Understanding Knee Pain: Why the Front of Your Knee Hurts and What to Do

Do you feel pain at the front of your knee when going up stairs, squatting, running or sitting for long periods? You might be experiencing patellofemoral pain (PFP) — a common condition that affects up to 25% of people at some point in their lives (McConnell, 1996). It’s sometimes called “anterior knee pain” and is especially common in runners, young adults, and people with physically demanding routines. It’s also one of the most frequent reasons people seek knee physiotherapy at Inner Strength Bayside.

What is Patellofemoral Pain?

PFP refers to pain that originates from the area between your kneecap (patella) and the thigh bone (femur). Another diagnostic term used to describe pain in this area is “chondromalacia patellae”. We now try to avoid that term, because it suggests that the cartilage damage is the cause of pain, which can increase fear and worry, whereas cartilage doesn’t cause pain — it’s aneural (has no nerve endings). In reality, PFP is more about joint pressure and load than structural damage.

Common symptoms include:

• Pain around or behind the kneecap
• Discomfort during or after running, up or down stairs, or squatting
• Pain after sitting for long periods (known as “cinema sign”)
• Clicking or creaking noises in the knee (crepitus)

What causes it?

There’s rarely one single cause of PFP. Instead, it’s usually a combination of factors that increase pressure or irritation around the kneecap. We describe this as a “shopping bag of risk factors” — the more that are present, the more likely pain becomes (Ferrari et al., 2017).

Common contributors include:

• Weakness or poor endurance of the glutes and quads
• Tightness in the quads, TFL, or calves
• Altered movement patterns or lower limb alignment like knees rolling inward during activity
• Poor footwear or a sudden change in shoes
• Prolonged standing with knees locked back
• Higher body weight

Emotional factors like anxiety or fear of movement can also increase pain. In fact, up to 50% of PFP sufferers report anxiety, and 20% report depression (Wride, 2019).

What is crepitus — and should I worry?

Crepitus is the grinding or popping noise you might hear when you move your knee. While these noises and feeling can be quite unnerving, it’s very common and not harmful. Studies show that crepitus has no link to pain, function, or arthritis progression (de Oliveira Silva et al., 2018; Pazzinatto et al., 2018). You don’t need to avoid activity or physio because of it.

Why are glutes and quads so important?

Your quadriceps help guide the kneecap and absorb force through the knee. Your gluteal muscles, especially gluteus medius and maximus, control the alignment of your hip and knee. Weakness here can increase inward knee movement and stress on the patellofemoral joint.

Exercise should be tailored to minimise joint stress and avoid flare-ups. It’s not about pushing through pain — it’s about gradually building strength and confidence. Wall squats, leg extensions in specific ranges, and glute-focused exercises (like side planks, clams, and lateral walks) are great starting points.

At our Cheltenham clinic, we design individualised rehabilitation programs to safely build strength and improve joint control — without flaring up your symptoms. We also educate you on how to avoid “pain traps” like poor squat form or shoes that increase load.

Footwear and the knee

Footwear can significantly influence knee loading. Flat shoes (like flip flops or soft slippers) offer little support, while high heels can increase pressure at the kneecap. Supportive shoes that reduce shock and improve alignment are often helpful — and in some cases, orthotics may be considered.

What should I do next?

1. Get a proper assessment – A physio can identify your personal contributing factors.
2. Stay active – Movement helps. The key is doing the right type, in the right amount.
3. Build strength – Particularly in your glutes and quads, without irritating the joint.
4. Don’t fear crepitus – Noisy knees aren’t dangerous.
5. Address lifestyle and training loads – Things like posture, footwear, and stress all matter.

Need Help With Knee Pain?

At Inner Strength Bayside Physiotherapy in Cheltenham, we see people with knee pain every week. Whether you’re a runner, a new mum, or simply want to move without pain, we’ll help you understand your knee and guide you through a personalised rehab plan based on the latest research.

You don’t need a referral to see us. Just get in touch to book an appointment and take the first step toward stronger, pain-free knees.

Contact us on 8555 4099 or CLICK HERE to book online.

References

• McConnell, J. (1996). Management of patellofemoral problems.
• Crossley, K. (2004). Patellofemoral pain in runners.
• Van Tiggelen, D. et al. (2004). Patellofemoral pain in military recruits.
• Glaviano, N. et al. (2015). Insurance claim data for patellofemoral pain.
• Wride, J. (2019). Anxiety and depression in PFP.
• Robertson, C. et al. (2010, 2017). Crepitus and patient beliefs.
• de Oliveira Silva, D. et al. (2018). Crepitus and function in knee pain.
• Pazzinatto, M. et al. (2018). Crepitus in knee osteoarthritis.
• Ferrari, D. et al. (2017). Shopping bag model of PFP risk factors.
• Cowan, S. et al. (2015). Fat pad volume and PFJ OA.