Anterior Knee Pain (Runner’s Knee): Causes, Symptoms, Treatments, and Prevention

Runner’s knee, also known as patellofemoral pain syndrome (PFPS), is especially common in athletes but can also occur in the average person. It is a broad term used to describe the pain you feel in the knee, sometimes referred to as anterior knee pain.

This condition occurs when the soft tissues and bone around the kneecap cause pain that your nerves detect. A few factors can contribute to the development of a runner’s knee, resulting in symptoms that make completing daily tasks difficult. Hence, it is important to get it treated early to prevent affecting your quality of life. 

Runner’s knee can develop due to three main causes: 

Overuse

Vigorous physical activities that put repeated stress on the knees can cause runner’s knee to develop. It is common in athletes because jogging and squatting or a sudden change in physical activity can all contribute to the condition. For instance, increasing the duration or intensity of physical activities is common to push an athlete’s limit, but can cause anterior knee pain to develop in the long run. 

Patellar malalignment

Runner’s knee can also develop due to abnormal tracking of the kneecap in the trochlear groove, in which the patella gets pushed out to one side of the groove when bending the knee. Problems with the alignment of the legs between the hips and the ankles and muscular imbalances or weaknesses can cause poor tracking of the kneecap. This malalignment and abnormality then cause an increased pressure between the joint, irritating the soft tissues. 

Injury

Suffering trauma to the knee can result in irritation of the soft tissues or lining of the knee, torn cartilage or strained tendons. A direct hit to the knee – from a fall while exercising or a blow to the joint when playing sports – are some examples of how injuries can cause runner’s knee. 

If you are unsure what could be the cause of your runner’s knee, it is advisable that you see an orthopaedic doctor for an accurate diagnosis.

One of the most common symptoms of runner’s knee is a dull, aching pain that most people tend to brush off. However, the pain can start off gradual and worsen as you increase the frequency or intensity of physical activities. Pain may be present in just one knee, or can occur in both.

Some other common symptoms include

• Pain during activities that involve bending the knee, such as running, jumping or climbing the stairs
• Pain felt on the front of the knee after sitting down for a long time with your knees bent
• Popping sounds or a grinding feeling in your knee when climbing the stairs or standing up after sitting down for long periods of time
• Swelling around the knee

If you notice any of these symptoms, make an appointment to see an orthopaedic doctor as soon as possible for early treatment before your condition worsens any further.

Your orthopaedic doctor will first perform a physical examination to discuss the symptoms you are experiencing. You will be asked some questions regarding your knee pain, the severity and what causes the pain to worsen. The doctor may also gently press on the front of your knees and get you to squat or jump to test your knee strength. You may be required to walk back and forth so that the doctor can examine the way you walk. This physical examination aids your doctor in diagnosing a runner’s knee and helps rule out other problems. 

Following the physical examination, your orthopaedic doctor may order further imaging tests like x-rays to rule out any damage to the bones and MRI scans for clear images of the ligaments, tendons and muscles. These imaging tests help your doctor to form an accurate diagnosis.

There are both non-surgical and surgical treatments for runner’s knee, both of which aim to relieve pain and help patients restore their range of motion and strength. 

Non-surgical treatments

Your doctor may recommend activity changes that will help you to manage the symptoms of runner’s knee and prescribe you anti-inflammatory medications to ease pain and reduce swelling. 

Sometimes, physical therapy may be needed to help you improve your range of motion, strength and endurance. This is especially important as your quadriceps act as the main stabiliser for your kneecap. 

You can also wear orthotics which are shoe inserts that can aid in aligning and stabilising your foot and ankle, taking the pressure off your knee. 

Surgical treatments

If conservative treatments prove to be ineffective, surgical treatments may be needed to treat runner’s knee so that you can get back to enjoying life. 

Arthroscopy is a common procedure where the surgeon inserts a mini camera into your knee joint through small incisions to remove damaged articular cartilage from the surface of the kneecap. A lateral release procedure may also be performed to correct a patellar malalignment. 

Tibial tubercle transfer may be performed in some cases, such as when there is a need to realign the kneecap by moving the patellar tendon with a portion of the tibial tubercle. This surgical procedure is more invasive, as it requires the traditional open incision. The surgeon will partially or totally detach the tibial tubercle to move the bone and tendon toward the inner side of the knee, then reattach the bone to the tibia using screws. 

Consult an orthopaedic doctor to find out which treatment method is most appropriate for you and your condition. 

Most cases of runner’s knee can be improved with physical therapy and it is important to make adjustments to your activity level to prevent it from recurring. Some ways to prevent runner’s knee include maintaining appropriate conditioning of the muscles around the knee, especially the quadriceps and hamstring. Take note to wear the right shoes, warm up thoroughly before exercising, increase training intensity gradually and maintain a healthy weight too.