Pain behind the kneecap


Pain behind the kneecap is a relatively nonspecific symptom and can not be clearly assigned to a disease. Often the pain is evidence of overuse or increased wear due to increased cartilage wear.

For the doctor to be able to make a reliable diagnosis, radiological imaging is often necessary.

The reasons

The patella is exposed to great forces during exercise, so it may eventually lead to cartilage damage behind the kneecap and even cartilage parts are repelled. These cartilage damage occurs due to the heavy burden, especially in athletes. In the case of overloading, in addition to cartilage damage, the patellar spike syndrome - an inflammation of the patellar tendon - can also occur.

In addition to sports overload but also trauma or anatomical deviations (eg hip deformity or X-legs) can lead to cartilage damage. The cartilage behind the kneecap serves as a buffer and thus reduces the forces acting on the knee joint. If there is cartilage damage, there is often a so-called patellofemoral pain syndrome.

Furthermore, the so-called Plica syndrome can cause pain. Within the knee are several folds ( plicae ) of the joint mucosa. If it comes to the thickening of such a fold, for example in the context of inflammation, pain and restricted mobility usually result as a result. In addition, there is a fat accumulation behind the kneecap, which is called Hoffa's fat body referred to as. When falling on the knee, this fat body can tear or ignite when overloaded. In both cases there is stinging pain behind the kneecap.

With increasing age, there is also a degeneration of bones. In the area of ​​the knee, retropatellar arthrosis can develop. Not infrequently, however, the pain can occur even in adolescence. This is due to rapid growth, which changes the direction of the patellar tendon and is responsible for knee extensor thigh muscle is not strong enough. The remedy here is usually a targeted training of this muscle.

The knee joint effusion as cause

One cause of pain behind the kneecap may be a so-called knee-joint effusion. This is a collection of fluid behind the kneecap within the joint capsule. The fluid may be synovial fluid, pus or blood.

Such effusions are caused in different ways. A common cause of knee ligament injuries, such as a cruciate ligament, dar. Also a dislocated kneecap or often occurring in the elderly arthritis are typical causes of knee joint effusion. The effusion leads to a swelling of the knee, often with limited mobility and pain accompanied. In addition, redness may occur in the area of ​​the knee.

The knee joint effusion can be diagnosed by simple examinations. A possible diagnosis is called "dancing patella" or "dancing kneecap". If a "dancing patella" is diagnosed, the affected knee should be protected and stored as high as possible.

Knee joint effusion - how dangerous is that?

Osteoarthritis of the kneecap as a cause

The kneecap (patella) was next to the femur and the tibia (the tibia), the third joint partner of the knee joint. It is crucial for heavy loads on the knee as well as movements of the legs. There is an articular cartilage between the kneecap and the femur. This is increasingly worn by movement and pressure. With complete wear it comes to the fact that the two bones lie directly on each other. This condition is called knee osteoarthritis. He is usually associated with severe pain.

By applying pressure to the patella, for example when working on the knees, or by general heavy load on the knee, for example, by lifting heavy loads, the kneecap is heavily loaded. With permanent loading this can lead to osteoarthritis of the kneecap. In addition, knee osteoarthritis may also have anatomical causes. Thus, in the case of a lack of fitting of the patella and femur, friction may arise, which ultimately leads to osteoarthritis. Runners in particular are at risk of knee osteoarthritis due to their heavy strain and movement of the knee.

The sporting activity as a cause

During or after exercise, especially after jogging, it can cause knee pain. These can have different causes. Typical causes are muscular dysbalances of the thigh muscles, congenital leg deformities (so-called "O-leg" or "X-legs") or instabilities of the hip and ankle.

In addition, a wrong running style can lead to pain behind the kneecap. For example, if you're jogging your knee too much and thus exerting increased pressure on the kneecap, you can cause inflammation of the cartilage below the kneecap. This inflammation eventually leads to a strong feeling of pain behind the kneecap and should be treated with restraint.

The patellar tendon syndrome as a cause

As Patellaspitzensyndrom one calls an inflammation of the Patellasehne. The patellar tendon runs from the lower edge of the kneecap to the upper edge of the tibia.

An inflammation of the patellar tendon usually has its cause in an increased or unfamiliar tensile load of the tendon. Frequently such inflammation occurs in jump-intensive sports such as volleyball or basketball as well as long-distance runners.

Patellar tendon syndrome can vary in size and is therefore divided into four degrees. Depending on the degree, the symptoms already occur at rest or only on exercise. The inflammation of the tendon is usually treated conservatively, ie without surgical intervention. Physiotherapy, massages, bandages, stretching exercises as well as medications and ointments can improve your symptoms.

Morbus Sinding-Larson as the cause

As Sinding-Larson disease is called a synonym for the Patellaspitzensyndrom. However, the term refers to the inflammation of the patella tendon especially in children and adolescents. Frequently, this inflammation or injury to the tendon occurs in the course of growth. Through the growth, small cracks and thereby inflammations can develop in the tendon, which finally stimulate cartilage growth. The resulting pain comes from the tendon insertion of the lower patella.

The symptoms

In addition to the pain behind the kneecap, swelling of the knee joint and a grinding, grinding noise often occur during the examination. If this symptom triad occurs, this can be regarded as an indication of a retropatellar cartilage damage (= cartilage damage behind the kneecap). The pain that occurs is often dull and diffuse, so that the affected person can not locate it clearly. During exercise, the pain usually increases. Even with normal movements like climbing stairs or squatting. These everyday complaints are typical of diseases related to the kneecap. In part, the patients also describe an increasing stiffness of the knee.

If, in addition to the cartilage damage, there are still free cartilage pieces in the joint, this often results in a restriction of movement, since the joint is blocked by the cartilage piece and causes pain behind the kneecap.

