Anterior Knee Pain / Knee Popping and Locking

By Jared Ernest, MPT

Anterior Knee Pain

If you think you have anterior knee pain, read this article.

Do you have pain in the front of your knee(s) with running, going up/downstairs, sitting for a prolonged time? Have you ever been diagnosed with Runner’s Knee, Chondromalacia, Patellofemoral Pain Syndrome or IT Band Syndrome?  Does your knee pop or lock in the front of the knee?

The IT band can get tight and cause anterior knee pain.

Illustration of the Iliotibial Band.

All of these symptoms can produce anterior (front of the knee) knee pain. Often times the pain associated with all of these diagnoses is a result of poor tracking of the patella (kneecap). The mal tracking of the patella in the femoral groove is usually related to a few problems:

  • Tight muscles and lateral knee structures.  These structures are the IT Band, hamstring muscles and the patella itself.
  • Weak muscles of the quad and more specifically, the VMO.
  • Poor body mechanics.  Alignment issues with the patella or kneecap itself.


What are the Causes of Anterior Knee Pain?

Tight Musculature

Tight lower extremity musculature can cause compression of the patella into the femoral groove by creating direct pressure (quads) or excessive flexion of the knee (hamstrings & calves). In addition, other tight muscles can cause the patella to pull out of the femoral groove. Therefore, both of these scenarios can cause significant pain, inflammation and possibly arthritis if left untreated resulting in a very painful and debilitating condition.

Exercises for Knee Pain

  • Stretches: Hold for 30 seconds.
  • Hamstrings: lay on your back with uninjured leg out straight. Keep involved leg straight and pull it up and over your head until you feel a stretch in the back of your leg.
  • Iliotibial Bands: lay on your back with uninvolved leg out straight. Place a rope or golf putter around the outside of foot of involved leg. Keep leg straight and pull it across body and up towards opposite shoulder until you feel a stretch along the outside of leg/buttocks area.
iliotibial band ITB stretch with belt

iliotibial band ITB stretch with belt

  • Quadriceps: Lay on stomach with. Place a rope around foot of involved leg. Bend knee and pull foot to buttocks until feel stretch in front of thigh.
  • Calves: Stand with toes and balls of feet on a step and let your heels hang off and down toward floor.  You can also do a calf stretch up against the wall.
Calf Stretching

Calf Stretch can help prevent strains

Tight Lateral Structures

Tight lateral structures of the knee cause the patella to track improperly in the femoral groove. In addition, improperly tracking patella can result in several problems including, but not limited to, baker’s cysts, fat pad inflammation and early arthritis due to wearing down of the articular cartilage of the patella and/or femur. Therefore, patella mobilization can assist to keep these lateral structures loose and the patella tracking normally.  The patella can be assisted with taping techniques as well which are call McConnell Taping.  This technique can assist the patella to stay in the proper position within the knee.  All JOI Rehab clinics provide McConnel Taping as needed.

Patella Mobilizations: Medial Glide and Medial Tilt.

Strengthening: It’s good to keep all the muscles in the lower extremity strong, but the two most important to focus on are listed below:

Exercises For Quadriceps 

VMO-Vastus Medialis Obliques: keeps the patella tracking properly by pulling it medially into the femoral groove.

  • Quad sets: With both legs straight contract thigh muscles. Hold for 5 seconds and repeat 20x.
  • Straight Leg Raise:  Do a quad set while laying on your back and lift your leg up off the table about 6 inches.  You can add weight to this exercise around your ankle.
Quad Sets

Quad Sets

  • Mini Squats: With feet shoulder width apart and toes straight forward bend hips and knees as if sitting in chair. Make sure knees align with middle of foot and stay behind toes. Perform 30-50 reps.

Buttocks or Gluteal Muscles 

PGM-Posterior Gluteus Medius: maintains proper hip/knee mechanics when climbing/descending stairs, bending, and standing.

  • Gluteus sets: While standing and feet straight forward and planted, rotate knees out and squeeze buttocks together. Hold for 30 seconds and repeat 6x.
  • Gluteus sets: Side lying straight leg raises- lay on uninvolved leg with leg slightly bent. With involved leg straight and thigh muscles contracted, extend leg behind body, rotate hips so toes point to the ceiling and lift leg up toward the ceiling. Don’t allow your body to roll backwards as you lift your leg. Perform 30-50 reps.

Alignment of the Patella

Mechanics within the knee play an important role in avoiding and eliminating anterior knee pain. Many times, people don’t realize how poor their mechanics are when they stand, bend, climb stairs, etc. Improper mechanics can cause compression of the patella in the femur and/or medial and lateral knee structures. Improper mechanics can cause compression of the patella in the femur and/or:

  • Alignment of hip knee-ankle:
    • Keep knees aligned with middle of foot when standing, bending and climbing or descending stairs.
  • Keep knees behind toes when bending foot:
    • Hyper-pronation (flat feet) can lead to a valgus knee causing mal tracking of patella and/or compressive forces on medial/lateral knee structures. An evaluation may be needed to assess this condition. Correction can be attained with foot orthotics.

Related Articles:

Treating Shoulder Injuries: Effective Methods

ACL Injuries: Causes, Symptoms, and Treatments

Articular Cartilage Damage in the Knee

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By: Jared Ernest, MPT

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