Ending Anterior Knee Pain

“It hurts right here”. I shook my head up and down in agreement. 1 out of every 5 new clients that I see has the same complaint. Pain in the front of the knee, otherwise known as anterior knee pain but not limited to jumpers knee, runners knee or the super complex patella-femoral pain syndrome. Very common but why?

Ending Anterior Knee Pain


You know if you’ve had anterior knee pain, usually you’ll feel a dull pain which increases when you bend your knee in activities such as running, jumping, squatting or going to bathroom. It might be swollen but doesn’t have to be and it might click or “lock” on you. With the exception of banging your knees with an opponent in a football or basketball game, direct trauma won’t really be the cause of your discomfort.

This leaves us with cumulative overload which can be broken down into one of two categories.

Repetitive strain or Chronic underuse. Yes I said underuse, we typically assume that most people overuse the joint that is causing them pain and while that’s true, most people underuse the joint the way that it was intended to be used. Recent literature has pointed to general movement restrictions being the base cause of anterior knee pain.

These general movement restrictions include but are not limited to

  • Increased age
  • High body mass
  • Structural alignment
  • Knee Laxity
  • Participation in activities that require various deep knee angles
How quick or slow your knee breaks is determined by a combination of the above factors but body mass appears to be a factor after the knee position is already compromised.

Anterior knee pain and your lower body

Stop thinking of your knee as just another joint and start understanding it as a conductor between your ankle, foot and hip. There are numerous muscles that cross both the knee and hip thus acting on both of those areas. If you have a ankle or hip problem then those alignment faults are going to be seen in the knee.

Ever watch someone do a single leg squat? Have you noticed that their knee tends to cave in? This is known as femoral adduction and is a hip issue that results in knee pain.

Now we get into a topic known as relative stiffness and flexibility. As an example, let’s take jumpers knee. As the foot plants the runner needs the lower leg (tibia) and upper leg (femur) to work with the muscles on the side of the leg (TFL-ITB). Well the tibiofemoral joint may not be as stiff as the TFL-ITB. As the foot strikes the TFL-ITB need to easily stretch but it can’t and the tibiofemoral joint does not provide enough passive stiffness to stabilize the joint.

The result? 

Your hip swings open each time and this repetitive motion results in pain and tightness on the side of your hip that is often mistaken for sciatic nerve pain and anterior knee pain. 



Here’s some other examples that may cause pain in your knee

  • Reduced ankle doriflexion.Try bringing your toes to your knee. Hard right? An immobile ankle like you just demonstrated to yourself shifts your weight over your knee. Once you mobilize your ankle then the pain will go away.
  • Poor core strength. Marathon runners in particular but anyone that does heavy squatting will notice this as well. As your trunk moves forward during movement your knees tend to shift slightly forward as well. You ask your quadriceps to do more then they should.
  • General soft tissue restrictions. We’ve already talk about how your hip lateral rotators and TFL-ITB can contribute to knee pain but trigger points on your glutes or hip flexors can also limit your range of motion which will contribute to the problem.

Solving Anterior Knee Pain:Jumper’s Knee

Jumper’s knee is typically misdiagnosed as tendonitis for basketball players. While commonly and easily treated, there are numerous ways around the dreaded jumpers knee that has plagues basketball and volleyball players for years. For starters most jumping athletes are quadriceps dominant. They’ve been told for years that they have to squat to jump high. As a result these athletes have a tendency to initiate the jumping movement from their quads instead of the more powerful force producing hamstrings and glutes. This faulty jumping pattern not only tightens your quads but continually wears down the knee joint. Inflammation kicks in and all of sudden we have jumpers knee.

Here’s a few tips for treating jumper’s knee pain

  • Start using enzyme therapy to reduce inflammation
  • Start supplementing with omega-3 fish oil
  • Stretch your quads
  • Stop squatting and start deadlifting
  • Perform more glute strength isolation work

I have knee pain when I squat and do lunges, what’s causing this?

More then likely you have knee pain from squats or lunges because your ankle joint is restricted. When your ankle joint is restricted and not moving properly, your knee joint has increased range of motion which leads to more inflammation. Combined with a tight quad muscle that pulls the knee cap upwards, you’re going to have some pain anytime you do high rep squats or lunges. Focus on stretching your calf muscle and performing some ankle joint self mobilization while improving the flexibility of your quad. That should eliminate all knee pain during squats and lunges.


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