Anterior Knee Pain


What is anterior knee pain?

Anterior knee pain is commonly known as patellofemoral pain. Patellofemoral pain is the term given to the pain or discomfort between the kneecap (patella) and thigh bone (femur). As many as one in three adults experience these symptoms at some point in their life with symptoms varying from person to person.

It often affects adolescents at the time of increased growth and can affect more girls than boys. However, it can also affect older patient groups most commonly associated with osteoarthritis on the underside of the kneecap.

What are the symptoms of patellofemoral pain?

Patients experience pain at the front of the knee or round their kneecap. In some cases it is also known as anterior knee pain (meaning at the front of the knee). Patients often experience an ache which can increase to a sharper pain with activity. In addition, they feel that their leg is about to give way but this does not usually happen.

People who experience patellofemoral pain are likely to notice that certain activities are painful, such as going up and down stairs or hills, squatting, running or jumping. They may feel a clicking or grinding sensation during these activities

What causes Patellofemoral pain?

There is usually a combination of factors that cause patellofemoral pain such as:

  • weakness in the buttock and thigh muscles;
  • tightness at the back of your thigh (hamstrings);
  • being overweight;
  • poor footwear selection such as high heels or flat arched shoes;
  • overuse; and
  • occupations that require kneeling.

The first three factors are by far the most common.

Why does muscle weakness cause knee pain?

The kneecap sits in a groove at the lower end of the thigh bone. Its shape allows the kneecap to move up and down when bending or straightening the leg. If the muscles of the buttock and thigh are weak this causes the kneecap to move away from its groove. This can put higher than expected pressure on the patella and femur, causing pain.

The future

Is actually very good but only if you make the necessary changes to your lifestyle. In most cases the symptoms will get better without any specific treatment. There is no link between this kind of knee pain and generalised knee-joint arthritis later in life. It is normal to experience a brief increase of symptoms when you first start the exercise programme. This is due to muscles working in an unaccustomed manner. These symptoms usually settle over a few weeks (over 12 weeks in some cases) and are not a sign that things are deteriorating.

What can I do for my anterior knee pain?

Changes in lifestyle and modifying the known causes, as previously explained, can reduce the symptoms getting worse. The one professional who can help you manage your symptoms is you!

Weight management – Additional weight can affect the patella. The patellofemoral joint can take eight times your body weight when squatting and descending stairs. Thus a small increase in weight has a large effect on the patellofemoral joint. Equally, however, a little weight loss has a large effect in reducing pain. The only person that can maintain a healthy weight is you!

Research shows that individuals whose Body Mass Index (BMI) is classified as ‘obese’ are up to four times as likely to develop patellofemoral pain. Follow this link to an NHS BMI calculator to guide you on whether you should consider weight management.

If you need help with your weight control, go to our weight management section for help in your area.


It is important to keep your thigh and buttock muscles strong to avoid putting extra pressure through the kneecap. It may take at least 12 weeks of doing strengthening and stretching exercises several times per day before any muscle imbalance or weakness is noticeably improved but by doing this can reduce your pain.

Local NHS Ayrshire & Arran physiotherapists have devised exercise clips to help with strengthening the correct muscles, please click on the exercise tab above to gain access to the exercises to help with your symptoms.


Simple painkillers such as paracetamol or ibuprofen may help to reduce the pain in the knee and allow you to perform the exercises properly. Do not exceed the daily allowance of these medicines even if your pain is high and always consult a GP prior to taking any new medication. If you are unsure of what medication you can take, speak with your local pharmacist, practice nurse or GP for guidance.


Reducing the load – there are also other important ways to reduce the strain on your knees

Pace yourself

If you are in pain don’t tackle all your activities of daily living, such has housework, at once. Break the harder jobs down into smaller time frames and do something gentler in between. Sometimes a short rest when your knee starts to feel painful can be helpful over the course of a day. It is recommended to pace rather than to fully stop all forms of movement or exercise. You may find that taking simple painkillers as previously mentioned may help you to keep active.

High heels

Avoid high heels. This will alter the position of your leg and it can increase the strain into your knee and big toe.


When climbing stairs you may need to consider using handrails and go up one leg at time until your muscles become stronger. It is better to go upstairs leading with the non-painful leg one step at a time. If coming down the stairs then lead with the sore leg one step at a time and use the handrail.


A hot water bottle or ice pack can also be used regularly to help control pain after you have been overactive. If using ice, wrap the cold compress in a towel and apply to the painful area for 10 minutes every two hours. If you are using heat, wrap the warm compress in a towel and place it on the painful area for 20 minutes every two hours. If you have any concerns about the sensation or feeling on the skin where you are placing any of the mentioned compresses, ask a GP to assess this before following this advice.