How The Knee Works
To understand how jumpers knee happens, it helps to understand how the knee works. The knee, which is the largest joint in the body, provides stability to the leg and allows it to bend, swivel, and straighten. Several parts of the body interact to allow the knee to function properly:
- Bones like the femur , the tibia , and the patella give the knee the strength needed to support the weight of the body. The bones that meet at the knee allow it to bend smoothly.
- Muscles provide the tug on the bones needed to bend, straighten, and support joints. The muscles around the knee include the quadriceps and the hamstring . The quadriceps muscle helps straighten and extend the leg, and the hamstring helps bend the knee.
- Tendons are strong bands of tissue that connect muscles to bones. The tendons in the front of the knee are the quadriceps tendon and the patellar tendon. The quadriceps tendon connects to the top of the patella and allows the leg to extend. The patellar tendon connects to the bottom of the kneecap and attaches to the top of the tibia.
- Similar to tendons, ligaments are strong bands of tissue that connect bones to other bones.
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How Is Patellofemoral Pain Diagnosed
The diagnosis is made from your symptoms, the history of the problem, plus an examination of your knee.
Tests, such as X-rays or scans, cannot diagnose patellofemoral pain and are often not helpful. However, sometimes they might need to be done to diagnose maltracking or look for other conditions. This might be the case if your symptoms aren’t the usual ones. Or they might be needed if you have injured your knee. It is very rare to have any other kind of tests for patellofemoral pain.
Pain On The Inside Of The Knee
Pain localized on the inside of the knee is quite common. It can be constant or intermittent. Often it occurs at or slightly below the joint line. Common causes of medial knee pain include osteoarthritis, medial meniscus injury, and inflammation of the low leg tendons. The latter is called pes anserine bursitis.
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Symptoms Of Pain At The Front Of Your Knee
Pain at the front of your knee can feel different for different people and will depend on whats causing it. You may have pain below your kneecap, around it, on either side of it or behind it. You may have a dull ache or a sudden, sharp pain.
Youll often get pain in both knees at the same time, unless its due to a particular injury. Pain at the front of your knee is often made worse by:
- standing up after sitting for a long time
- squatting or kneeling
- running downhill
Jumpers knee may cause pain only when youre active, but if it gets worse, it may be painful all the time.
Pain from an anterior cruciate ligament injury is usually sudden and you may hear a pop. Your knee is likely to swell up quite quickly and may feel as if it is going to give way.
Osteoarthritis in your knee usually causes pain when you put weight on the affected leg and gets better when you rest it. You may have stiffness and loss of movement first thing in the morning or after sitting for a while.
OsgoodSchlatter disease and Sinding-LarsenJohansson disease cause pain, tenderness and swelling just below your kneecap, at the top of your shin bone. Symptoms are usually brought on by running or jumping.
Knee Pain When Bending: Causes Prevention Treatment And Best Exercises
Medically reviewed by orthopedic surgeon Jonathan Lee, MD, senior expert physician at Hinge Health
Your body’s ability to move smoothly through life hinges on your knee. The knee has many parts that work seamlessly so you can bend, straighten, squat, walk, run, and jump. But age, injuries, or an uptick in your daily activity are all reasons your knee can hurt when it bends. “Knee pain can really limit so much of our day-to-day functioning. It prevents people from doing the things they love, like squatting down to pet a dog or pick up their grandchild,” says Mary Kimbrough, PT, DPT, OCS, a physical therapist at Hinge Health.
Although knee pain is common, it’s very treatable and preventable, often without surgery.
Here, learn more about what causes pain when you bend your knee, and how to prevent and treat it – especially with exercises from our Hinge Health physical therapists.
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How Is Knee Cartilage Damaged
Knee cartilage fails for many reasons. Accidents, injury, genetic deformities, overuse, and age are five common reasons for chondromalacia.
Fractured bones or lacerated muscles can cause an imbalance of strength in the leg and pull the kneecap to one side of the groove or another. The added stress can cause misalignment and pain.
Overuse injuries cause damage to the cartilage, especially in young athletes. Growing bones and excessive stress create a recipe for a chronic condition. If young athletes complain of knee pain at practice or during a competition, they should stop playing. Prolonged knee pain after activity indicates a more serious condition than normal muscle soreness from a strenuous workout. If you experience knee pain after practice or a game that does not diminish in 72 hours, you may need medical attention. Call your primary care provider, sports medicine physician or an orthopedic specialist.
Genetic deformities and age are risk factors you cannot change, but you there are some things you can do to avoid damaging the cartilage.
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How Do You Treat Anterior Knee Pain
Pain in the front of the knee is usually treated successfully without surgery. This may take some time. It is not unusual for the pain to last for many months. Many of you will respond to physical therapy, which should focus on your hips, yes, your hips and pelvic muscles as much as it focuses on your thigh muscles. Runners who focus on a strengthening program might repeat might have a lower incidence of anterior knee pain.
