Children's Hospital Colorado

Anterior Knee Pain and Runner's Knee

What is anterior knee pain, commonly known as "runner’s knee"?

Teenagers who participate in sports often develop an achy pain in the kneecap. This prolonged pain in the front of the knee, called anterior knee pain, is fairly common in young athletes and is typically aggravated (made worse) with physical activity.

This condition is also known as patellofemoral pain, chondromalacia of the patella or “runner’s knee” and is due to abnormal tracking of the kneecap.

What causes knee pain?

The anatomy of the knee is very sensitive to changes in alignment, training and overuse. If the kneecap pulls out of its normal groove, it can cause pain behind the kneecap. A number of factors may be involved, including:

  • Imbalance of the muscles around the knee joint
  • Poor flexibility of the quadriceps (thigh muscles) or hamstring muscles
  • Problems with alignment of the kneecap
  • Improper or high intensity sports training techniques
  • Overuse

Who gets anterior knee pain?

Anterior knee pain, or runner's knee, often occurs in young athletes and is the most common overuse injury among runners. It can also happen to other athletes who do activities that require a lot of knee bending, such as biking, jumping or skiing. Snowboarding knee injuries are also very common. 

Teens will generally not damage their knee by continuing with their activities, but it can cause an increase in pain. The pain might also be increased by walking after sitting for long periods of time, or going up and down stairs. This pain could simply mean that the athlete needs to adjust his or her training routine.

Learn more about sports and orthopedic conditions.

Resources for knee pain and runner's knee:

What are signs and symptoms of anterior knee pain?

Knee pain usually begins gradually during or after sporting activities. Typically there is no history of a specific injury. The pain is usually dull, diffuse (widespread) and achy behind the kneecap. The pain may occur in one or both knees. Prolonged sitting or squatting and going up and down stairs can worsen the pain. Some patients may even report mild swelling.

Without treatment, your child may also develop thigh muscle (quadricep) weakness. His or her knees could begin to buckle or give out from pain. In this case, buckling of the knee is not from a ligament or cartilage injury, but more from the pain behind the kneecap.

Who gets knee pain, or "runner’s knee?"

Prolonged pain in the front of the knee, known as anterior knee pain, is common among active, young athletes and is more common in girls.

Ways to prevent knee pain include:

  • Wearing shoes appropriate for specific sports or activities
  • Stretching before physical activity
  • Stopping any activity that increases pain in the knee
  • Limiting training accordingly

How is anterior knee pain diagnosed?

Experts at the Sports Medicine Program for Young Athletes at Children's Hospital Colorado will begin by getting a good history of your child's sports participation and training regimen. Recent changes in intensity, frequency and duration of training is important for us to know.

A knee examination will help your child's doctor determine the cause of pain behind the kneecap, and x-rays will be done to rule out other conditions.

During testing and diagnosis, your child’s doctor will be looking at the following things:

  • Alignment of the kneecap in relation to the hip and lower leg
  • Range of motion of the knees and hips
  • Signs of tenderness underneath the kneecap when pressure is applied
  • Strength, flexibility and tone around the knee
  • Signs of flat feet or knocked knees

How is anterior knee pain treated?

Treatment for knee pain depends on the specific problem causing the pain. Fortunately, anterior knee pain, or runner's knee, rarely requires surgery and usually heals in time.

Ice, rest and physical therapy are the best treatments for patients with pain behind the kneecap. Addressing training and exercise errors is also important.

  • Ice - Icing the knee will relieve swelling and inflammation under the kneecap. Ice can be applied a few times each day for no longer than 20 minutes at a time.
  • Rest or activity modification - Your child should modify or stop doing the activities that make his or her knee hurt. If he or she continues to perform activities that cause knee pain, the inflammation cycle continues.
  • Rehabilitation - Young athletes usually need to rehabilitate their knees to regain full range of motion, strength and endurance. Physical therapy can be used to change the abnormal tracking of the kneecap. This includes strengthening the core and hip muscles, as well as working on quadriceps and hamstring muscle flexibility and strength.

Most young athletes will have to change their training routine or learn proper exercise techniques to correct problems causing knee pain. They may also benefit from using a knee brace during activities.

Anti-inflammatory drugs, like ibuprofen, can also help control pain and inflammation. After treatment for anterior knee pain, it is very important that your young athlete returns to his or her sport gradually.

Learn why parents choose our Sports Medicine Program for their young athlete’s knee pain.


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