Why Do I Have Anterior Knee Pain?

Anterior knee pain is one of the most frequently reported sports injuries.  This injury is typically referred to as Patellofemoral Pain Syndrome (PFPS).  PFPS is a blanket term used to describe the various reasons that someone may be feeling pain around or behind their patella, or kneecap.  Let’s take a closer look.

How Common Is Anterior Knee Pain?

PFPS makes up 25% of all running related injuries and accounts for 25% of all knee injuries treated in sports medicine clinics.  PFPS will affect 25% of athletes and affects females 2.2 times more than males.  ACL injury is probably the most popular knee injury topic out there, but PFPS affects many more athletes and can be quite debilitating.

Women Are More Susceptible

Research has suggested many different reasons that women are more susceptible to PFPS such as our wider hips, flatter feet, weaker muscles, and the way we move during activity that is different from men.  One of the hottest topics in research right now is how to improve PFPS symptoms and how to prevent it from happening in the first place.  One method that seems to have a lot of support is the idea of hip and core strengthening routines.

In general, females tend to be naturally weaker than males.  It has been found that risk factors for developing PFPS are weak hip abductors, weak quadriceps, and weak hip external rotators.  Since women are weaker in their hips than men, this puts us at greater risk for PFPS.  The majority of athletes that I see with this in the clinic are female.

How Do You Fix Anterior Knee Pain?

When I see these people, most of the time they have very weak hip muscles, especially in the leg that is affected by PFPS.  I treat them by having them do specific hip and core strengthening exercises and usually have very good results and the athletes get back to playing their sport very quickly.

When you have weak hip muscles, the weaknesses get much more dramatic when they are combined while doing dynamic activities such as running, cutting, and jumping.  Because of this, your knee joint is put at a much higher risk of injury.  Most of the time there is no specific injury that happens.  It is typically something that comes on gradually over time after repetitive stresses to the knee.  These stresses happen because of the poor hip movement techniques being used due to weak hip muscles.

Fortunately, this can usually be fixed with a comprehensive hip and core strengthening program.  However, if the PFPS symptoms appeared as a result of a traumatic blow to the patella, such as being hit with a field hockey stick or landing directly on the knee, it is not so simple.  Hip and core strengthening can be helpful in this case, but it can take much more time to recover from because the damaged tissue can take awhile to heal.

So, the bottom line here is if you have anterior knee pain, talk to your physical therapist about what you can do in the way of hip and core strengthening to improve your pain.  If you don’t have anterior knee pain, there is a good possibility that you could develop it one day so why not work some hip and core strengthening into your workout routines and try to prevent it from happening.


  1. I’ve had runners’s knee since October last year. I’ve been doing physical therapy, orthopedic massage, yoga, acupuncture….not much helped until I focused my weight training on strengthening my glutes. My PT said they were weak and I saw a marked improvement after 4 weeks of focused work.

    I still have knee issues and they don’t seem to be going away entirely yet. But progress is good.

    1. Lisa, thanks for your comment. You’re my first comment ever! I’m glad the focused glute work is working out for you. I had similar issues and it did wonders for my knee pain and as a bonus, my back stopped hurting too! I hope you continue to make progress.

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