Why Your Knee Hurts: Understanding Knee Pain by Location

Why Your Knee Hurts: Understanding Knee Pain by Location

Knee pain isn’t random—it often gives us clues about what’s actually going on beneath the surface. Let's break down the most common types of knee pain based on where the pain is located, helping you better understand what's causing your discomfort and what you can do about it.

Pain Above the Kneecap

If your pain is located just above the kneecap, the likely culprit is quadriceps tendinopathy—a condition caused by repetitive stress on the tendon that connects your thigh muscle to your kneecap. Over time, this stress can lead to degeneration or even bone spurs at the attachment site. Luckily, this condition responds well to rehabilitation and strengthening exercises.

Pain Around or Behind the Kneecap

This is often due to patellofemoral pain syndrome, also known as runner’s knee. It’s typically caused by muscle imbalances, abnormal tracking of the patella, or even flat feet. While arthritis can also cause pain in this area, arthritis typically presents with swelling, whereas runner’s knee does not. Treatment usually involves correcting movement patterns through physical therapy and exercise.

Pain in Front of the Kneecap

Pain right beneath the skin but above the bone may point to prepatellar bursitis—inflammation of the bursa in front of the kneecap, often caused by prolonged pressure (like kneeling). Treatment includes ice, compression, and anti-inflammatories, but fluid may sometimes need to be drained by a doctor.

Pain Below the Kneecap

If the pain lies below the kneecap and runs down the front of the shin, the issue may be patellar tendinopathy, also known as jumper’s knee. This tendon transfers force from the thigh to the lower leg during dynamic activities like jumping and running. Another possible issue is infrapatellar fat pad impingement, where the fat pad under the kneecap becomes irritated. Both conditions can be managed with targeted rehab.

Pain on the Inside (Medial Side) of the Knee

Pain along the inside joint line may be due to medial meniscus tears or medial compartment arthritis—and sometimes both. Pain slightly above this area could be a medial collateral ligament (MCL) sprain, usually caused by a blow to the outside of the knee. Pain just below the inside of the knee could be pes anserine bursitis, often seen in people with muscle imbalances or poor mechanics. These conditions typically respond well to exercise therapy.

Pain on the Outside (Lateral Side) of the Knee

Pain here could indicate lateral meniscus tears or lateral compartment arthritis. Pain slightly above this region is commonly caused by iliotibial (IT) band syndrome, where a tight IT band causes friction and inflammation. Below the joint line, near the fibular head, pain may be due to common peroneal nerve irritation—often from trauma or frequent leg crossing. Often we find that your IT band is tight due to hip instability.

Pain Behind the Knee

Pain in the back of the knee may be caused by a Baker’s cyst—a fluid-filled sac that often develops due to underlying arthritis or meniscus injuries. When inflammation builds in the knee joint, it can collect behind the knee, causing discomfort and swelling.

Other Key Considerations

Two other conditions often get overlooked:

1. Arthritis – This can cause pain virtually anywhere around the knee depending on where cartilage loss is occurring.

2. Myofascial Trigger Points – These are tight, irritable spots in the muscles (like the VMO, vastus lateralis, gastrocnemius, and hamstrings) that can mimic joint pain. They’re commonly missed but can be treated effectively once identified.

Takeaway

Knowing where your knee hurts can give you—and your provider—important insight into what's causing the issue. Whether it's a tendon problem, cartilage degeneration, nerve irritation, or muscle imbalance, location matters. Fortunately, many of these issues respond well to targeted exercise, rehab, and proper diagnosis.

Want to learn more about your knee pain or how to treat it? Reach out to us at Live Active: Spine & Sport—we’re here to help you move better, feel better, and stay active for life.