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Common Causes of Anterior Knee Pain


Part I


Knee pain is one of the most common areas of complaint from people of all levels of fitness.  If you have not experienced knee pain yourself, then you probably know someone who has.  Knee pain presents in a variety of ways – sharp, dull, achey, unstable, stiff – and in various areas of the knee – front (anterior), back, inside, outside, above, below.  In this article, I explain some of the more common causes of anterior knee pain, including Patellofemoral Pain Syndrome, Patellar Tendonitis, Pes Anserine tendonitis/bursitis, and Osgood Schlatters Disease (primarily a youth condition); and finally, in Part II, I provide helpful tips for prevention and treatment.



Patellofemoral Pain Syndrome (PFPS) involves irritation of the cartilage under the kneecap (patella), as it interacts with and contacts the bone beneath it, called the femur.  Early on, pain may be associated with inflammation or softening of the cartilage, but as compression continues and the cartilage breaks down, arthritis may eventually develop.  Pain may be vague in location or appear to move around, but is generally localized to the medial or lateral side of the kneecap.  Quite often, there are multiple factors that contribute to PFPS, which may include some of the following:  tight iliotibial band (ITB), hamstrings, or quadriceps muscles; patella resting in a lateral tilt position; weakness of the gluteals and deep hip stabilizing muscles; or altered timing of quadriceps muscle activation, resulting in abnormal tracking or pressure on the patella.  PFPS generally continues to worsen until the appropriate factors are addressed and normalized.  Look for a future article from me on Patellofemoral Pain Syndrome - it is very close to my heart, as I have a personal history of this type of knee pain and have successfully managed it.


Patellar Tendonitis consists of inflammation and irritation at the upper portion of the Patellar Tendon,

which is in the front of the knee and attaches the kneecap (patella) to the lower leg bone (tibia).  Pain is often felt at the lower tip of the kneecap and into the tendon below.  The knee may feel tight, initially, and painful when running downhill or descending stairs.  In early stages, the pain may subside after warming up, but eventually the tendon breakdown will worsen, causing cellular changes and degradation of the tissue.  Contributing factors may include tightness of the hamstrings and quadriceps, lack of eccentric quadriceps strength, and poor shock absorption and landing control from the core, hips, and lower extremity.  Improper training progression may also contribute by increasing the demand on the tendon faster than the body can develop appropriate tolerance.