Anterior Knee Pain and Runner’s Knee

Anterior Knee Pain and Runner’s knee

Athletes are prone to a lot of wear and tear on their joints, and the knees are perhaps the biggest casualty of sports. One common, chronic problem is anterior knee pain. In fact, this problem is so prevalent that it affects both athletes and those with a more sedentary lifestyle.

For those that are athletes experiencing this pain, usually it advances gradually and the athlete can’t pinpoint when exactly the pain started bothering them. Others experience an injury, such as a direct hit to the area that damages the tissue, or a fall or sprain. The knee then flares up and swells to begin the process of healing. The RICE (rest, ice, compression and elevation) method of injury treatment is usually all that is needed to treat the knee.

For those individuals that experience the beginning of this problem in a more gradual way, treatment can be confusing since the injury can flare up, go away, and then flare up again. When athletes experience these repetition, a good course of action is to recognize the patterns and start a subsequent pain management strategy.

Further, some specific conditions and diseases can cause pain; these include Runner’s and/or Jumper’s Knee, chondromalacia patellae, bursitis, iliotibial band syndrome or fat pad impingement.

Anterior knee pain is different in everyone, and the different levels in pain and range of mobility can drastically vary in patients. Most patients with this condition will experience hesitation to use the knee completely, which leads to a decreased level of movement control. These factors lead to ongoing problems, and an increased rehabilitation time necessary before returning to athletics.

Luckily, the past decade has seen tremendous growth in testing, therapy and information about anterior knee pain syndrome. With these advanced methodologies, the cases of knee pain are more frequently pinpointed, and knee pain diagnosis are far more accurate than in the past. Athletes today are able to faster recognize the anterior issue, become educated about factors and causes of knee pain, and how better to treat their anterior problems, as well as what can bring knee pain relief. Whether what causes knee pain is acute, and can be directly attributed to injury, or inner knee pain and knee pain symptoms occur gradually, the causes and effect are easier dealt with today than ever before.

Besides athletes, people in everyday life situations can experience pain problems in their inner knee, and receive anterior knee pain treatment. Like athletes, patients in this group can experience both a blunt injury that causes knee pain, or a slow increase in knee pain over time. Sometimes, the gradual onset of pain is caused by a tissue breakdown that results in swelling. Other times, the tissue damage starts in another part of the body and centers in the knee. Causes of this include back problems manifesting throughout the body, nerve irritation, and general poor health. Undertaking too much physical stress on the knee can also cause anterior pain. Inflammation results, and sometimes this can be caused by chemical release from nerves rather than any sort of structural tissue damage. New technologies in imaging allow for more accurate pain diagnosis and knee therapy methods.

Anytime knee pain is attributed to a nerve causation, the treatment program is going to be more intensive and lengthy. Patients should prepare themselves for a longer course of therapy and not get frustrated at slow progress. Those with sedentary lifestyles, poor eating habits, higher stress levels and increased fatigue will require longer rehabilitation. An understanding of the brain to pain sensitivity will also help the patients recognize why their body naturally protects the anterior portion of the knee when it’s damaged. Often, half the battle in pain management for the anterior part of the knee is educating the patient on the importance of the mental factors at play in their recovery, such as patience, persistence and a positive outlook.

So as you have read, pain that exists in the anterior portion of the knee can affect all people; both athletes and those with very sedentary, restful lifestyles. Causation of the pain can be both a gradual onset, increasing in severity over time, or caused by an acute, blunt injury to the site. Thanks to advances in technologies, particularly imaging functions, doctors are able to better diagnose and pinpoint the factors that cause knee pain and prescribe an appropriate course of therapy. The patients must also do their part in learning the reason for their pain, what to do about it, and how to handle it from a mental perspective as they rehabilitate their body. They also must be knowledgeable and mindful of the lifestyle factors that either caused the anterior pain initially or that can further exacerbate it or halt recovery. They must make changes in their lifestyle so their rehabilitation treatment is effective and speedy.


In this instance, an athlete was originally diagnosed with minor quadriceps muscle strain and was treated for four weeks, with unsatisfactory results. When he came to our clinic, the muscle was not healing, and the patients’ muscle tissue had already begun to atrophy.

Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider. To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected.

The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. Using dynamic MSUS, we can see what happens when patients contract their muscles, something that cannot be done with MRI. From a diagnostic perspective, this interaction is invaluable.

Dynamic ultrasonography examination demonstrating
the full thickness tear and already occurring muscle atrophy
due to misdiagnosis and not referring the patient
to proper diagnostic workup

Demonstration of how very small muscle defect is made and revealed
to be a complete tear with muscle contraction
under diagnostic sonography (not possible with MRI)


Complete tear of rectus femoris
with large hematoma (blood)


Separation of muscle ends due to tear elicited
on dynamic sonography examination

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