Pain In Front Of Knee?
Stop Pain Above & Below Knee Cap

What Causes Pain Above Knee Cap?

Pain on the front of the thigh above the knee is usually caused by the quadriceps tendon.  This is the tendon that attaches the quadriceps to the kneecap.  The kneecap actually sits inside of the quadriceps tendon,  which continues on to become the patellar tendon below the kneecap.

However, a problem with the femoral nerve or the L3 or L4 nerve roots in the lower back can also cause thigh pain above the kneecap.

Pain On Front Of Leg Below Knee

Pain on the front of the leg below the knee is usually caused by patellar tendinitis / tendinopathy.

Patellar tendinitis means inflammation of the tendon below the kneecap.  Tendinopathy means an abnormal condition of the tendon in which there is no inflammation. Both of these problems can still hurt.  In both cases, the pain is usually felt on the front of the knee just below the kneecap.

This type of pain is caused from too much load on the quadriceps muscles, for example when squatting or going up and down stairs.

Flexibility of the quadriceps muscles can play a role in this type of pain, but more often it comes from the quadriceps muscle overworking because the glute (a.k.a. butt) muscles aren't doing their fair share.

Patellar tendinitis can often cause pain in front of the knee when running or jumping.  In fact, patellar tendinitis is often referred to as "jumper's knee" for that reason.

However, you don't have to be an athlete to have patella tendinitis or pain just below the kneecap.

What about those patellar tendon straps?  Do they work?

Patellar tendon straps can help take the edge off the pain if you have patellar tendonitis.

They relieve stretch on the attachment point of the patellar tendon below the knee. Thus, they help temporarily, but they don't fix the main problem. If the quadriceps muscles are still stiff, the pain will eventually come back.

Knee Pain In Front Of Kneecap

Knee pain in front of the kneecap is usually due to inflammation from a direct trauma.

Examples of this can include:

1. A fall on the knee

2. A car accident (dashboard knee)

3. Kneeling on a hard surface for too long

If the trauma is severe first, make sure you rule out a kneecap (patellar) fracture.

Assuming you've ruled out a fracture, you might notice some fluid, or "water on the knee".  This is called pre-patellar bursitis, and is cause by the fluid-filled sac on the front of the knee rupturing.

The short-term solution for knee pain and swelling in front of the kneecap is Rest, Ice, Compression, and Elevation (RICE).

But that doesn't mean bed rest.  It just means "resting" from more strenuous activities like running, jumping, and biking, and avoiding kneeling until the inflammation goes down.

If the pain and swelling last more than a few weeks though there are likely some other factors in play such as stiffness of the quadriceps muscles.

Pain In Front Of Knee Behind Kneecap

Pain behind the kneecap is usually caused by either kneecap arthritis, or chondromalacia patella.

Kneecap (patellofemoral) arthritis

This refers to arthritis (wearing down of the cartilage) on the back side of the kneecap.

Your knee cartilage normally lubricates the knee joint, but when it wears down, the back of the kneecap rubs against the thigh bone.  This cause inflammation as you bend and straighten your knee.

This is compounded if the thigh (quadriceps) muscles are too stiff, creating further compression of the kneecap on the thigh bone.

Chondromalacia patella

Technically this means "softening" of the cartilage behind the kneecap, but really it's kind of like a precursor to arthritis.

It's typically found in younger people - sometimes as young as adolescents and teenagers.  However, the same issues mentioned above about patellofemoral arthritis apply.

If you have kneecap arhtirtis or chondromalacia patella, you might also have pain when sitting for long periods of time with your knee bent or knee pain when standing up after sitting.

Pain On Front Inside Of Knee

This type of knee pain is usually caused by irritation of tendons that attach on the inside of the leg just below the knee. This can be caused by overpronation (flattening) of the foot when walking.

Read our post "Pain On The Inside Of The Knee?" to learn more.

Pain On Front Outside Of Knee

Pain on the outside of the knee is commonly due to irritation of the IT band.

The IT band is a long tendon that runs from the hip to the outside-front of the lower leg bone just below the knee.

This type of pain can also be caused by overpronation (flattening) of the foot when walking, much the same as above. Weakness of the hip rotator muscles and stiffness of the ankle joint can be at fault.

Read our post "Pain On The Outside Of The Knee?" to learn more.

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How To Relieve Pain On Front Of The Knee

Regardless of what tissue or structure is causing your knee pain, there are basically 3 mechanical causes of pain in front of the knee:

Mechanical Causes of Pain In Front Of The Knee Include:

1. Too Much Compression Of The Kneecap
2. Too Much Force Through The Quadriceps Muscles
3. Too Much Side To Side Movement Of The Knee

In this post, we'll discuss mostly the first 2 items listed above.  If you have pain on the inside of the knee or on the outside of knee, the respective posts on those topics discuss the third item in more detail.

Too Much Compression Of The Kneecap

The kneecap the tendon of the quadriceps muscles.  The quadriceps are the muscle group in the front of the thigh that straightens the knee. Quadriceps means in Latin "four heads."

The head that most often causes trouble is a 2-joint muscle (the rectus femoris) that also flexes the hip.

When the quadriceps get too tight, that pushes the knee back of your kneecap against your thigh bone.  This causes rubbing of the two joint surfaces.

Stiff quadricep cause knee pain when bending your knee, especially activities the require repetitively such as cycling.  Stiff quadriceps muscles can also cause knee pain when squatting or when sitting with you knee bent for a long time.

So how do you stop pain in front of the knee caused by stiff quadriceps?

Stretch them.

But it's not enough just to stretch them... you really need to stretch them correctly.

Learn 7 Stretches For Stiff Quadriceps

Now you might think, "If I get knee pain when bending my knee, wouldn't bending it to stretch make is hurt more?"

...and you'd be right to think that.

If you have stiff quadriceps muscles, rolling them with a rolling pin, TheStick, or rolling on a foam roller before stretching can help loosen them up so that they'll stretch more easily.

Manual trigger point release, myofascial release, and trigger point dry needling can also help.  Those are services that we offer here at More 4 Life.

Too Much Force Through The Quadriceps Muscles

Using too much force from the quadriceps can cause pain above, below, or behind the knee. If your quadriceps are irritated or overworked, harder you contract your quadriceps muscles, the more they hurt.

Pain just below the knee is often caused by patellar tendinitis, the tendon that attaches the quadriceps to the lower leg bone.  Pain just above the knee is often caused by irritation of the quadriceps tendon, the tendon that attaches the quadriceps muscle to the kneecap.

Additionally, if you quadriceps are stiff, as noted above, you can get pain behind the kneecap when you contract the muscle as hard.

Why do the quadriceps muscles work too much in the first place?

Often it's because the gluteal (buttock) muscles are weak.

When you use your glute (butt) muscles more, the quadricep muscles don't get overworked.

One easy way to do this is to keep your weight more on your heels than on your toes when doing things like squatting and going up and down stairs.

Other strengthening exercises like squats, lunges, and leg presses can help as well.