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Knee Bone or Joint Injury

Knee Pain Running | Front Knee Pain Running

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Posted 1 year ago


Last updated: 29/11/2022


by James McCormack

James McCormack
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While it is common to experience knee pain relating to running it is not normal and should not be accepted and put up with a part of running. Some pain can occur in muscles around the knee if the session has been particularly hard or long, and this will not be related to an injury. Differentiating between these “normal” pains and the pain of injury can be difficult. We recommend that if you experience high levels of pain, if pain lasts more than 2-3 days, returns each time your run, or if it is different to the other knee then you should see a medical professional such as a physical therapist with experience in running injuries. 

Part of the diagnosis process is determining your injury risk factors which your age, health, strength, flexibility, training and running styles will all contribute to. 

An assessment with a specialist medical professional such as a physical therapist will include a conversation with you about your life, exercise and running routines, you and your family history of injuries, and many other elements. This will help to direct your physical examination.

The most common causes of front knee pain running are:

  • Patella Femoral Joint Pain or Chondromalacia Patellae
  • Hoffa’s Fat Pad Impingement
  • Patella or Quadriceps Tendonitis
  • Osgood-Schlatter or Sinding Larsen Johansson Syndromes (children and teens)

Photo of different injury pain locations

Patella Femoral Joint Pain & Chondromalacia Patellae

Pain around the knee cap can be from damage to the cartilage of the patella, with Chondromalacia patella or irritation to the underside of the patella with patellofemoral pain. Pain is typically felt under the knee cap and the joint might click, creak or grate more than usual. Swelling is less common and the knee will usually still feel stable and mobile but can be painful at the end of the range of flexion. Read more in the related articles: Patellofemoral Pain Syndrome (Runners Knee) and Chondromalacia Patella.

Hoffa's Fat Pad Impingement

Hoffa’s fat pad sits under the patella tendon at the front of the knee, and it is compressed with the potential for irritation when the knee is fully straightened, especially if there is hyperextension, or when completely bent. Pain is focal at the front of the knee, will be worse on straightening the knee and the front of the knee is often hot and slightly swollen. Symptoms can be relatively easy to aggravate and can take a long time to settle. Often people notice the pain has worsened only after they have done too much. You can read more about this injury in our related article: Hoffa’s Fat Pad.


Patella or Quadriceps Tendonitis

These tendons sit above and below the patella and are part of the quadriceps muscle, inserting it to the front of the shin bone. Tendon pain is typically delayed after activity and will feel worse after a period of rest or first thing in the morning. Pain is very local to the tendon and it will be painful to pinch or press on it. While there isn’t swelling, the tendon itself may be thickened. Learn more about these conditions in our related articles: Patella Tendonitis and Quadriceps Tendonitis. 

Osgood-Schlatter or Sinding Larsen Johansson Syndromes

These are two conditions that mainly affect children and teenagers as it is a condition that is caused by the inflammation of the boney insertion point of the quadriceps and patella tendons. In the immature skeleton, the bone is soft enough to be irritated, as it matures the bone hardens and these conditions are no longer seen. Osgood-Schlatter presents with pain at the front and top of the shin bone, it is painful to press on this boney prominence. Sinding Larsen Johansson presents with pain at the top of the patella, which will be painful to press also. Both will be painful with the activity of the quadriceps muscle. You can read more about these conditions here: Osgood-Schlatter and.Sinding Larsen Johansson.

Front Knee Pain Running Styles

Running styles that overload the front of the knee include those that have a high knee flexion angle in mid-stance, landing on a straight knee, high dorsiflexion angle on landing (toes held high off the floor), having a pelvis drop and hip adduction and poor control of pronation at the foot and ankle. These are all movements that if present in your running style are to be worked on in order to improve your technique and running efficiency. This will not only help your running performance, but also reduce your risk of injury.

Pelvis Drop

When putting weight through one leg the muscles on the side of the hip need to contract to keep your pelvis level. If they are not strong enough or the movement pattern is not learnt well the pelvis will drop. This drop can cause the leg to adduct, and come across the body, which encourages an inward movement of the knee and therefore a greater straight on the structures at the front of the knee.

Landing on a Straight Knee

Landing on a straight knee means that the muscles of the leg are less able to absorb the impact of the landing. More impact will go through the joints of the ankle, knee and hip. The front of the knee as well as structures deeper in the joint will be loaded more heavily with this running style.

Physiotherapy with James McCormack

This is not medical advice. We recommend a consultation with a medical professional such as James McCormack. He offers Online Physiotherapy Appointments for £45.

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