Anterior knee pain (AKP)

What is it? 

Anterior knee pain (AKP) is pain in the front of your knee which is very common.  It is usually not related to any significant injury and can arise at various stages of life.  It is related to various structures around your knee becoming sensitive.

What are the common symptoms?

Things that may be painful may include deep squatting, walking up or down stairs and slopes, or standing up after a prolonged sitting period.  You may notice clicks within the knee, do not worry about these as they are not necessarily a sign of something being wrong.

How to manage it? 

Activity modification 

  • If you have significantly increased your activity levels before the onset of the pain try to reduce the activity
  • Identify any changes in your lifestyle that could have resulted in knee pain, both internally e.g. have you gained weight? or externally e.g. have you started wearing new shoes? If you do, try reversing the changes and see what effect it has on the pain
  • Limit as much as possible, activities or postures that you know cause your symptoms to worsen.
  • As the pain improves, gradually re-introduce any normal day-to-day activities that you have been avoiding, returning to full activity once the pain has gone

Weight loss 

Losing weight will reduce the amount of pressure the patella (kneecap) is putting on your knee and even a modest loss in weight will improve your symptoms and reduce the chances of it coming back.

Exercise

Exercises can be very helpful in this condition but be aware that it may take up to three months before you notice significant improvement. Don’t be disheartened – stick with it! Generally the longer you have had the anterior knee pain, the longer it takes to improve.

  • Exercises that often help include stretching of the calf muscles and strengthening of the thigh (quadriceps).
  • The hip and buttock muscles are also key in controlling leg movement while under load (such as going down stairs) and there is evidence to suggest that strengthening of these muscles can also help.
  • Some pain during exercise is okay but should be tolerable and settle within two hours following exercise

Try the simple exercises below. If you are having difficulty with them please speak to a physiotherapist for advice.

Strengthening exercises

Isometric knee extension in lying

Lie on your back with one leg bent and the other leg straight.

Bend the ankle of the straight leg and press the back of the knee against the floor using your front thigh muscles.
Hold the tension for a moment and then relax.

Repeat 10 times. Rest for 1 minute. Repeat 3 times.

Knee End-range Extension in lying

Lie on your back with one leg bent and the other leg straight. Place a towel roll under the straight knee.

Bend your ankle and straighten the knee using your front thigh muscles. Keep the back of your knee against the towel roll.
Keep the tension for a moment and then relax.

Repeat 10 times. Rest and then repeat 3 times.

Wall squat

Stand with your back against the wall and your feet slightly away from the wall.

Slide your bottom down the wall. Slowly straighten your knees and then repeat. Gradually go further down the wall as you get stronger.

Repeat 10 times. Rest. Repeat 3 times.

Stretching exercises

Hamstring (back of the thigh) stretches

Take the leg you want to stretch in front of you, heel on the floor.

Move your pelvis backwards, bend the supporting leg and bend your trunk forward until you can feel a stretch in the back of your thigh.

Hold for 30 seconds. Repeat 3 times.

Quadriceps (front of the thigh) stretches

Lying face down, take hold of your foot and draw towards your buttocks until you feel tension in your thigh muscle.

Hold still for 30 seconds. Repeat 3 times.

Calf (back of the lower leg) stretches

In standing, step forwards and bend your front knee, leaning on a chair. Keeping feet facing forwards, straighten the back knee and push the back heel into the floor.

You should feel tension in your calf muscle.

Hold still for 30 seconds. Repeat 3 times.

Physiotherapy 

If you find that you are not improving, some advice or treatment from a physiotherapist can be helpful in managing knee pain. Click here to self-refer to a physiotherapist.