Knee Pain: Front-of-Knee Pain, Osteoarthritis and What Actually Helps
Knee Pain: Front-of-Knee Pain, Osteoarthritis and What Actually Helps
Quick summary
- Two of the most common causes of knee pain are patellofemoral pain (pain around or behind the kneecap) and knee osteoarthritis. They affect different age groups and behave differently.
- For patellofemoral pain, exercise therapy, especially combined hip and knee strengthening, is the recommended first-line treatment (Crossley et al., 2016).
- For knee osteoarthritis, international guidelines strongly recommend exercise, education and weight management where relevant (Bannuru et al., 2019).
- After a knee injury, the Ottawa knee rule helps decide who needs an X-ray (Stiell et al., 1996). A hot, swollen knee or a knee that gives way or locks needs prompt assessment.
Knee pain is one of the most common reasons active people and older adults seek care. It can stop you running, make stairs hard, or ache after a long day on your feet. The good news is that the most common causes respond well to the right kind of exercise. Here is how we think about knee pain at Spirit Chiropractic in Parramatta.
Front-of-knee pain (patellofemoral pain)
Patellofemoral pain is a dull ache around or behind the kneecap. It is common in runners, teenagers and people who have recently increased their activity. It is typically worse with:
- stairs, especially going down;
- squatting or kneeling;
- running, particularly downhill;
- sitting for a long time with the knees bent (the "movie-goer's sign").
An international consensus statement on patellofemoral pain recommends exercise therapy as the core treatment, with combined hip and knee strengthening preferred over knee exercises alone (Crossley et al., 2016). Short-term taping or foot orthoses may help some people, while passive treatments on their own are not recommended. Adjusting training load, for example temporarily reducing hills or mileage, is also important.
Knee osteoarthritis
Knee osteoarthritis is more common from middle age onwards. It usually causes:
- pain with weight-bearing activity, which often eases with rest;
- morning stiffness that lasts less than about 30 minutes;
- stiffness after sitting, and sometimes creaking or swelling.
Osteoarthritis is not simply "wear and tear" that can only get worse. The OARSI guidelines strongly recommend structured exercise, education and, where relevant, weight management as core treatments for knee osteoarthritis (Bannuru et al., 2019). Many people with changes on an X-ray have little pain, and many people improve their pain and function substantially with a consistent exercise program.
When a knee needs prompt assessment
After an injury, the Ottawa knee rule helps decide whether an X-ray is needed to check for fracture (Stiell et al., 1996). See a doctor promptly if you:
- cannot take four steps or bear weight after an injury;
- have marked tenderness over the kneecap or the top of the fibula (outer knee);
- cannot bend the knee to 90 degrees;
- have a hot, red, very swollen knee, especially with fever (this needs urgent care);
- have a knee that locks or repeatedly gives way, or rapid swelling after a twisting injury.
Why we look above and below the knee
The knee sits between the hip and the foot, and both affect how it is loaded. Weakness in the hip muscles is commonly found in people with patellofemoral pain, which is one reason hip strengthening is part of recommended care. We also check how your foot and ankle move, and in some cases the lower back, because pain from the lumbar spine or hip can refer to the knee.
How we help at Spirit Chiropractic
- Assessment: history, injury screen, movement and strength testing of the hip, knee and ankle, and referral for imaging only when it will change the plan.
- Exercise plan: a progressive hip and knee strengthening program matched to your goals, whether that is running, stairs or playing with your kids.
- Load management: practical changes to training or daily activity while symptoms settle.
- Hands-on care: soft tissue work and joint mobilisation where they help you move more comfortably, as part of an active plan.
Knee pain stopping you from running, squatting or taking the stairs?
We assess the hip, knee and foot together and build a strengthening plan that fits your goals.
Frequently Asked Questions
What is the most common cause of knee pain in runners?
Patellofemoral pain, an ache around or behind the kneecap, is one of the most common causes. It is usually linked to a change in training load and responds well to hip and knee strengthening and temporary load adjustments.
Is exercise safe if I have knee arthritis?
Yes. International guidelines strongly recommend exercise as a core treatment for knee osteoarthritis. It can reduce pain and improve function. The program should be progressed gradually and adjusted to your symptoms.
Do I need an X-ray for knee pain?
Most knee pain does not need imaging. After an injury, the Ottawa knee rule helps decide whether an X-ray is needed, for example if you cannot bear weight or cannot bend the knee to 90 degrees.
Can knee pain come from the hip or back?
Yes. Problems in the hip joint or lower back can refer pain to the knee, which is why a good assessment looks at the hip, lower back and foot as well as the knee itself.
References
- Crossley, K.M., van Middelkoop, M., Callaghan, M.J., et al. (2016). 2016 Patellofemoral pain consensus statement from the 4th International Patellofemoral Pain Research Retreat, Manchester. Part 2: Recommended physical interventions (exercise, taping, bracing, foot orthoses and combined interventions). British Journal of Sports Medicine, 50(14), 844–852. https://doi.org/10.1136/bjsports-2016-096268
- Bannuru, R.R., Osani, M.C., Vaysbrot, E.E., et al. (2019). OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis. Osteoarthritis and Cartilage, 27(11), 1578–1589. https://doi.org/10.1016/j.joca.2019.06.011
- Stiell, I.G., Greenberg, G.H., Wells, G.A., et al. (1996). Prospective validation of a decision rule for the use of radiography in acute knee injuries. JAMA, 275(8), 611–615.
This article is general information, not a diagnosis or a substitute for individual advice from your health professional.