When bending or stretching

When bending and stretching the knee, large forces act on the kneecap, often resulting in pain behind the kneecap during these movements. If the human had no kneecap, a stretching of the leg would hardly be possible.

When climbing stairs

Pain behind the kneecap does not only occur during physical activity. Especially when climbing stairs or going downhill, the knee is bent to one and is at the same time compared to normal running, exposed to increased pressure, so that patients, for example, with a cartilage damage, especially when climbing stairs feel pain. When climbing stairs, there is an increased pull on the kneecap and the patellar tendon.

Under pressure

Typical of knee pain is that they usually occur under load when greater pressure is applied to the knee, while the pain is no longer present under rest.
Cycling is usually a sport that is recommended to patients with knee problems, as the knee is moved but not exposed to great force, such as jogging. However, if, for example, there is a so-called "runner's knee", in which an inflammation of a large tendon plate ( iliotibial tract ) has occurred, it can lead to discomfort in the area of ​​the patella after a long period of cycling or jogging. These tendons glide over the joint when flexing and stretching the leg, which happens in high frequency during cycling, and it hurts when inflammed.

The diagnosis

First, the doctor first clinically examines the knee, to see what structure is probably the cause and / or to specifically check when the pain is greatest. As a further step, an ultrasound examination is often added, with which it can be checked whether there has been a thickening or inflammation of a tendon. Inflammation often causes a knee joint effusion (fluid accumulation in the knee joint), which can be detected by ultrasound. In some cases, an X-ray or even an MRI scan must be consulted for diagnosis, for example, to conclude a cartilage damage or ligament injury.

For example, cartilage damage, which often causes pain behind the kneecap, is more likely to result in an audible grating of the kneecap during clinical examination, since in this case bone rubs more on bones and not on protective cartilage is separated from each other.
Also, calcifications, for example, in a chronic tendinitis, can be determined by means of an X-ray.

The therapy

The therapy for pain behind the kneecap usually consists of a conservative, non-operative, therapy. You can choose from a number of therapy procedures that are often used in parallel. On the one hand, anti-inflammatory and analgesic medications can be used when the pain is no longer sustainable otherwise. Pain relieving ointments such as Voltaren® are also frequently used for this purpose. Especially with inflammation of the tendon approach, local injections of painkillers play a major role, which usually provide immediate relief.

Furthermore, cold in the form of ice envelopes can improve the symptoms. In order to not only alleviate the symptoms in the short term, physiotherapy exercises can be used for targeted muscle training to relieve the knee joint itself, so that the muscles can absorb the force acting on them. During muscle training, especially the muscles of the thigh are trained, as these can best stabilize the knee.
In addition to physiotherapy, the orthopedist may also prescribe treatments such as ultrasound, electrotherapy or manual therapy. Many athletes also like to wear knee-joint bandages in the disease phase, as these stabilize the joint and additionally relieve the pain. In addition, they are advised to keep their knees quiet for a certain period of time or to significantly reduce their performance, so that regeneration can occur. Often the protection should take place over a period of eight weeks. If complete restraint is not required then sport like swimming or cycling is an alternative.

In the case of a patella dislocation is often indicated by a restraint by a bandage or orthosis. Subsequently, however, follows a muscle-building therapy. If you have problems with knee problems you should do without high heels and hard soles. Obesity is also a risk factor, so weight loss should be considered.
If the treating orthopedist detects a cartilage damage, it can be repaired using a minimally invasive procedure (knee arthroscopy = knee joint mirroring), for example by smoothing the cartilage. If it comes to a detachment of cartilage, they can also be removed in the context of arthroscopy from the joint. If a patient suffers from repeated dislocations of the kneecap, the loosened retaining band of the patella can be surgically replaced with the help of a body-own tendon, thus stabilizing the knee again.

The exercises

The exercises, which can be done independently at home, aim primarily to strengthen the thigh muscles. Another effect is that the knee is increasingly supplied with blood and consequently the cartilage is better supplied with blood, which itself has no own blood vessels, but is supplied with nutrients via diffusion. An exercise that primarily benefits the cartilage is performing squats. The arms should still be stretched forward and the knees should not protrude the toes.

Important, and this applies to all exercises, but is that you do not overload the knee through the exercises. Also convenient for the knee is cycling. The knee is moved, but is not exposed to excessive pressure. Other exercises that can be done well at home are:
let the knee swing while sitting. This promotes especially the formation of synovial fluid. Stretching the knee while sitting and holding it for a while also has a beneficial effect on the thigh muscle, which can relieve the knee. Furthermore, to strengthen the thigh muscle ( quadriceps ), a leg at the ankle can be placed in a sling (for example a towel) and pulled slowly upwards through the arms. This exercise will stretch the quadriceps and permanently stabilize the knee joint. It is also favorable to carry out a lunge step. This position is then held for some time while making small rocking movements.

Can a knee bandage help?

Knee straps are often recommended for pain behind the kneecap or general pain in the area of ​​the knee. These bandages are said to provide additional stability and pain relief within the knee joint. This can prevent muscular imbalances and instabilities within the knee joint. In addition, it supports the kneecap, so that they can not stretch out as a rule.

In addition to the bandages, physiotherapy is also recommended to strengthen the muscles in the thigh and knee area.


Since the pain behind the kneecap are triggered by various factors can be formulated flat rate no prognosis. Often, the pain can be reduced by a physiotherapeutic treatment, in particular, the muscles is strengthened to relieve the knee, reduce or completely off.

Even a short break in training is often enough, so that the knee has time to regenerate. If there is cartilage damage, the damage and thus also the pain can usually be remedied by means of a knee joint arthroscopy.

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