Front (anterior) knee pain
- Mr Damian McClelland, Trauma and Orthopaedic Consultant, and Clinical Director for Musculoskeletal Services at Bupa
- Rachael Mayfield-Blake, Freelance Health Editor
Pain at the front of your knee is also called anterior knee pain. Anterior means ‘front’. There are lots of things that can cause this type of knee pain. But most of the time, some simple self-care measures should help to get rid of your pain.
Causes of pain at the front of the knee
Pain at the front of your knee may come from your kneecap itself or from the tendons and ligaments in your knee. Tendons connect muscles to bones, and ligaments connect bones together. There are several things that can cause pain at the front of your knee or increase your risk of developing it. These include:
- using your knee a lot – for example, doing lots of exercise or playing sports
- injuring your knee – for example, having a direct blow to your knee
- being overweight – this puts your knees under more stress
- problems with the alignment of your knees (how your kneecap moves over your thighbone)
- having flat feet
- having overly flexible joints (hypermobility)
Conditions linked to pain at the front of the knee
There are several health conditions linked to pain at the front of your knee. They include the following.
Patellofemoral pain syndrome (PFPS)
Patellofemoral pain syndrome is one of the most common reasons for pain at the front of the knee. When you bend and straighten your leg, your kneecap slides up and down a groove at the end of your thigh bone (femur). Patellofemoral pain syndrome describes pain related to this joint. It can happen if there’s repeated stress on your knee – for example, from jogging, squatting, or jumping. It can also result from problems with the alignment between your kneecap and thigh bone. Doctors sometimes call it runner’s knee. It often happens in people who are very active – particularly teenagers and young adults.
When the patellar tendon in your knee becomes worn down, you may develop patellar tendinopathy. The patellar tendon attaches your kneecap to your shin bone, and it can tear. This can be due to overuse and stress over time, particularly in sports that involve jumping – like basketball and volleyball. Because of this, it’s often called jumper’s knee.
Quadriceps tendonitis
Quadriceps tendonitis is a similar condition to patellar tendinopathy that causes pain and tenderness where the tendon from your thigh muscle attaches to your kneecap.
Infrapatellar fat pad syndrome
If the fat pad below your kneecap gets pinched between your kneecap and thigh and shin bone, you might have infrapatellar fat pad syndrome. It causes inflammation and is usually due to either an injury or repeated stress on your knee. It’s sometimes called Hoffa’s syndrome.
Anterior cruciate ligament injury
Your anterior cruciate ligament runs across the inside of your knee, connecting your thigh and shin bones. You might completely or partially tear your anterior cruciate ligament. It’s a sudden injury, usually caused by twisting your knee. It can happen if you suddenly slow down, stop or change direction. This injury is nearly always associated with sports.
In osteoarthritis, there are structural changes to your joints over time. Cartilage covers the ends of your thigh and shin bones and helps them to glide over each other. This cartilage can become damaged and painful. Osteoarthritis mostly affects people over 50 and is a common cause of knee pain.
Less common conditions that cause pain at the front of the knee
Prepatellar bursitis is inflammation of the fluid sacs that act as cushions around your kneecap. The exact cause of prepatellar bursitis isn’t known but you can get it if you kneel a lot. It’s sometimes called housemaid’s knee or clergyman’s knee. Bursitis can also be caused by overuse, a fall, or an injury, and is associated with health conditions such as rheumatoid arthritis and gout.
Recurrent partial dislocation (subluxation) of the patella is where your knee regularly ‘gives way’. This is because your kneecap moves out of position. It’s more common in girls, especially those with ‘knock-knees’ (where your knees are turned inwards).
Osgood–Schlatter disease and Sinding-Larsen–Johansson disease are causes of knee pain in children and teenagers who play a lot of sports. They both cause pain and tenderness just below your kneecap, at the top of your shin bone.
There are other conditions that may cause pain at the front of your knee. If your pain doesn’t go away with self-help measures, a doctor or physiotherapist can help you to find the cause.
Symptoms of pain at the front of your knee
Pain at the front of your knee can feel different for different people and will depend on what’s causing it. You may have pain in front of your knee below your kneecap, around it, on either side of it, or behind it. And you may have a dull ache or a sudden, sharp pain in front of your knee.
You’ll often get pain in both knees at the same time, unless it’s due to a particular injury. Pain at the front of your knee is often made worse by:
- standing up after sitting for a long time
- squatting or kneeling
- using stairs
- walking
- running downhill
Jumper’s knee may cause pain only when you’re active but if it gets worse, it may be painful all the time.
Pain from an anterior cruciate ligament injury is usually sudden and you may hear a ‘pop’. Your knee is likely to swell up quite quickly and may feel as if it is going to give way.
Osteoarthritis in your knee usually causes pain when you put weight on the affected leg and gets better when you rest it. You may have stiffness and loss of movement first thing in the morning (for no more than half an hour), or after sitting for a while.
Osgood–Schlatter disease and Sinding-Larsen–Johansson disease cause pain, tenderness, and swelling just below your kneecap, at the top of your shin bone. Symptoms are usually brought on by jumping or kneeling.
When to seek medical help
If your injury is mild, you may be able to manage your symptoms yourself, without seeking medical advice. But you should see a doctor if:
- you can’t put weight on the affected leg
- you have severe pain, even when you’re not putting weight on it
- your knee gives way, clicks painfully, or locks (gets stuck)
- you can’t move your knee
- your knee is hot, red, very swollen, or you have a fever
Self-help for pain at the front of your knee
There’s a lot you can do to help yourself if you have a knee injury. It’s a good idea to follow the POLICE procedure.
