Factors such as weak thigh muscles, excessive pronation, and tight leg muscles and tendons can cause pain in the front part of the knee.
People may feel pain when running downhill but eventually may have pain during walking.
Magnetic resonance imaging (MRI) and arthroscopy may be needed for diagnosis.
People should stop running until there is no pain and then use exercise to strengthen and balance muscles around the knee.
If excessive pronation causes pain, shoe inserts can help.
(See also Overview of Sports Injuries Overview of Sports Injuries Sports injuries are common among athletes and other people who participate in sports. Certain injuries that are traditionally considered sports injuries can also occur in people who do not participate... read more 
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The kneecap (patella) is a circular bone that is attached to ligaments and tendons around the knee and normally moves up and down the thighbone during running.
When the Front of the Knee Hurts
Normally, the kneecap (patella) moves up and down the thigh bone during running. People may feel pain in the kneecap because thigh muscles are weak or the feet roll in too much (pronation). As a result, the kneecap rubs abnormally against the thigh bone, causing increased wear and tear.  |
Pain in the front of the knee (anterior knee pain) may be caused by
A kneecap located too high or too low in the front of the knee joint
Off-center insertion of the muscles around the knee cap
Tight, shortened hamstring muscles
Tight Achilles tendon
Weak thigh muscles—which normally help stabilize the knee
Runner’s knee
Weak thigh muscles are a common cause of runner’s knee, a treatable cause of anterior knee pain. Weak thigh muscles allow the kneecap to move sideways and rub abnormally against the thighbone. Runner’s knee usually starts out with knee pain when running downhill. Later, any running or walking, especially down steps, is painful.
Excessive pronation
Excessive pronation of the foot (rolling of the foot inward) when walking or running can cause knee pain. Pronation forces the thigh muscles (quadriceps) to pull the kneecap outward and rub abnormally against the end of the thighbone.
Diagnosis of Knee Pain
A doctor's evaluation
Doctors ask about symptoms and examine the person. Sometimes magnetic resonance imaging (MRI), arthroscopy (looking inside the joint with a flexible viewing tube), or both are needed.
Treatment of Knee Pain
Rest
Rehabilitation
Running is avoided until it can be done without pain. Ice applied to the affected area, nonsteroidal anti-inflammatory drugs (NSAIDs), and temporary use of a knee sleeve or elastic support also help. Other exercises, such as riding an exercise bike (with high seat position, low repetition, and low resistance) or swimming, can be done to protect the knee and maintain physical fitness during recovery. Exercises to strengthen and balance the muscles in the back (hamstrings) and front (quadriceps) of the thigh are helpful.
In runner’s knee, stretching before exercise can help balance the abnormal forces caused by tight muscles and reduce injury.
A shoe insert can help correct excessive pronation.
1. Lie on stomach.
2. Bend involved knee and loop towel around the ankle.
3. Gently pull towel to stretch muscle on front of thigh pulling ankle toward buttocks.
4. Hold stretch for 30 seconds.
5. Do 1 set of 4 repetitions, 3 times a day.
6. Repeat on the other leg.
7. Special instructions
a. For added stretch, place a towel roll under and just above the knee to place the hip in slight extension.
Courtesy of Tomah Memorial Hospital, Department of Physical Therapy, Tomah, WI; Elizabeth C.K. Bender, MSPT, ATC, CSCS; and Whitney Gnewikow, DPT, ATC.
1. Lie on back, flex the hip and knee of the involved leg, hold behind the knee, and pull it gently toward the chest.
2. Gently extend the knee to straighten the leg.
3. Hold stretch for 30 seconds.
4. Do 1 set of 4 repetitions, 3 times a day.
5. Repeat on the other leg.
Courtesy of Tomah Memorial Hospital, Department of Physical Therapy, Tomah, WI; Elizabeth C.K. Bender, MSPT, ATC, CSCS; and Whitney Gnewikow, DPT, ATC.
1. Sit with involved leg extended.
2. Contract quadriceps muscle on the front of the leg to push back of knee down to the floor/table.
3. Hold exercise for 10 seconds.
4. Do 1 set of 10 repetitions, every hour.
5. Special instructions
a. Do not hold your breath during the exercise.
Courtesy of Tomah Memorial Hospital, Department of Physical Therapy, Tomah, WI; Elizabeth C.K. Bender, MSPT, ATC, CSCS; and Whitney Gnewikow, DPT, ATC.
1. Lie on back with uninvolved knee bent so foot is on the floor/table.
2. Keep involved leg straight and raise foot to thigh level of uninvolved leg.
3. Return to starting position slowly.
4. Do 3 sets of 10 repetitions, 1 time a day.
Courtesy of Tomah Memorial Hospital, Department of Physical Therapy, Tomah, WI; Elizabeth C.K. Bender, MSPT, ATC, CSCS; and Whitney Gnewikow, DPT, ATC.
1. Lie on involved side.
2. Keep shoulders and hips in line with ankles slightly behind the body with the knees bent approximately 90°.
3. Keep feet together while lifting top knee up toward the ceiling.
4. Lower and repeat.
5. Repeat exercise lying on the uninvolved side.
6. Do 3 sets of 10 repetitions, 3 times a day.
7. Special instructions
a. For added resistance, place a band around the knees, start with the least resistance.
Courtesy of Tomah Memorial Hospital, Department of Physical Therapy, Tomah, WI; Elizabeth C.K. Bender, MSPT, ATC, CSCS; and Whitney Gnewikow, DPT, ATC.
1. Stand with feet about hip width apart.
2. Toes should point forward to stay aligned with the knees.
3. Keeping core tight, move buttocks backward, similar to beginning to sit in a chair, and squat down until the thighs are almost parallel with the floor.
4. Return to start position and repeat.
5. Do 3 sets of 10 repetitions, 1 time every other day.
6. Special instructions
a. Keep your weight on outside of foot and heels.
b. Start with a partial squat and increase as you become familiar with the movement.
c. Add weight only as tolerated. Start with 1 to 2 pounds (0.5 to 1 kg [for example a soup can]) held in each hand.
Courtesy of Tomah Memorial Hospital, Department of Physical Therapy, Tomah, WI; Elizabeth C.K. Bender, MSPT, ATC, CSCS; and Whitney Gnewikow, DPT, ATC.
1. Stand about a foot away from the wall with the involved leg closest to the wall.
2. Place the uninvolved leg in front of the involved leg.
3. Keep the involved knee straight.
4. Lean trunk away from the wall so the hip on the involved side goes toward the wall.
5. Be sure not to lean forward at the waist.
6. Hold stretch for 30 seconds.
7. Do 1 set of 4 repetitions, 3 times a day.
Courtesy of Tomah Memorial Hospital, Department of Physical Therapy, Tomah, WI; Elizabeth C.K. Bender, MSPT, ATC, CSCS; and Whitney Gnewikow, DPT, ATC.
