Chronic Knee Cap Pain Guide – Common Causes, Diagnosis and Best Treatments

If you are suffering with chronic knee cap pain, then you may have one of the most common knee problems called Pre-arthritis, also known as Patellofemoral Syndrome (P.F.S), Runner’s Knee and Chondromalacia.

These are all the same knee problem just to confuse you.

This knee problem is often missed by doctors because it does not show on x-ray or MRI scan.

What is Pre-Arthritis, Chondromalacia, Patellofemeroal Syndrome or PFS that’s Causing My Knee Pain?

Early damage to the knee cap (patella) cartilage, causing pain and inflammation. Often this cartilage damage progresses to full common knee arthritis or osteoarthritis.

Signs and Symptoms – usually mild intermittent swelling with pain around knee cap ( aka patella knee pain) or more commonly on inside (medial).

The pain is diffcult to localize and is common on certain activities.

You may suffer with…

  • pain below knee cap
  • pain above knee cap
  • pain under knee cap
  • generalized knee cap or patella pain

Knee pain is worse during activities like running, jumping, squatting, kneeling, sitting, doing stairs and standing. You feel better with rest, ice and inactivity.

Diagnostic Testing – diagnosis is best by history, symptoms and physical exam. Knee arthroscopy will confirm diagnosis but is not really needed or recommended. X-rays and MRI scans will usually read as normal.

Common Causes – poor joint mechanics from misaligned bones often with functionally flat feet (overpronation) leads to knee cap (patella) mal-tracking which irritates and eventually wears the back of the kneecap cartilage.

3-Step Treatment

Step 1) Reduce Inflammation and Pain– ice, *natural anti-inflammatory supplements and treatments – not drugs, knee brace, patellar taping (McConnell), knee exercises for joint synovial fluid movement and VMO strengthening, physical therapy

Step 2) Find and Correct the Cause– knee exercises, arch support inserts (foot orthotics), proper shoes, knee pads, avoid eating inflammatory foods

Step 3) Prevent Knee Pain and Inflammation from Returning – knee exercises to strengthen weak muscles, strength weight training, cardiovascular fitness, foot inserts (orthotics), proper shoes, anti-inflammatory diet, fish oil, vitamin D3 supplementation to normal levels, natural anti-inflammatory supplements with healthy-joint nutrients

*Anti-inflammatory drugs are not recommended as a first choice for two reasons: serious side effects like bleeding ulcers, heart attacks and pre-mature death; and, this class of drugs actually accelerates cartilage damage causing common arthritis up to three times faster.

Natural Anti-inflammatories with healthy – joint nutrients are a much superior choice because they relieve pain and inflammation while rebuilding and protecting cartilage.

Last Resort and All-Else-Fails Common Knee Treatments – anti-inflammatory drugs, cortisone injections, Hyaluronic injections, Knee Replacement Surgery .


I’ve seen Doctors recommend either cortisone or Hyaluronic acid injections (Synvisc) for Pre-arthritis. Cortisone softens and increases cartilage damage.

In my experience, Hyaluronic acid injections are a minimally-effective treatment for common knee arthritis and have no place in the treatment of Pre-arthritis or Patellar Femoral Syndrome knee pain.

Also, micro fracture surgery has been a big failure. The author had one and it was not good. The studies results were poor,


Other causes of knee cap pain

  • Chronic Subluxing or Dislocating Kneecap (Patella)
  • Osteoarthritis or common arthritis
  • Patellar Tendonitis (Osgood-Schlatter Disease in teens and children)
  • Prepatellar Bursitis
  • Quadriceps Tendonitis

Knee cap (patella) dislocation or Subluxation – swelling is usually severe.

Knee joint pain is usually on the inside (medial).

Knee cap usually dislocates (slides) too far to the outside.

Common causes include –

* high velocity fall or major force trauma from car accidents and sports like football, rugby, hockey, soccer, basketball

* pre-disposition towards poor joint alignment (excessive knee valgus)

Knee Osteoarthritis or common knee arthritis – damage to cartilage leading to degenerative joint disease usually from a knee injury. Knee swelling is usually mild.

Common causes include –

  • major knee trauma from falls and sports injuries
  • high velocity injuries from accidents
  • minor repetitive trauma from poor joint mechanics, running, jobs that involve squatting and kneeling
  • poor joint nutrition, lack of Omega 3, low-level vitamin and mineral intake from diet with inadequate fruits and vegetable consumption, low vitamin D3, poor glucosamine and chondroitin intake
  • genetics

Patellar Tendonitis – swelling is usually mild. Knee pain is just below the knee cap (patella) on the tendon.

Common causes include –

  • Sports involving running, jumping or squatting

Bursitis – a bursa is a small, fluid-filled sac which reduces friction wherever tendons ride over bones. Bursitis occurs when these sacs become inflamed. Swelling is usually mild. Pain location depends on the specific bursa being inflamed.

Common causes include –

  • Overuse of knee causing the tendons to rub on the bursa, causing inflammation
  • Trauma to the bursa

Rare causes of knee cap pain include ligament sprains, meniscus tears and Iliotibial Syndrome.

Hopefully, this helps you find the answer to your knee cap pain.

Please have your knee examined by a qualified medical doctor who is a sports medicine specialist or expert to confirm the diagnosis and  best treatment choice.