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Patellar And Quadriceps Tendinitis
These two types of tendinitis also occur in the setting of repetitive, forceful contractions of the quadriceps or thigh muscles. Erratic exercise, poor conditioning and flexibility, or over-aggressive training all contribute to this problem. Some examples might include doing certain exercises before good baseline conditioning, strengthening and flexibility have been achieved. Some of the more common offenders include squats, plyometrics, and hill or stair running. For patella tendinitis, a patella tendon strap can provide relief of symptoms while healing and rehabilitation is taking place.
What Are The Symptoms Of Runner’s Knee
These are the most common symptoms of runner’s knee:
Pain in and around the kneecap that happens when you are active. Or pain after sitting for a long time with the knees bent. This sometimes causes weakness or feelings of instability.
Rubbing, grinding, or clicking sound of the kneecap that you hear when you bend and straighten your knee
Kneecap that is tender to the touch
The symptoms of runner’s knee may look like other conditions and health problems. Always talk with your healthcare provider for a diagnosis.
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Too Much Hip Adduction
Weakness in the gluteal muscles and hip abductors, can cause the knee to drift over the arch of the foot when lunging or squatting. This is known as excessive hip adduction and can lead to incorrect knee alignment. Often both excessive internal rotation and adduction occur together. If your knee tends to drift over the arch of your foot when you do a squat it may indicate that you have excessive hip adduction. Women tend to exhibit greater inward drift of the knee over the foot in weight bearing activities, and may be more susceptible to this type of injury than men.
I have written another blog which outlines how to check if your gluteals and core need strengthening. It will help you check out your own knee alignment and determine if you need to take some remedial action. Check it out here
If you are a cyclist, increased hip adduction and/or internal rotation can be observed by watching whether your knee drifts inwards over the arch of your foot on the down stroke. Ideally it would stay in line with the centre of your shoe. More on this in my blog here
Thigh bone rotates inwards causing a flick out of the foot
Ligament Sprain Or Tear
A ligament sprain or tear can also cause pain when trying to straighten the knee. This is often caused by a sudden twisting motion of the knee joint thats common with cutting and changing directions. Youll feel or hear a pop within the knee and feel as if the knee is unstable and may give out.
Ligaments are bands of tissue that connect one bone to another and they help stabilize the joint. When they are stretched too far or torn, it can cause pain when they are stretched to normal range of motion.
The body typically can heal on its own if its an LCL or an MCL tear but it can take nearly 12 weeks to recover. Physical therapy is recommended to work on a range of motion, strengthening, and getting back to normal activities.
If you suffer an ACL or a PCL injury, then these may require surgery to fix. These do require an MRI to correctly diagnose.
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Other Factors Affecting Kneecap Pain: Ligament Laxity And Core Strength
Ligament laxity has been found to be a risk factor for PFP. There is a ligament attaching the kneecap to the inside of the femur and laxity in this may allow it to track towards the outside of the knee.
A study by Cronstrom et al found that reduced trunk lateral flexion strength, as assessed by the side plank, was associated with increased drifting of the knee over the arch of the foot in a single-leg squat. In addition, increased leaning of the trunk to the weight bearing side during a single leg squat can indicate trunk stability. This pattern can occur to compensate for weak core muscles. The side-plank tests the lateral flexion strength of the trunk and also hip abductor strength. A weakness of these core muscles may lead to both increased trunk instability and increased knee abduction that together may induce an increased risk of injury at the kneecap.
Conditions Associated With Pain At The Front Of The Knee
There are several medical conditions linked to pain at the front of the knee. They include the following.
Patellofemoral pain syndrome is one of the most common reasons for pain at the front of the knee. When you bend and straighten your leg, your kneecap slides up and down a groove at the end of your thigh bone . Patellofemoral pain syndrome describes pain related to this joint. It can happen if theres repeated stress on your knee for example, from jogging, squatting or jumping. It can also result from problems with the alignment between your kneecap and thigh bone. Doctors sometimes call it runners knee. It often happens in people who are very active particularly teenagers and young adults.
Patella tendinopathy means the patellar tendon in your knee becomes worn down. This tendon attaches your kneecap to your shin bone, and it can become inflamed and tear. This can be due to overuse and stress over time, particularly in sports that involve jumping like basketball and volleyball. Because of this, its often called jumpers knee. Quadriceps tendonitis is a similar condition but is less common. It causes pain and tenderness where the tendon from your thigh muscle attaches to your kneecap.
Infrapatellar fat pad syndrome is a condition where the fat pad below your kneecap gets pinched between your kneecap and thigh bone. Its usually due to repeated stress on your knee. Its sometimes called Hoffas syndrome.
