Anterior Knee Pain (Patellar Maltracking): Causes, Symptoms and Treatment Bristol
- Daniel Taylor
- Jul 7
- 6 min read
Updated: Jul 9
What is Anterior Knee Pain?
Anterior knee pain, often referred to as patellar maltracking syndrome or patellofemoral pain syndrome (PFPS), is one of the most common knee conditions seen in young adults and active individuals. It is characterised by pain around or behind the kneecap (patella), particularly during activities that place increased stress through the knee joint.
Common aggravating activities include:
Walking up or down stairs
Squatting
Kneeling
Running
Walking uphill
Standing up from a chair
Prolonged sitting with bent knees
Many patients also report grinding, clicking, or crunching sensations around the kneecap, known as crepitus.
What Causes Anterior Knee Pain?
The kneecap sits within a groove at the front of the thigh bone (femur) and should glide smoothly during bending and straightening movements.
Anterior knee pain commonly develops when there is an imbalance in the muscles and soft tissues surrounding the knee, hip, and lower leg. This can cause the patella to move slightly off its optimal path, known as patellar maltracking.
Contributing factors may include:
Weak quadriceps muscles
Weak hip muscles (gluteals)
Tight iliotibial band (ITB)
Tight quadriceps
Poor foot mechanics or overpronation
Reduced flexibility
Sudden increases in activity levels
Prolonged sitting or repetitive bending activities
When the kneecap does not track efficiently, increased pressure is placed on the joint surfaces and surrounding soft tissues. Repeated irritation can then lead to inflammation and pain.
Common Symptoms
Patients with anterior knee pain often describe:
✅ Pain around or behind the kneecap
✅ Grinding, clicking, or crunching sensations
✅ Pain when climbing stairs
✅ Discomfort getting up from a chair
✅ Pain during squatting or kneeling
✅ Symptoms that worsen after prolonged sitting
✅ Mild swelling around the front of the knee
Self-Management and Treatment
The good news is that most cases improve significantly with conservative treatment.
1. Activity Modification
You do not need complete rest, but reducing aggravating activities for a short period can help settle symptoms.
Examples include:
Reducing hill walking
Limiting deep squats
Avoiding repetitive kneeling
Breaking up prolonged periods of sitting
2. Stretching Exercises
Quadriceps Stretch
How to perform:
Stand upright.
Hold your ankle behind you.
Gently pull your heel towards your buttock.
Keep your knees together.
Hold for 30 seconds.
Repeat: 3 times each side.
ITB Stretch
How to perform:
Cross the affected leg behind the other.
Lean away from the painful side.
You should feel a stretch along the outside of the thigh and hip.
Hold for 30 seconds.
Repeat: 3 times.
3. Foam Rolling
Foam rolling can help reduce tension within the quadriceps and iliotibial band.
Focus on:
Front of the thigh (quadriceps)
Outer thigh (ITB region)
Hip muscles
Spend approximately 1–2 minutes on each area daily.
4. Strengthening Exercises
Research consistently shows that strengthening the quadriceps and hip muscles is one of the most effective treatments for patellofemoral pain.
Straight Leg Raises
Lie on your back.
Tighten your thigh muscle.
Lift your leg approximately 12 inches.
Hold for 2 seconds.
Slowly lower.
3 sets of 10 repetitions
Mini Squats
Stand with feet shoulder-width apart.
Bend knees to approximately 45 degrees.
Keep knees aligned with toes.
Return to standing.
3 sets of 10 repetitions
Glute Bridges
Lie on your back with knees bent.
Lift your hips from the floor.
Squeeze your buttocks.
Hold for 2 seconds.
3 sets of 10 repetitions
You can find further strengthening exercises on the Elite Joint Solutions YouTube channel.
Entry level exercises : https://www.youtube.com/watch?v=pbPP_h6mphA&t=1s
Intermediate level exercises : https://www.youtube.com/watch?v=k0OG_aAAyZo
Most patients experience significant improvement within 6–12 weeks when they consistently follow an exercise programme.
If symptoms persist despite appropriate rehabilitation, additional treatment options may be beneficial, including:
Physiotherapy
Trigger point therapy
Soft tissue release
Patellar taping
Foot orthotics (insoles)
Biomechanical assessment
Activity modification advice
At Elite Joint Solutions, we assess the entire kinetic chain—from the foot through to the hip—to identify the factors contributing to your knee pain and develop an individualised treatment plan.
Footwear and Orthotic Insoles
The position of your feet has a significant influence on the alignment of your ankles, knees and hips. In many people with anterior knee pain (patellofemoral pain syndrome), the feet roll inwards excessively during walking or running—a movement known as overpronation.
When the foot overpronates, the arch collapses and the shin bone (tibia) rotates inwards. This inward rotation can cause the knee to move into a more inward (valgus) position, altering the way the kneecap (patella) tracks within the groove at the front of the knee. Over time, this abnormal movement can increase pressure behind the kneecap, contributing to pain during activities such as walking, running, climbing stairs, squatting or getting up from a chair.
