a relatively small bone that sits at the front of your knee and its main job is to help the quadriceps (front of your thigh) muscles work to straighten your knee.

It is held in place by a number of things including soft tissues (tendons and ligaments), the shape of the groove it sits in and the quadriceps muscle group itself.

It is designed to be a very mobile bone to allow it to do its job properly, in other words it is meant to be wobbly! It is also very normal to hear or feel noises from your patella as it moves; this is normally nothing more than friction and although can sound unpleasant, does not mean that anything is wrong and does not mean you are causing harm to your knee.

How do you get pain from your patello-femoral joint area?

This is a surprisingly tricky question to answer as there is not always a clear and obvious reason as to why you might be getting issues around the front of your knee.

Patello-femoral pain (PFP) is thought to be caused by a number of factors ranging from poor muscle strength, a sudden or unaccustomed amount of activity, reduced general physical fitness, repeated tasks (such as kneeling for long periods) or trauma (an injury).

In most cases, PFP is not caused by something nasty and although it can be very uncomfortable, it is normally nothing to worry about.

You say it’s nothing to worry about, but my knee is really sore!

Absolutely, PFP can be really quite uncomfortable and can get in the way of all sorts of normal day-to-day things like stairs, walking or even simply getting out of the chair. However, for the vast majority of cases it is caused by some of the structures of your knee being irritated and unhappy, rather than something sinister (nasty) or something that should cause distress.

What are the normal signs of a patella-femoral joint issue?

Firstly

It is normally characterised by pain at the front of the knee.

Secondly

You will often find that the pain is aggravated (made worse) when doing things that require your patella and its surrounding structures (ligaments/tendons etc.) to work harder such as coming downstairs, walking down slopes, deep kneeling or squatting.

What about noises? My knee is really noisy, should I be worried?

Noises coming from any of your joints can be concerning but for the most part, they are normal and nothing to worry about. Crunches, creaks, snaps and cracks are common in knees that don’t have pain as well as those that do. In most cases, the noise that you hear is actually friction between the joints' surfaces as they move.

But won’t that wear my joint away?

Absolutely not. As mentioned above, it is normal for your knees to make noise and it is quite common for people to worry about it, but your kneecap is made of bone and is designed to last you a lifetime. It is not fragile or delicate and is designed for running, jumping, kicking and kneeling. It can be noisy and it can be sore but it is not vulnerable and it will not simply ‘wear away’.

Don’t I need an X-ray or scan to be able to tell what is wrong with my knee?

No, not normally. Most issues that cause problems around the front of the knee can be managed well without the need for X-rays or scans.

Careful questioning and a physical assessment can often be all that is needed to help your physiotherapist or other healthcare professional work out what might be causing or contributing to your knee pain.

X-rays and scans are not a form of treatment and therefore they won’t help make your knee feel better, however, there may be circumstances where your physiotherapist or healthcare professional may send you for one, but this is not common and would normally be for a very specific reason.

Will I need to have surgery?

No, not normally.

In the vast majority of cases, people with pain at the front of the knee do very well with physiotherapy alone. Surgery is not something that is often needed.

Ok, so if my knee is sore but safe, what can I do to get it better?

There are normally a number of things that you can do to help your knee recover, however, we’ve broken them down to 3 main things.

If you can understand the issue, you can normally deal with it better. This is why we have provided you with all of the information above, to give you the right advice about what is normal for knees and hopefully take away some of the worry or concern out of the situation.

In a lot of muscle and bone complaints, the first step towards recovery is allowing the problem to calm down first. This doesn’t mean doing nothing and resting completely (although rest is not evil), what it means is looking at what your knee is saying it doesn’t like, in other words what is painful, and making some changes to how you do that task. This might mean not walking so far, or coming down the stairs differently or modifying how you kneel. You won’t need to do this forever, but it is really important to helping calm your knee down.

You can find some more information and help about this here: Load Management

It is very normal when you have a painful knee, you find yourself moving differently. Perhaps you find you are leading with the other leg or putting more pressure on the other leg when getting out of the chair. Frustratingly, it doesn’t take very long for your muscles to lose size and strength if you do not use them properly. Just one week’s bed rest can cause muscle size to reduce by 3% and strength to reduce by nearly 7% (Dirks et al, 2016). By building/ re-building your strength and confidence, you can find that your knee can start to move further forwards with its recovery.

What exercises should I do?

We’ve pulled together a programme of exercises that are often really useful for trying to help you get your knee moving after a patella dislocation. We’ve also included a selection of strengthening exercises to progress to once the knee feels like it’s moving a bit better.

When should I do these exercises?

Well, it is worth being kind to yourself and allowing your knee to calm down first, which might take several weeks but you can consider starting work on your knee as soon as you feel confident.

What are the exercises trying to do?

Good question and it’s useful to know the answer before you start.

Firstly, the exercises are simply helping you get your leg moving. Your knee is designed to move and although it might be sore to do it initially, it is exactly what your knee needs to start its recovery.

Once the knee is feeling like it is moving a bit better, you may want to explore our strengthening and balance exercises below. The aim of these is to start to improve your muscles in terms of their strength and ability to help support your knee.

Lastly, one of the most important things about all of these exercises, is they are trying to help you regain some trust in your knee. Often, after a dislocation you may feel better quite quickly but it is the confidence to use the knee normally that requires some time and support.

Apart from these exercises, is there anything else I can be doing to help myself?

Some people will choose to manage their knee pain with pain relief, whilst some may choose to avoid medication. Applying something cold to your knee may also be useful in helping with some of the pain (do remember to wrap your frozen peas in a towel before applying them to your skin to avoid cold burns).

Weight loss is recommended as something that is important for the management of most muscle and bone issues. Losing weight is difficult and we understand that.

Often people will think that simply putting more weight through their joints is the reason why they get problems and being closer to their ideal body weight will simply stop their symptoms. Unfortunately, it isn’t that easy. It is worth knowing that fat cells are very active cells and they produce chemicals that can affect pain sensitivity (Tashani et al, 2017).

By looking at diet, exercise, sensible goal setting and establishing a good support network, a weight loss journey is more likely to succeed and the benefits to your knee are more likely to be influenced by the journey you take to lose weight rather than being lighter.

If you would like some support to help you with your weight loss journey, please contact our partners at Feel Good Suffolk or Active Norfolk.

Getting the best out of your diet is important to support your training programme. There are lots of different opinions about what is best but generally it is agreed that if you want to build muscle, you should look to increase the protein in your diet. 1.5 grams of protein to every kilogram of your body weight is often suggested as a good starting point. More advice about diet can be found here: Eat Well

Sleeping well will help your recovery and support your training programme. More advice about sleeping better can be found here: Sleep Well

Exercise tip:

For the movement exercises, aim to try and complete these little and often throughout the day.

For the strengthening exercises, aim to complete the exercises (as many or as few as you want to) about 3 to 4 times a week.

Each exercise should be completed between 8-12 times (or repetitions) for 3 to 4 sets. Make sure you have about 1 minute's rest in between each set.

In order to change your muscles, you need to challenge them. In other words, you should really feel the effort with each set of exercises and should really not be able to do more than 12 each time around.