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When The Front Of The Knee Hurts
Normally, the kneecap moves up and down the thigh bone during running. People may feel pain in the kneecap because thigh muscles are weak or the feet roll in too much . As a result, the kneecap rubs abnormally against the thigh bone, causing increased wear and tear.
Pain in the front of the knee may be caused by
A kneecap located too high or too low in the front of the knee joint
Off-center insertion of the muscles around the knee cap
Tight, shortened hamstring muscles
Weak thigh muscleswhich normally help stabilize the knee
Can Someone With Pfp Syndrome Play Sports
Most people with PFP syndrome need to cut back or stop sports for some time. Follow the health care provider’s instructions on when it’s safe for you to go back to sports. This usually is when:
- Hip, leg, and core strength is near normal.
- Flexibility, especially in the hamstring muscle, has improved.
- There’s no pain with everyday activities, such as walking and going up/down stairs.
- Any pain with activity is very mild and goes away within a few minutes of starting the activity.
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Is It Arthritis If My Knee Hurts When Straight But Not When Bent
Often, when people suffer from knee pain, they experience pain as a sensation when bending the knee. However, some conditions cause the knee to hurt more when its straight rather than when bent.
If you suffer from knee pain when its straight but not when bent, you may be wondering about the cause and how it can be treated. Some have concerns that this pain could be the sign of arthritis. While its possible that your knee pain when straightening your knee could be related to arthritis, its more likely related to runners knee or jumpers knee.
Anterior Cruciate Ligament Tear
The anterior cruciate ligament is one of four important knee ligaments. They connect our bones together and keep our joints stable.
An ACL tear happens when the ligament stretches beyond its capacity.
Most ACL tears are traumatic injuries. Meaning, you will likely be able to tell how and when it happened. Common causes include :
- Twisting the knee,
- Sudden changes of direction, or
- After a direct hit.
This makes ACL tears a common injury in running sports.
You may feel a popping sound and the knee giving out at the moment of injury. Pain and swelling often appear during the first 24 hours. Your knee can feel unstable. It can be hard to walk as well.
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Front Knee Pain When Bending
An examination of the front of your knee can reveal a condition known as patellar arthritis or patellofemoral tendonitis. It is common for knee pain to occur when bending the knee, kneeling, or squatting. The deeper the knee bend, the worse it will usually be.
One of the most common causes of knee pain is bending. Because the knee bends due to forces exceeding seven times its body weight, it is no surprise that it is a common cause of disability. In this section, well look at several types of bending knee pain, the most common causes, and how to manage them. Runners knee, in addition to anterior knee pain and patellofemoral pain syndrome, is known as anterior knee pain. As the knee bends and straightens, the cartilage becomes frictional and becomes more stressed. The inflammation of one or more bursa, which are located around the knee joint, is referred to as bursatitis. When people are bending over while kneeing, they frequently experience swelling and pain.
Potential Reasons Your Knee Hurts When Straight But Not When Bent
When you have knee pain when your leg is straight, it is usually related to one of the following:
- Patellofemoral pain syndrome More commonly known as runners knee, this condition develops when the kneecap shifts out of its natural position. This can occur as the result of misalignment of the patellar groove, which is the track of tendons that keep the kneecap in its right place. Tension or weakness in the tendons can cause the misalignment, or it may be the result of a traumatic injury.When you have runners knee, it can be difficult to straighten the knee without pain.
- Patellar tendinitis More commonly known as jumpers knee, this condition is the result of irritation and inflammation along the patellar tendon. The patellar tendon connects the bottom of your kneecap to the top of your shinbone. Frequent physical activities, especially those that involve jumping, can exert great amounts of force on the knee, which causes pain when trying to straighten the knee.
If you suspect you have knee pain from one of these conditions, please dont hesitate to reach out to a health care professional for assistance.
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Common Treatments For Knee Pain When Bending And Straightening
Specific treatment will depend upon the specific type of knee injury and its severity. Not all knee injuries are treated the same. Establishing a proper diagnosis is essential so that treatment and rehabilitation are tailored for your specific condition. When appropriate conservative care should be the first line of treatment. Common treatment options include:
Can Knee Pain Resolve On Its Own
Only a few self-help measures can usually relieve knee pain, and further medical treatment will be unnecessary. The anterior part of the knee is the most common source of knee pain.
Chronic Knee Pain? Cooled Radiofrequency May Be The Treatment For You
Despite the fact that many treatments exist, many people continue to experience chronic knee pain. Cooling is the most recent treatment option. Radio frequency energy is used in this minimally invasive procedure to block signals from nerves to the brain. Mobility and pain relief can last up to a year after receiving the procedure. People who are suffering from chronic knee pain benefit greatly from cooled radiofrequency therapy. A minimally invasive procedure, in addition to improved mobility and pain relief, can be performed for as little as 12 months. If you have chronic knee pain, you may want to consider cooled radiofrequency treatment. When is the best time to see a doctor?
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