Supportive footwear and prescription or off-the-shelf orthotic insoles can help improve these mechanics by supporting the arch of the foot and reducing excessive pronation. By improving foot position, the forces travelling through the ankle, knee and hip become more balanced, which may help improve patellar alignment and reduce irritation within the patellofemoral joint.
It is important to understand that insoles do not physically "move" the kneecap back into place. Instead, they help optimise the alignment of the entire lower limb, reducing abnormal stresses on the knee during movement. When combined with strengthening exercises for the quadriceps, gluteal muscles and core, they can form an important part of a successful rehabilitation programme.
At Elite Joint Solutions, we perform a detailed biomechanical assessment to identify whether abnormal foot posture is contributing to your knee pain. We assess:
Foot posture and arch height
Degree of overpronation
Walking and running biomechanics
Alignment of the ankle, knee and hip
Muscle strength and flexibility
Patellar tracking during movement
Following this assessment, we can recommend the most appropriate orthotic solution for your individual needs. One of the insoles we commonly prescribe is the Vasyli Red Orthotic, which provides excellent arch support while maintaining comfort for everyday activities, work and sport.
Choosing supportive footwear is equally important. Worn-out trainers or shoes with poor arch support can allow excessive foot movement and place additional strain on the knee. Replacing old footwear and selecting shoes with good stability, cushioning and motion control can often make a noticeable difference to symptoms.
Research suggests that foot orthoses are particularly beneficial for patients with patellofemoral pain who demonstrate excessive foot pronation or other biomechanical abnormalities. They appear to be most effective when used alongside a structured rehabilitation programme rather than as a standalone treatment.
Bespoke Orthotic Modifications
Many of the insoles we prescribe are high-quality prefabricated orthotics, such as the Vasyli Red Orthotic. However, very few patients have identical foot mechanics, which is why we frequently modify these insoles to better match your individual biomechanics.
Following a detailed biomechanical assessment, we may add forefoot posting, rearfoot posting, or a combination of both. These small wedges alter the position of the foot, helping to improve alignment throughout the ankle, knee and hip.
For example:
Rearfoot posting can help control excessive heel movement and reduce overpronation during the early stages of walking.
Forefoot posting can improve the position of the forefoot during the later stages of gait, helping to optimise weight distribution and improve lower limb alignment.
By combining these modifications, we can often improve the alignment of the entire lower limb, helping to reduce excessive inward rotation of the leg and improve the tracking of the kneecap (patella). This can reduce abnormal loading through the patellofemoral joint and may help relieve anterior knee pain.
One of the major advantages of this approach is that it allows us to create a semi-bespoke orthotic tailored specifically to your biomechanics. Rather than spending £400 or more on a fully custom-made orthotic, many patients achieve excellent results using a high-quality prefabricated insole that has been expertly modified to meet their individual needs.
Our advanced practitioners have extensive experience in lower limb biomechanics and orthotic prescription. Following your assessment, we'll determine whether simple footwear advice, a standard orthotic, or a modified orthotic with forefoot and/or rearfoot posting is most appropriate for your condition.
While some patients with complex foot deformities or significant structural abnormalities may still benefit from a fully custom orthotic, many people with anterior knee pain, overpronation and common lower limb conditions can achieve excellent outcomes with a professionally modified prefabricated orthotic at a fraction of the cost.
Conclusion
Anterior knee pain is a common and often frustrating condition, but it responds extremely well to the correct treatment approach. Improving flexibility, restoring muscle balance, and addressing biomechanical factors can significantly reduce pain and help you return to normal activities.
If you are struggling with persistent anterior knee pain or patellar maltracking, our team at Elite Joint Solutions can help In Bristol
References
British Journal of Sports Medicine Best Practice Guide to Patellofemoral Pain (2024).
American Physical Therapy Association Clinical Practice Guideline for Patellofemoral Pain (2019).
National Institute for Health and Care Excellence Guidance on musculoskeletal conditions and exercise therapy.
Barton CJ, Lack S, Hemmings S, Tufail S, Morrissey D. The "Best Practice Guide to Conservative Management of Patellofemoral Pain." British Journal of Sports Medicine.
Crossley KM, van Middelkoop M, Callaghan MJ et al. Patellofemoral Pain Clinical Practice Guideline. Journal of Orthopaedic & Sports Physical Therapy.
Collins N, et al. Foot orthoses in lower limb overuse conditions: a systematic review and meta-analysis. Br J Sports Med. 2007.
National Institute for Health and Care Excellence. Clinical Knowledge Summary: Patellofemoral Pain Syndrome.
Journal of Orthopaedic & Sports Physical Therapy. Patellofemoral Pain Clinical Practice Guideline. 2019.
British Journal of Sports Medicine. Best practice guide for patellofemoral pain. 2024.
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