Anterior knee pain occurs at the front of the knee and is caused by softening of the cartilage or misalignment of the patellofemoral joint (where the kneecap connects with the thigh bone).

The health care provider will perform a physical examination of the knee to confirm and assess the pain.

Tests that may be performed to rule out possible structural damage to the knee or connective tissue include the following:

• Joint X-ray
• Joint CT scan
• MRI scan of the knee

The most common cause of runner's knee is pronation and lateral (away from the middle) pulling of the patella. This causes misalignment with the connective tissues and muscles involved with knee movement.

Anterior knee pain may also be caused by softening of the cartilage beneath the kneecap (chondromalacia patellae), arthritis or by pinching of the inner lining of the knee with knee motion (synovial impingement).

• Knee pain below the kneecap and on the sides of the kneecap, particularly with deep knee bends or prolonged sitting.
• In cases of runners knee, pain occurs initially when running downhill then progresses to all running. Finally pain is present even when not running

Treatment of anterior knee pain involves resting the knee and not resuming running until it can be done without pain.

Stretching exercises for the hamstrings and quadriceps and strengthening exercises for the muscle that pulls the kneecap toward the center of the body may be prescribed by a sports medicine specialist or physical therapist. Bicycling may be substituted for other exercise if it can be done without pain.

Special shoe inserts and orthotics (support devices) may help prevent further injury after healing.

Do not perform deep knee bends or overuse the knee until symptoms resolve.

Call your health care provider if knee pain persists in spite of resting the joint.

Proper warming up before exercise, stretching after warm-up or exercise, and cooling down after exercise can help prevent sports injuries.