The term anterior knee pain (AKP) is used to describe pain felt at the front of your knee, usually under the kneecap (patella).

Why do I have it?

AKP can be due to many different factors. It is often due to one or a combination of the following:

• Weak thigh muscles and (or) hip muscles
• Normal ageing process (osteoarthritis)
• Overuse injuries
• History of previous knee injuries
• Altered working or positioning of the foot and leg

One or more of these factors can mean that the kneecap is not gliding correctly over the thigh bone as your knee bends and straightens. This can lead to the joint becoming irritated and painful.

Symptoms

Potential symptoms can include:

• Pain after prolonged sitting
• Pain going up and (or) down stairs and steps
• Pain on squatting and kneeling
• Pain localised to the kneecap area
• Crepitus (noises such as clicking, grinding from the knee

Self management

If your knee is swollen then using ice can help to reduce swelling. This can be applied by wrapping ice in a damp tea towel and applying it for 10 to 15 minutes up to 3 times a day.

Try to keep your knee moving so it does not get stiff and try some of the exercises overleaf.

Painkillers such as Paracetamol and Ibuprofen (if tolerated) in tablet or cream and gel form can be useful, although if you are unsure about taking these please discuss it with you GP or pharmacist.

It is also important to avoid activities that increase your knee pain, such as regular kneeling, crouching etc.

Physiotherapy

Physiotherapy treatment is likely to involve advice, education and appropriate exercises. The aim of this is to ensure the movement, muscle strength, balance and control of your knee movements is as good as possible. We are unlikely to carry out scans and X-rays of the knee as they may not offer any benefit in terms of treatment options for this problem.

Footwear and insoles

It is best to wear comfortable, well supporting footwear such as trainers to help keep your feet in a good position and therefore improve alignment at your knee. Trainers also help to reduce any impact going through the knee joints. Sometimes insoles may help to improve this alignment and may be measured and fitted for you by a podiatrist or orthotist.

Exercises for anterior knee pain

Please note if any of these exercises lead to an increase in your pain please stop them until you have seen your healthcare professional.

Quadriceps stretch in side-lying

• Lie on your left or right side with a towel round your left or right foot and your hips slightly bent forward.
• Gently extend your hip whilst pulling your foot up towards your bottom. When you feel the stretch hold for 30 seconds and repeat 5 times.
• Perform exercise twice a day

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Gluteal muscle strengthening

• Lie on your side with affected leg on top and hips bent to 60 degrees, heels together.
• Lift top knee upwards. Ensure hip does not roll backwards.
• Hold for a few seconds and repeat until the muscles around your hip feel tired.

Straight leg raise

• Sitting on your bed, keep your right / left leg as straight as possible.
• Lift your leg up approximately 15cm.
• Hold for 10 seconds and repeat 10 times.
• Perform 3 sets of this exercise a day.

What is PFP and why have I got it?

PFP is a very common condition that occurs in both males and females of all ages.  It is described as pain around the kneecap and can sometimes be called ‘anterior knee pain’, ‘chondromalacia patellae’ or ‘patella mal-tracking’. There are many potential contributing factors for developing PFP:

• Excessive loading of the knee
• Sudden increases in activity levels
• Inactivity (having a sedentary lifestyle)
• Wearing unsupportive footwear
• Weakness in the thigh and hip muscles
• Tightness in the thigh and hip muscles.

What are the signs and symptoms?

Pain at the front of the knee, around or under the kneecap (the patella). Pain on activities like walking, going up or down stairs, running, squatting or prolonged sitting. Other symptoms can be stiffness, clicking, catching, or grinding. This grinding sound is called crepitus which is a common complaint and does not indicate any harm.

Do I need any tests to confirm the diagnosis?

There are no specific tests to diagnose PFP. Diagnosis is made based on where the pain is and the activities that aggravate it. A healthcare professional can help make the diagnosis if you are unsure. Specialist musculoskeletal practitioners such as physiotherapists, sports and exercise medicine doctors and orthopaedic doctors often only see people with PFP when symptoms aren’t settling with self-management and exercise.

What treatments are available?

Exercise

Exercises to strengthen your thigh and hip muscles have been shown to be important for the management of this condition. We have included some examples at the end of this document.

Taping

Taping can be an effective temporary treatment for PFP.

What happens if I do not get treatment?

If you avoid activity your leg muscles can become weaker which can contribute to pain. Symptoms can take between three to six months to improve but it is hard to predict recovery for everyone.

Is there anything I can do to help myself?

Activity modification

This means reducing activities that are very painful in the short-term to allow pain to settle. When pain has settled down to a tolerable level, slowly increase your activity levels.

Footwear

Wearing supportive footwear can help with pain.

Ice therapy

Ice can be helpful for short term pain relief and you can use this method before or after exercise. You can use a bag of frozen vegetables or an ice pack wrapped in a tea towel. Leave over the painful area for a maximum of 15 minutes. This can be repeated up to four times per day.

Exercise programme

If you are seeing a physiotherapist, they will help design a specific exercise programme for you but we have listed some recommended exercises below.  The most important aim with exercise is to restore any strength loss. You may experience some discomfort during and (or) after completing the exercises which is normal and not harmful. If the pain increases for more than 24 hours after exercising, try doing fewer exercises the next time. Aim to keep pain at a low level when you perform the exercises.

Complete the exercises every other day. Aim to perform three sets of 8 to 12 repetitions.

Bridge

Step 1: Lie on your back with your knees bent and feet flat on the floor.

Step 2: Squeeze your bottom and lift your bottom and lower back off the floor. Hold for 3 to 5 seconds then slowly lower down.

Wall squat

Step 1: Lean against a wall, with your feet away from the wall and shoulder width apart. Your back and buttocks should remain in contact with the wall throughout.

Step 2: Slide down the wall to a depth that you can comfortably tolerate. Push yourself back up the wall, driving the movement with your buttock muscles.

*Helpful tip: if your pain allows, you can progress this exercise by sliding further down the wall or by holding a weight.

Staggered sit to stand

Step 1: Sit upright in a chair and move yourself forward, close to the edge. Position your feet hip width apart but place your unaffected foot slightly further ahead of the other.

Step 2: Lean your body forward and push through your legs to stand up straight.  As this becomes easier, place your unaffected foot further forwards before you stand up.