Knee Pain in CrossFit, Running, Lifting

Are you a CrossFitter, runner, athlete experiencing pain at the front of your knee?

Knee pain can  be a frustrating and self-limiting injury, but it does not necessarily have to be. Often, there are ways to heal while continuing many of the activities you enjoy, and it may even be a critical part to the healing process to remain active and in the gym.

Here, we’ll explore common injuries at the front of the knee, treatment, possible causes—particularly in CrossFitters, and a few exercises I like to use in prevention and rehab.

Pain at the Front of the Knee

While there are many locations within and around the knee where you might be experiencing pain, one of the most common areas our crossfitters and runners complain about is anterior (front) knee pain below the kneecap along the patella tendon (depicted below) The patella tendon is part of one of the quadricep muscles called the rectus femoris which crosses at both the hip and the knee joint.

Pain and Provocation

Typically, this type of knee pain is reproduced with load when the knees travel over the toes or upon direct contact with a surface such as kneeling on the floor. This can be the result of a variety of factors including but not limited to:

  • Excess training without adequate recovery time

  • Poor movement mechanics

  • Weak hip or calf muscles

  • Tight IT band

  • Improper footwear

Acute vs. Chronic 

The type of injury or issue you are experiencing and how long it has lasted will impact the proper treatment and healing time.

When this is an acute injury (lasting between 0-6 weeks) it is referred to as “patella tendonitis,” and involves inflammation of the tendon at a local level. A chronic injury (anything over 6 weeks), however, is referred to as “patella tendonosis,” and involves structural changes at the tissue level.*

Both patella tendonitis and tendonosis fall under the umbrella term of “patella tendonopathy,” which is pathology of the tendon. Where you fall within this spectrum influences the timeline of healing; with an acute injury having a much faster recovery than a chronic one.

Treatment

If you are in the initial acute stage of patella tendonitis, treatment will focus on:

  • Load management: this doesn’t necessarily mean complete shut down of your activity but reducing the load or volume

  • Reducing inflammation

  • Isometrics and gradual loading of the patella tendon

  • Movement mechanics

If you are in the chronic phase of patella tendonosis, treatment will focus on:

  • Load management

  • Gradual loading of the patella tendon

  • Movement mechanics

  • Hip and knee strengthening

In both cases, it is essential for progressive and gradual loading of the patella tendon. But, remember, a full body examination is important to get to the root of the problem and will help to direct treatment. For example, ankle issues can affect up the chain and cause more stress at the knee and weak hips can cause overuse at the patella tendon because you are not able to use your glutes or hamstrings as much. 

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Common CrossFit Presentations:

Common presentations I see within my CrossFit client population include:

  • Squatting or catching lifts too far forward in the toes

    • This puts a lot of stress on the patella tendon

    • In this case, it’s important to also address posterior chain strengthening of the glutes and hamstrings, as well as movement mechanics

  • Overuse / Under Preparation

    • We see this when it starts getting warm outside and all of a sudden there’s a lot of running in WODs with high volume running repeats 

    • This can cause overuse of the patella tendon if the athlete is not used to running at that volume and does not appropriately build to the volume

  • Limited thoracic extension

    • When you’re limited in thoracic extension, to counterbalance the weight, the athlete shifts forwards into their toes which puts a lot of pressure on the patella tendon

    • We commonly see this in overhead squats or snatches

  • Weak midline:

    • If you can’t hold your trunk upright by engaging through your core, the athlete will bend at the trunk and be forward in their toes during lifts, putting more stress on the patella tendon

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3 Accessory Exercises for Anterior (Front) Knee Pain

These accessory exercises are just a few that I like to use in the preventative and rehab stages to focus on gradually loading the patella tendon:

  1. Heel Elevated Goblet Squat: Use a wedged box or plates under your heels and then proceed to squat. Start body weight and then progress to weighted using a dumbbell or kettlebell.

  2. Spanish Squat: Use a heavy band that is appropriate for your bodyweight. Wrap the band around a rig and step each foot into the straps. Keeping your chest up, sit back into your heels as you lower into a squat. Hold for 30 seconds.

  3. Anterior Step Down: Start with a smaller box then progress to higher height. Keeping your stance foot on the box and flat, lower your front heel to the ground then rise to stand. If you have trouble balancing, you can hold a PVC pipe in your hand that is opposite to whatever foot is in front. 

You can view all of these exercises on our Instagram page @suarezsopt. If you are experiencing pain at the front of your knee, give these a try and progressively increase the load. 

But, if you’re experiencing significant and/or consistent knee pain (doesn’t stop when you stop) when using these exercises, or otherwise, be sure to stop and adjust. Keep in mind that identifying the source of your issue and creating an individualized plan often requires a more fulsome assessment. 

If you’re not getting to where you want to be on your own, reach out to me for a full assessment and recovery plan to help get you out of pain and back to achieving your goals: sarah@suarezphysicaltherapy.com!

 

About Sarah:

Sarah Clift is a Physical Therapist in the Capital Region with Suarez Sport & Orthopedic Physical Therapy. She is an avid CrossFitter and former gymnast who specializes in injury prevention and rehab in CrossFit and female athletes.

You can find Sarah at Suarez PT’s Latham location and CrossFit Spur.


Sources:

* Reinking M. F. (2016). CURRENT CONCEPTS IN THE TREATMENT OF PATELLAR TENDINOPATHY. International journal of sports physical therapy, 11(6), 854–866.

** Bass E. (2012). Tendinopathy: why the difference between tendinitis and tendinosis matters. International journal of therapeutic massage & bodywork, 5(1), 14–17. (https://doi.org/10.3822/ijtmb.v5i1.153)

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