Pain in the front of the knee is one of the leading reasons for reduced activity and sport participation. Read on to find out about potential causes of anterior knee pain and strategies that can help avoid or eliminate it.
Limited knee range of motion
A reduction in available range of motion in your knee can lead to a significant increase to the forces applied through the front of your knee.
A simple way to test this yourself is to lay on your back on a hard surface, then try to straighten your legs out all the way by pressing the back of your knees towards the floor. If you can feel the back of the knee press into the floor, well done! If not, how much space is there between the floor and your knees? If it’s more than a finger width you may be lacking a bit of extension range of motion. Also, make note of differences between one side and the other.
Test your knee bend by sitting up on the floor, slide your foot in towards your bottom by bending one knee as far as you can, and then assist the movement by using your hands to pull your shin in towards you as far as it can go. Does that feel the same on both sides? Does one knee feel like it can bend further than the other? Do you have some pain or tightness across your knee when at it’s end range of movement (this indicates some swelling or soft tissue block) or does the deepest part of the bend feel like a hard stop (a more bony limitation)?
How to manage:
To improve knee EXTENSION:
Place a ball or towel roll behind you knee. Keep your knee pressed down on it as you lift your heel up as high as you can (without lifting your knee up off the ball). Hold for 5 seconds. Repeat 10-20 times about 1-3 times per day.
To Improve knee FLEXION:
Use a towel (like in the picture) or use your hands directly on your shin to pull your knee into as much bending as you feel comfortable. Hold for 3-5 seconds then straighten leg back out again. Repeat 10-20 times, 1-3 times per day.
Your knee cap (patella) moves both up and down and side to side in a specific pattern when you bend and straighten your knee. This is to help with leverage to increase the amount of force your quadriceps have on your lower leg. Some researchers theorise that the movement of the knee cap can go slightly off it’s “track.” This may cause excess forces going through the knee cap which can contribute to some sensations of pain. These issues can be complex to work out yourself so if you suspect the knee cap is the area of most discomfort, book in with your local physio for an assessment!
Hip muscle involvement
Our hips play a big role in the position of our knees when we’re walking and running. If our outer hip muscles are a bit weak then the knees can drift inwards towards each other while walking and running. This can again put excessive forces through your the inner side of the knees and may also contribute to anterior knee pain just below the knee cap on the tendon or just above the knee cap on the outside. This may be a player with patellar tracking as well.
How to manage: These two exercises are a great first step in increasing your hip strength. Lift and lower slowly (3 seconds up, 3 seconds down). Try for about 3 sets of 10 and repeat 3-4 times per week.
Our bodies are amazingly strong and adaptable. We can manage a small amount of patellar tracking issues and lacking a little bit of range of motion or a bit of hip weakness in our day to day activities and if we build up our activity levels slowly, we can usually adapt quite well and pain-free. However, if we jump into something different, such as drastically increasing our running mileage or suddenly play in three 5 a side football matches in a week, we may feel the effects of this overloading as anterior knee pain.
How to manage: Don’t stop completely! The best way to manage this is to back off on your activity to small volumes at a time or less times per week, allow the knee pain to settle down, then build back up slowly. Of course, a physiotherapist will be able to go over your training with you and help you find a plan that is safe and appropriate for you.
These strategies should help you manage or resolve low level anterior knee pain. You may want to consider seeking advice from a physiotherapist for a robust assessment if your symptoms persist, are worsening or if they are still keeping you from doing the activities you want to be able to do.