Anterior Knee Pain
Pain behind the kneecap (patella)

An active teenage athlete who starts to feel a dull, aching pain behind the kneecap (patella) on either or both legs may need training routine adjustments. And fortunately, treatment for this condition does not usually require surgery. However, chronic pain in the front and center of the knee, called anterior knee pain, requires a closer look.

Symptoms

First, this type of pain is common among active, healthy young athletes -- especially girls. The pain usually begins gradually. You might hear popping or crackling sounds in the knee when you climb stairs or stand up and walk after prolonged sitting. Pain might flare during activities that repeatedly flex the knee, such as jumping, squatting and running, and at night. The knee may even become swollen and tender. Without treatment, you may also develop tendon strains and thigh muscle (quadriceps) weakness. Your knees could begin to buckle or give way from pain.

The complex anatomy of the knee joint that allows it to bend while supporting heavy loads is extremely sensitive to small problems in alignment, training and overuse. Pressure may pull the kneecap sideways out of its groove, causing pain behind the patella. In teenagers, a number of factors may be involved. These include

• Inflexibility of thigh muscles that support the knee joint


• Knock-knees or abnormal hip rotation


• Improper use of sports training techniques or equipment

Details Are Important

Tell your doctor when your knee pain started and provide details about your sports participation and training. Were there any recent changes to the duration, frequency or intensity of your activities? Any alterations in your equipment or the surfaces you play upon? Tell the doctor exactly what activities aggravate your knee pain. A standard knee exam will help your doctor determine the cause of pain behind your kneecap and rule out other problems. You may be asked to walk, jump, squat, sit and lie down. It’s important to relax! Additionally, both legs will probably be X-rayed, and the doctor may check:

• Alignment of the lower leg, kneecap and quadriceps


• Knee stability, hip rotation and range of motion of knees and hips


• Under the kneecap for signs of tenderness


• The attachment of thigh muscles to the kneecap


• Strength, flexibility, firmness, tone and circumference of thigh and hamstring muscles


• Tightness of the heel cord and flexibility of the feet

Treatment and the Road to Recovery

Rest is very important too. Until the tissues heal, stop doing the activities that make your knee hurt. This probably means changing your training routine. You might need to learn proper exercise techniques. If you are obese, your doctor may recommend that you lose weight to reduce pressure on the knee. You may also benefit from using a simple knee sleeve with kneecap cutout or strap, support devices such as braces or shoe inserts, and nonsteroidal anti-inflammatory medications for pain.

After the pain and swelling go down, you will probably need to rehabilitate your knee to regain range of motion, strength, power, endurance, speed, agility and coordination. Your doctor may prescribe an exercise program to normalize your thigh muscle and hamstring flexibility and strength, or recommend cross-training activities that emphasize stretching of the lower extremities. Water aerobics and cycling help accomplish this. Resume running and other sports activities gradually.

You may be able to prevent recurrences of pain behind the kneecap. Recommendations include:

• Wear shoes appropriate to your activities


• Warm up with stretching exercises before physical activity


• Stop any activity that hurts your knees


• Limit the number of miles you run in training and competition