Anterior Knee Pain

What is it?

Anterior knee pain is pain experienced at the front of the knee. It is a symptom that can have many different causes and therefore anterior knee pain is not in itself a full diagnosis.

What are the Symptoms?

The patient may experience pain and at times swelling in and around the front of the knee. The pain may vary in severity and is generally localised to one specific area.

What are the causes?

Anterior knee pain has many causes, these can be related to age, trauma, repetitive strain and biomechanics. Some of the more common causes are listed below.

Patellofemoral joint dysfunction (or Patella mal tracking) – The patella (knee cap) articulates with the femur (thigh bone) when you bend and straighten your knee. In order to remain stable when bending and straightening your knee, the patella is shaped in a way that it can precisely track around the grooves of the femur. If this tracking is slightly off due to a muscle imbalance (e.g the structures on the outside of the knee are stronger then the muscles on the inside of the knee) then the patient can experience anterior knee pain.

Apophysitis – Is inflammation of the bone where strong tendons attach, generally found in people between 8-15yrs of age. The most common area for apophysitis is where your patella tendon attaches to your tibia bone (just below the knee cap). This type of apophysitis is known as Osgood Schlatters disease. The patient suffering with Osgood Schlatters disease may experience anterior knee pain and a bony lump just below the knee cap.

Sinding Larsen Johnannsen disease is a similar condition to Osgood Schlatters disease, although this time the apophysitis occurs where the patella tendon attaches to the bottom of the patella. Again this apophysitis will present with anterior knee pain and a possible bony lump under the patella.

Osteochondritis Dissecans – Most commonly found in people between 8-15yrs of age, it is a combination of compromised blood supply and repetitive micro-trauma that can cause a breakdown of very small areas of bone within the knee joint. The patient may experience anterior knee pain, clicking, swelling and even locking of the knee joint.

Patella Dislocation (or instability) – Can be due to underlying laxity of tendons and ligaments which support the knee, in which case patella instability may become a chronic problem unless the patient is seen by a physiotherapist for appropriate exercises. Patella dislocation can also occur from a direct blow to the patella, for example during a contact sport. The patella may relocate straight away with the patient experiencing a popping sensation with extreme anterior knee pain, or the patella may remain dislocated until an appropriate health professional can relocate it for you.

Fat Pad Impingement (or Patella bursitis) – There are many different fat pads around the knee that protect the components of the knee as they move about one another. A common fat pad to be impinged is the infra-patella fat pad which lies just below and behind the knee cap. This can become impinged when the knee is over extended. Once impinged the fat pad can become swollen, leaving it prone to further impingement. The patient may experience anterior knee pain and inflammation around the patella (knee cap).

Genu Valgum – This is an issue with the biomechanics of the lower limb that causes the knees to be closer together then the feet, when the patient is standing (also known as knock knees). This can either be due to mal alignment of the hip and/or over pronation of the feet (flat feet). Genu valgum can put excessive loading through certain structures of the knees, leading to anterior knee pain.

Repetitive Strain (Patella Tendonitis) – Another common cause of anterior knee pain is repetitive forceful loading, particularly on the tendons of the knee. This is most commonly found when the individual has had little or no preparation for high level activity (e.g an unfit individual moving house). The patient may experience anterior knee pain and also some inflammation around the front of the knee.

What types of treatment are available?

*It is important to note that as there are so many different causes for anterior knee pain, effective treatment is very much dependent on a thorough assessment and accurate diagnosis. Some of the more common approaches to treatment are as followers. Our Physiotherapists are experts in the assessment, diagnosis and treatment of these musculoskeletal disorders.

Manual Mobilisation Therapy – This could be provided to the patellofemoral joint in order to increase range of movement and reduce pain and discomfort within the knee.

Soft Tissue Massage – This can reduce muscle tension, correct muscle imbalance, enhance muscle contraction and desensitise any painful and overactive areas.

Ultrasound Therapy – This can speed up and optimise the recovery process.

Interferential - Can provide pain relief, muscle stimulation, enhance blood flow and reduce oedema (swelling).

Acupuncture - Can stimulate the body's natural healing response, release pain-killing endorphins and improve functioning of the hormonal system.

Exercise and Rehabilitation – We can provide you with a personalised exercise programme for your needs, this will help to correct any muscle imbalance in your knee, increase proprioception and rehabilitate you to your previous level of mobility.

Taping Techniques – We can apply taping techniques to your knee to prevent further injury, reduce anterior knee pain and give you confidence during the early stages of rehabilitation.

Knee Braces – We can give you professional guidance as to what knee braces will best suit your needs, allowing you to return to work or sport with confidence.

Podiatry – We can refer you to our experienced Podiatrist for a biomechanical assessment, he can then provide you with custom made orthotics to correct any biomechanical abnormalities in your feet.

Consultant and Sports Medicine referral – We are familiar with a range of expert Consultants who we can refer you to if further medical intervention is required.

Any Questions? Please Contact us