Sensible advice for aches, pains & injuries
Supposedly, women get more anterior knee pain than men. But the evidence still fails to support that theory.

Supposedly, women get more anterior knee pain than men. But the evidence still fails to support that theory.

Knee Pain in Women

Do women get more runner’s knee?

updated (first published 2008)
by Paul Ingraham, Vancouver, Canadabio
I am a science writer and a former Registered Massage Therapist with a decade of experience treating tough pain cases. I was the Assistant Editor of for several years. I’ve written hundreds of articles and several books, and I’m known for readable but heavily referenced analysis, with a touch of sass. I am a runner and ultimate player. • more about memore about

In October 2007, physician Elizabeth Arendt published a nice little summary of gender differences in kneecap pain in the The Journal of the American Academy of Orthopaedic Surgeons. With refreshing style and sass, the journal published it with the fun title, “Putting a little sex in your orthopaedic practice.”

She was writing, of course, not about “sex” but about gender — and the effect of gender on knee pain. Supposedly, women get more kneecap pain (patellar pain) than men. I’ve written about this extensively in my advanced patellofemoral pain syndrome tutorial. (This article is an excerpt.)

This is often attributed to structural differences … an allegedly scientific argument which can sound suspiciously sexist and old-fashioned when it comes from male experts, almost like they are arguing that the feminine knee is designed to be pretty and not functional. So I like the fact that Dr. Arendt is a woman talking about the issue, and she makes a number of excellent points.

Male experts can sound like they are arguing that the feminine knee is designed to be pretty and not functional.

But Dr. Arendt also contradicts herself a little. She starts out, quite correctly, by saying that there is not adequate science to support the idea that women get more kneecap pain. She then presents a bunch of that inadequate evidence — not really a single compelling study showing significant pain differences between the kneecaps of men’s and women’s kneecaps — but then, somewhat bizarrely, concludes that “clinical data do support that [kneecap] problems are more common in females.”

What’s going on here? Is Dr. Arendt confused? Or is this just semantics?

It’s more semantics. I think Arendt brings up a number of interesting studies that do indeed show that there are more “problems” with women’s knees … but not necessarily more painful problems, and that’s the odd, newsy thing that makes writing about this so interesting. (Hopefully reading about it is interesting, too!)

The only studies Dr. Arendt brings up (which were new to me) which really do show clear gender differences do not actually indicate a difference in levels of pain and suffering, but simply in the presence of problems which are not necessarily painful. Here are the clear differences:

Difference #1: Women really do have a lot more degeneration of the cartilage under their kneecap (see McAlindon and Dejour), a condition called “chondromalacia patellae.”

Difference #2: Women really do tend have looser kneecaps … although only after the first incident of a subluxation or dislocation (see Fithian). Yes, that’s right: the first time, this type of injury occurs at the same rate in men and women, but women have a harder time getting that kneecap to stay put afterwards, and will tend to have many re-injuries over the years compared to men.

Women have a harder time getting that kneecap to stay put after its first dislocation.

Now, those may sound like some pretty significant differences, and they are interesting. But the point I want to make really clear to my readers with knee pain is this:

Those conditions are not necessarily pain-causing. And neither of them is closely correlated with typical patellefemoral pain.

Kneecap pain is notoriously not closely associated with arthritis (chondromalacia patellae). Many people have pitted, cruddy looking cartilage under their kneecaps … and no pain whatsoever. And many people have nice smooth cartilage … and lots of pain. So the fact that women get chondromalacia patellae significantly more often than men is probably not particularly significant! At least, not so far as patellar pain is concerned.

As for the way women’s kneecaps tend to try to “escape” the knee more frequently after the first attempt than they do in men … well, we’re talking about the aftermath of an injury here, not standard aching kneecap pain. Indeed, standard aching kneecap pain is more likely after you dislocate your knee (that’s both logical, and supported by the evidence). But — and it’s a big “but” — we’re talking about an equal number of men and women. There is no difference in the rate of initial injury, just the rate of re-injury.

And the frequency of re-injury is relatively trivial as far as patellar pain is concerned. Standard aching knee pain is extremely common, while kneecap dislocations are quite rare by comparison. More frequent post-injury kneecap slippage has very little to do with overall rates of the standard aching kneecap problem … which happens to a huge number of people who’ve never dislocated anything.

Let’s all stop talking about kneecap pain like it’s particularly a problem for the ladies.

So, Dr. Arendt points out a couple of interesting differences in kneecap problems between men and women, but these differences are not especially important as far as patellofemoral pain is concerned. The case is not exactly “closed,” but I stand by my unconventional opinion that how women are built has not very much to do with kneecap pain. So let’s all stop talking about kneecap pain like it’s particularly a problem for the ladies until the evidence actually supports that theory. To date, that evidence just can’t be found — if anything, the evidence actually is pretty persuasive that there is not any such difference, as discussed in detail in the full tutorial.

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About Paul Ingraham

Headshot of Paul Ingraham, short hair, neat beard, suit jacket.

I am a science writer, former massage therapist, and I was the assistant editor at for several years. I have had my share of injuries and pain challenges as a runner and ultimate player. My wife and I live in downtown Vancouver, Canada. See my full bio and qualifications, or my blog, Writerly. You might run into me on Facebook or Twitter.

Related Reading

This article is a free chapter from’s huge patellofemoral pain syndrome (PFPS) tutorial, one of 96 chapters in all. There are also several other articles on about patellofemoral pain and related topics: