Anterior knee pain (also known as 'runner's knee' or 'jumper's knee) is one of the most common injuries for runners. The pain is often felt under the knee cap (patella) at the front of the knee and can become more painful the more you run, often requiring you to stop.
To keep you in tip-top shape so there's minimum disruption to your training, follow our tips on how to treat, recover, and prevent knee pain.
Signs and symptoms
The most common symptom is pain underneath or around the edges of the kneecap. The pain can radiates on the inside leg side of the kneecap other leg, although others experience vague pain in the knee that isn’t centred in any one spot. The pain is made worse by any activities that load the patella-femoral joint, such as running, hill walking, or going up and down stairs, and kneeling or squatting is often too painful to even try.
Keeping the knee bent for long periods, such as when sitting in a car or during a movie, may also cause pain.
Sometimes there may be a sensation like the kneecap is slipping or giving way when you jump or run, although rest assured most often this is thought to be a reflex response to pain and not because there is any instability in the kneecap.
The knee may grind, or you may hear a crunching sound when you squat or go up and down stairs. In most cases this is nothing to worry about if pain is not present in the knee. If there is a considerable amount of wear and tear, you may feel popping or clicking as you bend your knee. These sounds are caused by the uneven surface of the underside of the patella rubbing against the femoral groove.
The knee may swell with heavy use and become stiff and tight. This stiffness can be because of fluid accumulating inside the knee joint, sometimes called ‘water on the knee’. This swelling is not unique to this condition but sometimes occurs when the knee becomes irritated.
Causes of anterior knee pain and how to prevent it
Poor tracking of the patella in the femoral groove as the knee moves can cause excessive stress on the back of the patella, thus wearing and irritation of the cartilage. This can be due to:
- Muscle imbalance between the two main thigh muscles. The patella gets pulled sideways by the stronger muscle, irritating the cartilage on that side. If you feel this is an issue, strengthen your thigh muscles to correct the imbalance
- Muscles within the lower extremity being too tight – e.g. quadriceps itself (front of thigh), hamstrings (back of thigh) and gastrocnemius (a calf muscle). If you feel that this is an issue, ensure adequate length of muscles and good range of movement at the knee by undertaking a regular stretching programme.
- The muscles of the hip control the position of the knee. A weakness of the muscles that pull the hip out and away from the other leg, or turn the thigh outward (hip abductor and external rotator muscles,) can lead to imbalances in the alignment of the entire leg including the knee. If you feel this is an issue, strengthen your hip muscles to correct the imbalance.
- Poor foot control, flat feet or feet rolling inwards causes inward rotation of the knee and therefore poor tracking of the patella. If you feel that this is an issue for you please visit your GP, Chartered Physiotherapist or Podiatrist to receive an expert opinion and appropriate intervention.
- Wear and tear as a result of acute injury to the patella e.g. a fall or chronic friction between the patella and the femur such as during jumping
- A sudden introduction or escalation in hill/stair activity
- Walk up stairs leading with your unaffected (pain free) leg, walk downstairs leading with your affected (painful) leg. This can be remembered easily by the saying ‘the good leg goes up to Heaven, the bad leg goes down to Hell’
- Graduate or phase the increase in the activity. If this is not possible within a work environment make use of escalators / lifts where possible and reduce over time to create the phased approach.
- Take regular short breaks and when safe to do so
- A sudden introduction or escalation in squatting
- Try to raise the area to waist height e.g. use raised beds in a garden/garden centre or place a case / box onto a higher workbench.
- Use a low chair/stool where possible e.g. a teacher bending down at the side of a young child at school when he/she needs help in the classroom, should sit next to them on a chair.
- Kneel using kneeling pads and alternate the kneeling position/leg.
- Weight bearing through a bent knee
- Try to minimise this activity, but when you do so ensure that your patella is lined up with the midline of your foot (so when you look down you can see your big toe on the inside of your bent knee) and clench your buttock muscles for power.
- Prolonged postures, such as sitting and getting up from prolonged sitting
- Keep your knees moving when you are sitting down.
- Ensure that your workstation is not cluttered and that you can stretch out your legs while you sit.
- Poor footwear - unstable or not fit for the activity undertaken
- Wear suitable shoes for the activity and also for your foot biomechanics (type, fit and condition of footwear)
- Restrictive clothing around the hips / knees e.g. tight pencil skirts
- Wear suitable clothing for the activity that allows a good knee position
First aid advice
The best results after a knee injury come when treatment is started right away. A simple way to remember the essential steps of initial treatment is by the letters in the word RICE. These stand for rest, ice, compression, and elevation.
The injured tissues in the knee need time to heal. Rest prevents further injury and reduces the stress on already inflamed tissues. If the injury is severe crutches or a walking stick (placed in the opposite hand to the injury) will prevent too much weight being placed on the knee in the early days of injury when walking is essential.
Applying ice will help ease pain and reduce the swelling and warmth. You should apply the ice as soon after the injury as you can to prevent as much of the inflammation developing as possible. This will help ensure a speedy recovery. It is advised to apply ice in the form of crushed ice cubes, frozen peas or an ice pack.
DO NOT apply directly to your skin, oil can be applied to protect the area. All of these are to be wrapped in a damp tea towel and applied to the knee for approximately 15 minutes every two hours. It is advised that you check the skin every five minutes to avoid the possibility of an ice burn from the cold temperature. Apply frequently in the first two days.
Use tubigrip (elasticated tubular bandage available at the chemist) on your knee, this will help prevent inflammation and swelling. Apply the tubigrip from mid thigh to mid calf, make sure it is not too tight and take it off at night time.
Supporting your knee above the level of your heart helps to control swelling by aiding your body to reabsorb the fluid that has leaked into the tissue. Ideally lie on your bed or the sofa or floor and prop your knee up on pillows or a chair so that it is higher than your heart. Even propping your knee up on a chair if you are unable to lie down (e.g. at work) is beneficial.
- If swelling in the knee is severe, self-massage can help. Apply massage strokes from the knee toward the hip with your leg kept in an elevated position. This helps get the excess tissue fluid moving out of the knee and back into circulation.
- Gentle mobilisations of the patella from side to side can aid pain relief and reduce swelling and stiffness. You must sit up straight with your back supported (hips bent to 90 degrees) and your legs straight. This can be done while sitting on your bed with your back supported by the headboard, or sat on the floor with your bottom against the skirting board and your back supported by the wall. Reach out to your knee with your arm while your back is still resting on the wall. Your sitting position is important as if you lean forward away from the wall, your thigh muscles will tighten and you will not be able to move your patella!
- Mild pain relievers may help with the discomfort. Anti-inflammatory medications can help ease pain and swelling and get people back to activity sooner. These medications include common over the counter drugs such as ibuprofen. Talk to your Doctor or Pharmacist if you have specific questions about which pain reliever is right for you.
- Avoid repetitive activities or prolonged activities ( such as sitting for a long time) that aggravate your symptoms until you are feeling more in control of the pain and slowly reintroduce these activities. For example driving long distances, break up the drive by taking frequent breaks.
Please remember to use this advice under the guidance of your physiotherapist or sports massage therapist. For more tips and advice visit PhysioMed.