Anterior Knee Pain – Build a base before you load it


Anterior knee pain (pain at the front of the knee, often around the kneecap) is one of the most common reasons people seek physiotherapy. It can affect anyone — from athletes to office workers — and is often linked to activities like running, stair climbing, or prolonged sitting.





Typical Symptoms


People with anterior knee pain often notice discomfort during:


• Going up or down stairs

• Running or jumping activities

• Squatting or bending the knees deeply

• Sitting for long periods (“theater sign”)

• Kneeling or lunging


The pain may feel sharp during activity or like a dull ache afterwards, and it can be accompanied by stiffness or mild swelling.


When knee pain strikes, it’s common to hear advice such as: "You just need stronger quads and glutes" — often followed by a prescription of squats, lunges, and hip thrusts. While these are excellent strength exercises, they are not always the right starting point for someone with anterior knee pain. In fact, attempting them too soon can make symptoms worse, as they place high loads on an already irritated joint.





Why Rehab Comes First


Before heavy strengthening, the knee needs to go through a phase of rehabilitation. This involves:


• Pain reduction and inflammation control – through load management, soft tissue work, and gentle mobility exercises.

• Activation of key stabilisers – small, controlled movements to re-engage muscles like the VMO (vastus medialis oblique), hip abductors, and deep gluteal muscles.

• Movement retraining – teaching your body to move efficiently so the kneecap tracks correctly and stress is spread evenly.


Safe Starting Exercises

Some low-load activities can often be started early to maintain fitness and muscle activity without flaring symptoms:

• Gentle cycling (low resistance, pain-free range)

• Straight leg raises

• Calf raises

• Hamstring curls or bridges

• Side planks on the knees

• Triple extensions

• Light resistance band work for hips and core





Only once pain has settled and control has improved can you safely progress to more demanding exercises like squats, lunges, and hip thrusts — where strength gains will truly be effective and sustainable.


The Bottom Line


For anterior knee pain, jumping straight into heavy quad and glute training can often backfire. A physiotherapy-led approach focuses on targeted rehab first, so you can return to full strength training without setbacks. Think of it as building the foundation before constructing the house — the stronger the base, the longer your knees will last.




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