Knee

What It Is

Adolescent anterior knee pain is common in healthy, active young people, especially girls (AAOS, n.d.). The pain is felt in the front (anterior) and centre of the knee, usually underneath the kneecap. It usually gets better with simple measures such as changes to activity and a programme of exercises, and surgery is very rarely needed (AAOS, n.d.; Sherwood Forest Hospitals NHS Foundation Trust, 2024). Usually, the pain is not caused by any particular abnormality in the knee (AAOS, n.d.).

It often affects young people who are very active in sport, and it is common during growth spurts (Sherwood Forest Hospitals NHS Foundation Trust, 2024).

Causes

Several factors can contribute to anterior knee pain, including

An imbalance between the thigh muscles (quadriceps and hamstrings)
Tight thigh muscles, especially the quadriceps along the front of the thigh and the hamstrings at the back
Problems with the alignment of the legs between the hips and the ankles
Overdoing sports activities, or changing the type of training
Starting a new sport or increasing activity too quickly
Using unsuitable training techniques or equipment, or changes in footwear or playing surface

(AAOS, n.d.)

Not a diagnosis — for more information, contact me or another trusted healthcare provider.

Symptoms

How It Feels

Symptoms

A dull, aching pain that comes on gradually and is often related to activity
"Popping" or crackling sounds in the knee when climbing stairs or standing up after sitting for a long time
Pain during activities that involve repeated knee bending, such as jumping, squatting and running
Pain at night

(AAOS, n.d.)

Treatment

Self-Care & Treatment

How to Manage Pain

Rehabilitation exercises help you regain range of motion, strength and coordination, and I can set you a programme to help you return to sport gradually and safely. See the My Approach tab for how I work.

Ice: an ice pack after activity may relieve some discomfort. Do not put ice directly on the skin; wrap it in a towel and use it for about 20 minutes at a time (AAOS, n.d.).
Activity changes: cut out the activities that make the knee hurt until the pain has gone, and switch to low-impact activities such as cycling or swimming in the meantime. Then build back up to running and sport gradually (AAOS, n.d.).
Pain relief: the AAOS says over-the-counter anti-inflammatory medicines such as ibuprofen or naproxen may help relieve the pain, and should be taken with food to avoid stomach upset. If they do not help, see your doctor (AAOS, n.d.). (This medicine information comes from the American Academy of Orthopaedic Surgeons (OrthoInfo), not from me. Always check with a pharmacist or your family doctor or nurse practitioner before taking any medicine.)

How Does Manual Therapy Help?

Exercise is the main treatment: research recommends exercise therapy that strengthens the muscles around both the hip and the knee (Crossley et al., 2016), with a focus on stretching and strengthening the thigh muscles, especially the quadriceps, which help to keep the kneecap steady (AAOS, n.d.). I can assess your feet, knees, hips and spine for anything that might be playing a part, set your programme, and add soft tissue massage to tight muscles alongside the exercises. See the My Approach tab for how I work.

It is important to keep doing the exercises for as long as I advise, as the pain can come back (AAOS, n.d.).

Tips to Prevent Recurrence

Wear shoes that suit your activity and replace them when they are worn out.
Warm up thoroughly before physical activity, make stretching part of your warm-up, and stretch after activity.
Reduce any activity that has hurt your knees in the past.
Limit the total distance you run in training and competition.

(AAOS, n.d.)

Treatment

My Approach

Pain at the front of the knee is rarely just a knee problem. The hips, thighs, calves and feet all affect how much load goes through the kneecap, so I look up and down the whole leg. My aim is to settle the pain, then build strength around the hip and knee so you can get back to sport and stay there.

I start by asking about training, recent growth spurts and what brings the pain on. Then I assess how you squat, step and walk, the strength of your hip and thigh muscles, and the flexibility of your quadriceps, hamstrings and calves. Most people with this are teenagers: parents are welcome to sit in, with their child's agreement, and if a younger child can't consent for themselves, a parent or caregiver approves the treatment.

When It's Sore

Cutting back stairs, deep squats, running and jumping for a while, and swapping in swimming or easy cycling
Pain-free strengthening: thigh tightening, small-range straightening over a towel roll, and side-lying hip work
Stretches for the quadriceps, hamstrings and calves
Hands-on work for tight thigh, hamstring and calf muscles alongside the exercises
Taping to take some load off the kneecap in the short term

As It Settles

Mini-squats, partial lunges and slow step-downs, keeping the knee lined up over the middle of the foot
If pain comes on, we change the range or the load rather than pushing through
Light, supervised strength work, with good form first and small steps up in load
A home programme and a gradual return to running and sport

Work on the buttock and hip muscles can help, but only when it's clinically relevant, with informed consent and a signed consent form, and you can say no at any time. If the feet roll in a lot, I'll help you work out whether an insole might help and how to get one, and point you to a chiropodist or podiatrist if you need a custom orthotic.

The pain can come back if the exercises stop too soon, so a home programme you'll actually keep up matters most. If the knee swells, locks, clicks or gives way, see your doctor.

What to Expect

Typical Course

Typical course: Most young people come once or twice a week at first while we settle the pain and learn the exercises, then weekly, then spacing out as they manage the home programme on their own, with a reassessment at about 4 to 6 weeks. The pain usually improves over 6 to 12 weeks of regular exercise, and keeping the programme going after that helps stop it coming back.

What I Focus On

Whole-Leg Assessment

Hip & Thigh Strength

Thigh & Calf Release

Taping

Gradual Return to Sport

Please read

When to See a Doctor First

When to see a doctor

Adolescent anterior knee pain does not usually cause swelling. Swelling, clicking, locking, snapping or the knee giving way suggest a different problem in the knee, so see your doctor if you notice any of these, or if the pain does not go away and stops you doing your activities (AAOS, n.d.).

Sources

References

American Academy of Orthopaedic Surgeons (n.d.) Adolescent anterior knee pain. OrthoInfo. Available at: https://www.orthoinfo.org/diseases--conditions/adolescent-anterior-knee-pain/ (Accessed: 7 October 2026).
Crossley, K.M., van Middelkoop, M., Callaghan, M.J. et al. (2016) '2016 Patellofemoral pain consensus statement from the 4th International Patellofemoral Pain Research Retreat, Manchester. Part 2: recommended physical interventions', British Journal of Sports Medicine, 50(14), pp. 844–852. doi: 10.1136/bjsports-2016-096268
Sherwood Forest Hospitals NHS Foundation Trust (2024) Anterior knee pain in children and adolescents. Available at: https://sfh-tr.nhs.uk/media/x2za5xke/pil202407-03-akpca-anterior-knee-pain-in-children-and-adolescents.pdf (Accessed: 7 October 2026).

Massage therapy · Kitchener–WaterlooAdolescent Anterior Knee Pain

What It Is

Causes

How It Feels

Symptoms

Self-Care & Treatment

How to Manage Pain

How Does Manual Therapy Help?

Tips to Prevent Recurrence

My Approach

When It's Sore

As It Settles

Typical Course

When to See a Doctor First

When to see a doctor

References

Related Conditions

Book a session

Massage therapy · Kitchener–WaterlooAdolescent Anterior Knee Pain

What It Is

Causes

How It Feels

Symptoms

Self-Care & Treatment

How to Manage Pain

How Does Manual Therapy Help?

Tips to Prevent Recurrence

My Approach

When It's Sore

As It Settles

Typical Course

When to See a Doctor First

When to see a doctor

References

Related Conditions

Anterior Cruciate Ligament (ACL) Injuries

Chondromalacia Patella

Degenerative Joint Disease

Fat Pad Impingement

Book a session