Anterior knee pain

This can be caused by structural abnormalities but may be related to everyday loads placed upon the knee without any actual structural abnormality of injury being present.

Anterior knee pain is one of the most common knee problems and accounts for almost 25% of all adult knee problems. The pain is not usually related to any damage or significant problems but can still cause a lot of distress to the individual and limit the ability to complete activities such as stairs, walking and sport.


The most common symptom of this condition is pain arising from around or beneath the kneecap. Symptoms will typically occur over a gradual period of time. It is often described as a deep ache with occasional episodes of sharp pain on activity.

Typically people struggle with activities that involve weight-bearing on a bent knee, such as going up and down stairs and walking up and down inclines. The majority of people will find walking on a flat surface quite manageable.

There are multiple elements causing Anterior Knee pain and this can include dynamic structures such as tight or weak muscles of the legs and buttocks and also more structural issues such as the shape or size of the knee cap (patella) or trochlear groove (groove at the end of the thigh bone which the kneecap articulates with).

Some of the factors we are able to change and others we are not, so therefore, we focus on the things we can alter and are able to gain very good results.

Cause of symptoms

Anterior knee pain is not caused by bones directly rubbing together as is commonly thought. Pain is a result of increased pressure between the knee cap and the groove that it runs through. The cells within the bone can then sense this increased pressure, interpreting this as painful. This will occur when bending the knee beyond 30 degrees. Weak buttock and leg muscles causes abnormal pressure within the knee and in turn results in pain.

Common symptoms/Reasons for pain:

Going up stairs

This commonly caused by weak Gluteal muscles (Buttock muscles) that are needed to drive us up the stairs. If these are weak then it places more pressure in the knee.

Going down stairs

This is commonly caused by:

  • Changes to the smoothness of the back of the knee cap, such as early Osteoarthritis.
  • Tight Quadriceps muscles (Front of the thigh) or weakness of the quadriceps. If there are tight Quadriceps muscles, this causes the kneecap to be pulled closer to the groove again increasing the pressure in the joint.

When walking up inclines

This is commonly caused by tightness in the calf and hamstring muscles which cause the knee to have to bend sooner than usual. This leads to the kneecap entering its groove more than it would have done previously and leading to more pressure in the joint.

Pain when sitting with knees @ 90 degrees

This is described as a positive Cinema sign (similar to knee pain you may experience when sitting in the Cinema). This pain is typically caused by tight Thigh muscles (Quadriceps) which pulls the knee cap against its groove, causing a gradual pain. Most people will experience ease by releasing the tightness of surrounding muscles by straightening their knee.

Management of knee pain

In general, Anterior knee pain is caused by a number of the smaller problems mentioned above. In order to improve these symptoms, you need to gradually address each individual issue, such as tight muscles, reduced muscle control, balance and even footwear/clothing.

Unfortunately, there is no “quick fix” for this problem, but it relies upon activity modification and perseverance. Most people will take between 3- 12 months to settle their symptoms and then most individuals will need to maintain a regular exercise routine to stop developing future symptoms.

General exercise is safe to perform, but in the early stages of anterior knee pain rehab, you may need to reduce the intensity and duration of these activities. This helps to prevent the gradual irritation in the knee which will cause your painful symptoms. As symptoms get less intense you then gradually increase your activity levels based on how your knee feels.

Other treatments

For some people with excessively flat feet (Pronated feet), They may benefit from insoles to improve support of the foot and ankle. On assessment, if this deemed necessary then your medical practitioner can organise this for you.

Surgery is rarely advised  or undertaken as a treatment with Anterior Knee Pain. This is because surgery can only fix a structural problem or damage, However Anterior knee pain is caused by too much pressure in the joint, rather than a structural abnormality requiring surgery.

Level 1 Anterior knee pain specific exercises can be found here

Level 2 Anterior knee pain specific exercises can be found here

Or click here to view knee and hip exercises on youtube