Protect. Protect your injury from further damage. Rest immediately after the injury but not for long. Consider using some form of support or crutches.
Optimal Loading. Get active sooner rather than later. Start to put weight on your knee and build up your range of movement. Do this gradually – be guided by what feels right for you.
Ice. Place a cold compress such as a bag of ice or frozen peas wrapped in a towel onto your knee. Do this for around 20 minutes every couple of hours for the first two to three days.
Compression. Compress your knee using a bandage to help reduce swelling.
Elevation. Elevate your knee above the level of your heart to reduce swelling. Sit or lie on a chair and use a cushion to raise your leg.
Infographic: POLICE principles
Bupa's POLICE infographic (PDF, 0.5 MB), illustrates the ‘POLICE principles’ to reduce your pain and help you to recover. Click on the POLICE image below to download the PDF.
And there are certain things you should avoid in the first three days after your injury so you don’t damage your knee further. These can be remembered as HARM, which stands for the following.
H – Heat. Don’t have hot baths, showers or saunas, and avoid heat packs and rubs.
A – Alcohol. Drinking alcohol can slow down your recovery and mask your symptoms – increasing the risk that you’ll injure yourself again.
R – Running. Don’t run or do any other form of moderate exercise.
M – Massage. Massaging the affected areas can cause more swelling and damage, so avoid this for the first day or two.
Infographic: HARM principle
Bupa's HARM infographic (PDF, 0.6 MB), illustrates the ‘HARM principle' of things you should avoid doing in the first three days after your injury. Click on the HARM image below to download the PDF.
POLICE and HARM are measures you can take to treat any type of soft tissue injury to your knee.
In the longer term, you can help to stop your knee pain coming back by making some changes to your lifestyle and exercise regime. These include:
- avoiding activities that have previously hurt your knees
- warming up and cooling down properly when you do any activity
- trying to incorporate strengthening your core muscles (back and tummy), hamstrings, and thigh muscles into your exercise routine
- losing any excess weight if you need to, to reduce stress on your knees
- wearing the right shoes for your activity
- asking a physiotherapist about foot orthoses (these are inserts you put in your shoes)
- gradually increasing how much exercise you do rather than suddenly doing a lot more
If you see a physiotherapist, it’s worth asking them to check if your feet naturally turn in or out when you walk or run. This is quite common and can cause knee pain or make it worse. It’s usually quite easily corrected with an orthotic shoe insert.
Diagnosis of pain at the front of the knee
If you see a doctor because of your knee pain, they’ll examine your knee and ask you some questions. These include:
- when your pain started and if there’s anything that makes it worse
- if there’s any activity, accident or injury that could have caused it
- if you have any other symptoms such as your knee giving way or clicking, or pain in any of your other joints
They may suggest an X-ray or a magnetic resonance imaging (MRI) scan, but this is often not necessary. Your doctor may be able to diagnose you based on the examination and your symptoms.
If you have cartilage or ligament damage, you may need to have a procedure to look inside your knee. This is called an arthroscopy (keyhole surgery). It involves making a small cut in your knee and inserting a thin tube and camera. As well as diagnosing the problem, your doctor may sometimes be able to repair or remove any damaged tissues during the procedure.
Treatment of pain at the front of the knee
Whether or not you need further treatment for your knee pain and what treatment you have, will depend on what’s causing the pain. Most conditions that cause pain at the front of the knee can be treated with painkillers and physiotherapy. Surgery is usually only needed if other treatments haven’t worked.
For information on treatments, please see the relevant knee condition page.
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The treatment you need for pain at the front of your knee will depend on exactly what’s causing it. There are many things you can do yourself, including taking some over-the-counter painkillers or putting an ice pack on your knee. But for some conditions, physiotherapy or surgery may help.
For more information, see our sections on self-help for pain at the front of your knee and treatment of pain at the front of your knee .
Pain at the front of your knee can be caused by problems with your kneecap or the tendons that hold it in place. Ligament injuries and osteoarthritis can also cause this type of pain.
For more information, see our sections on causes of pain at the front of your knee and conditions linked to pain at the front of the knee.
Your doctor can assess how serious your knee pain is by asking you questions and examining your knee. If necessary, they’ll carry out some scans too. You should see a doctor if your symptoms are severe or your knee is hot, red, very swollen, or you have a fever.
For more information, see our section on symptoms of pain at the front of your knee.
Front knee pain is called anterior knee pain. Anterior means ‘front’. Lots of things can cause anterior knee pain.
For more information, see our sections on causes of pain at the front of your knee and conditions associated with pain at the front of the knee.
Knee arthroscopy
Knee arthroscopy is a type of keyhole surgery used to diagnose and treat knee pain or other knee problems.
Patellofemoral pain syndrome
Patellofemoral pain syndrome is sometimes called ‘runner’s knee’ because it’s particularly common in people who run or do other sports.
Patellar tendinopathy (jumper's knee)
Patellar tendinopathy is also called ‘jumper’s knee’ because the injury commonly occurs during sports that involve jumping, such as basketball.
Infrapatellar fat pad syndrome
Infrapatellar fat pad syndrome is when your fat pad becomes pinched (impinged) between your kneecap and thigh bone, or your thigh and shin bones.
Anterior cruciate ligament (ACL) injury
An ACL injury can be a partial or a complete tear, an overstretch, or a detachment of the ligament.
Knee osteoarthritis
Osteoarthritis is a disease that causes pain and stiffness in your joints. Your knee is one of the joints that’s most commonly affected.
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