There are many potential causes that contribute to experiencing pain in the front of your knee. Due to the variety of symptoms, pain location and pain level experienced by individuals, imaging cannot always explain the main source or sources of pain. When it comes to Physiotherapy treatment - education, load management and exercise selection plays an important role in managing front of knee pain.
Below are the five most common types of front of knee pain that we see in the clinic!
Patella-Femoral Pain: the most common type of front knee pain and is aggravated by loading activities such as running, deep squatting and stairs. This type of pain is commonly seen in females and adolescents and can be very sensitive.
Bursitis: there are four bursa’s of the knee, but the most common is the pre-patella bursa which sits under the knee cap. Bursa is caused by repeated micro-trauma such as cycling and kneeling, and when aggravated causes pain and swelling. Another cause of bursa is infection, which can be indicated if the area is hot to touch.
Patella Tendinopathy: the patella tendon attaches to the bottom of the kneecap (patella) to the top of the shinbone. Localised pain and tenderness can be felt on the inferior pole of the knee cap, but sometimes this is not always the case. This type of pain presents with morning stiffness and has a warm up effect, meaning it might be sore with activity to begin with but then feels better the more you move. It also has a latent response, meaning pain can come on up to two days after activity. This type of injury is typically seen in jumping type sports.
Fat Pad: there are three different fat pads in the knee, but the most common structure to cause pain is the infra-patella or Hoffa’s Fat Pad. This type of pain feels like a deep burning, aching sensation around the front of the knee. This can be aggravated when the knee is in extension (straight) or hyperextension for a sustained period of time. For example pain felt with prolonged standing with very straight knees.
Plica: there a four different plica in the knee, but the common one to cause pain is the medial plica. Pain is associated with clicking, crunching, grinding or popping when moving the knee from a bent to straight position. Plica may be associated with an inflammatory component, therefore night pain and swelling may be experienced.
Causes for front of knee pain are multifactorial
Findings of imaging are not always the source of pain
Education, load management and exercise selection is key to a successful recovery
Reviewing with a physiotherapist is vital in assessing drivers to pain and improving knee function