Friday, 4 February 2022

Pain at the front of the knee……

Knee pain around the front of the knee and knee cap when there has been no obvious accident or injury is a common complaint and is not just restricted to runners! This is sometimes called Anterior Knee Pain or Patellofemoral pain syndrome.


The most common symptom is a dull ache or a slight pull or compression across the knee joint. For example, pain may routinely come on half way through a run, when going up or down the stairs or there maybe stiffness after sitting.

The causes of knee pain:

Overactivity and excessive muscle and skeletal load on the joint are the most common causes of knee pain. So this could be from increasing your distance and time running too much too soon therefore the soft tissue do not get a chance to recover and adapt, imbalances of muscle strength and skeletal alignment from the hip to knee, ankle and foot and so the distribution of load through the leg is uneven, or there could be dysfunction within the joint itself (this might be from degeneration of the articular cartilage and hence reduced“cushioning” through the joint).

The physical and mechanical muscle and skeletal factors that have been shown to increase knee pain are: 

  • Excessive tension in the quadricep muscles
  • Weakness in the hip stabilisers (which predominantly occurs in the gluteal muscles) 
  • Stiffness in the ankles and feet
  • Restricted range of movement in the hips 
  • Imbalance in the muscles that surround the knee, from either or both, the quadriceps in front and the hamstrings at the back of the leg

All of the above can lead to the kneecap (patella) being misaligned and/or compressed. The kneecap is the bone that sits within the tendon of the quadricep muscles and glides over a groove on top of our thigh bone. Biomechanics and muscular imbalances pull the kneecap against this groove and an imbalance can result in increased pressure between your kneecap and thigh bone surfaces and subsequent wear, inflammation and pain.

IT Band:

With lateral knee pain/tenderness (on the outside of the knee) the IT Band needs to be considered. I know I have mentioned to many that the IT band is a very strong cable like structure that cannot be stretched (so squashing with a foam roller won’t help!).  However fascially it is heavily entwined with the hamstrings and quadriceps muscles (fascia is the name of our connective tissue that binds us all together) 

This is a cross-section of the thigh, here you can see all the different layers of the soft tissue and how they are all interlinked. The bottom layer is the quadricep.


Increasing running or sporting activity too quickly, or not giving the body enough time to adapt and to rest and repair and get stronger or carrying extra weight, can all cause too much repetitive stress on the knee joint and its supporting muscles. 

There are other potential causes of knee pain which can have similar symptoms to the above e.g. bursitis, ligament sprain, meniscus problems, so an assessment of the joint and it’s movement is key to help recovery. 

Massage for the Knees

Massage treatment can be help to alleviate pain around the knee by reducing the hypertonicity (tension) of the soft tissue that surround and the knee joint itself.  This is to restore muscle balance through stretching and activation techniques and release joint restrictions and this prevents excessive pulling of the tendons over the knee, compression of the joint and rotations of the bones and prevent misalignment of the kneecap (patella).  

The key muscles are the quadriceps at the front of the thigh that cross and surround the anterior knee joint and cap, the hamstrings and one of the calf muscles, the gastrocnemius,  at the back that again cross the knee joint, plus all the fascial layers around the IT Band. 

Key to treatments is also assessing the strength of the muscles and joint movement of the hip, knee and ankle to identify any weaknesses which maybe causing an imbalance, and then planning a home-care rehab exercise plan.

Please get in touch if you have any queries on any of the above.

Nicky Holbrook
Sports Massage & Remedial Soft Tissue Therapist
February 2022