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One of the most common problems in active women is anterior knee pain, or pain that occurs in the front and center of the knee. Women are predisposed to this type of pain because of a combination of anatomy and muscle imbalances. It can come on suddenly and cause discomfort with daily activities and sports, and may even disrupt your sleep.

The anatomy of the knee allows the leg to bend and straighten, and includes the femur (thigh bone), tibia (leg bone), and patella (knee cap) working together with the quad muscles and tendons. Every time you put weight on the leg or flex the quad, it engages this extensor mechanism and the joint between the knee cap and femur gets loaded. The other muscles that play a key role optimizing hip and knee function include the gluteus muscles and hamstrings, as well as the IT band, which is the thick band of tissue and muscles that run on the outside of your leg between the knee and hip. 

Causes of Anterior Knee Pain

Because women have wider pelvises and tend to be more knock kneed than men, several things can happen when they load the knee joint (i.e. running, jumping, squatting, climbing stairs, etc.). An abnormal kneecap movement over the front of the knee or overtightened soft-tissues on the front or side of the knee can commonly lead to anterior knee pain over time. In addition, women tend to rely on the quad muscles for all loading activities and may have weaker glute and hamstring muscles. This muscle imbalance can lead to pelvic instability, which can impact leg and knee alignment. Women with flat feet are also more likely to develop anterior knee pain.

Symptoms of Anterior Knee Pain

The symptoms of anterior knee pain include the following:

  • Increased pain in the front of the knee with activities like going up or down stairs, kneeling, squatting, lunging, running, and jumping
  • Difficulty fully straightening the leg
  • Pain with prolonged sitting with the knee flexed, especially if the feet are dangling
  • Pain while sleeping at night
  • Pain in the back of the knee (referred) 
  • Vague and achy in nature, but can be burning or sharp with loading
  • Popping/crunching/grinding in the front of the knee when bending/extending

Examination and Treatment of Anterior Knee Pain

Treatment of anterior knee pain does not typically require surgery. When some or all of these symptoms are present, an orthopedic surgeon will examine your glute strength, hamstring and IT band flexibility. He or she will examine your kneecap for tightness or hypermobility and see if there is grinding or popping under the knee cap when the knee bends. In addition, the orthopedic surgeon will check for signs of pain around the IT band and knee cap at rest, as well as with flexion and extension. There are usually no signs of joint swelling, instability, numbness, or tingling with this condition.

“Recovering from anterior knee pain is usually very successful, especially if patients commit to their rehabilitation exercises and strengthen their core, glute, and hamstrings,” said Ekaterina Urch, MD, orthopedic surgeon at The Center Orthopedic & Neurosurgical Care. “Modifying activities is crucial to mitigate the pain. For example, women who primarily run are encouraged to take up cross training like biking, rowing, or swimming. Yoga can also be an excellent addition to any active woman’s exercise regimen.”