Talk to Orthopedic Surgeon on Sharp Knee Pain

I’m 29 years old and have been involved in sports activities since a very young age. I started gym training in 2017 and initially had no problems with my legs. I used to do heavy leg workouts regularly without any issues. After I started working, I became inconsistent with training and sometimes stopped going to the gym for long periods. Around 2023, I was no longer training my legs regularly, and my leg strength had decreased. In 2023, when I decided to return to proper leg training, I first spent around 2–3 weeks doing lighter workouts. After that, I increased the weight during hack squats. During one session, I suddenly felt a sharp pain underneath my left kneecap. I stopped the workout, and the pain eventually disappeared. However, after that incident, whenever I tried to put heavier loads through my legs, the pain would return, particularly with weighted squats, lunges and hack squats. I could perform these movements with bodyweight or very light/no weight without pain, but as soon as I increased the load, the pain would come back. Because of this, I stopped doing weighted squats, lunges and hack squats. I then worked on strengthening my hips and hamstrings and did mobility exercises for my hips, ankles and surrounding muscles/joints. Interestingly, I have never experienced this pain on the leg press machine, even when using weight. The pain mainly occurs with weighted squats, lunges and hack squats. In normal daily activities, I have no pain or limitation. I can walk, sit and perform normal activities without any problem. The pain specifically appears when I put significant resistance/load through my legs during certain exercises. Recently, after being careful with my training and mainly using lighter weights, I thought the problem had resolved. However, when I tried walking lunges again, the same sharp pain underneath my left kneecap returned, so I stopped the exercise. I have also played football on and off over the years. There has been no major traumatic injury that I can recall. The problem has essentially been present since the 2023 hack squat incident and is reproducible with certain loaded movements. I would appreciate your assessment of what could be causing this and whether you think I need any imaging, such as an X-ray or MRI, or whether physiotherapy/strengthening would be more appropriate.

I’m 29 years old and have been involved in sports activities since a very young age. I started gym training in 2017 and initially had no problems with my legs. I used to do heavy leg workouts regularly without any issues. After I started working, I became inconsistent with training and sometimes stopped going to the gym for long periods. Around 2023, I was no longer training my legs regularly, and my leg strength had decreased. In 2023, when I decided to return to proper leg training, I first spent around 2–3 weeks doing lighter workouts. After that, I increased the weight during hack squats. During one session, I suddenly felt a sharp pain underneath my left kneecap. I stopped the workout, and the pain eventually disappeared. However, after that incident, whenever I tried to put heavier loads through my legs, the pain would return, particularly with weighted squats, lunges and hack squats. I could perform these movements with bodyweight or very light/no weight without pain, but as soon as I increased the load, the pain would come back. Because of this, I stopped doing weighted squats, lunges and hack squats. I then worked on strengthening my hips and hamstrings and did mobility exercises for my hips, ankles and surrounding muscles/joints. Interestingly, I have never experienced this pain on the leg press machine, even when using weight. The pain mainly occurs with weighted squats, lunges and hack squats. In normal daily activities, I have no pain or limitation. I can walk, sit and perform normal activities without any problem. The pain specifically appears when I put significant resistance/load through my legs during certain exercises. Recently, after being careful with my training and mainly using lighter weights, I thought the problem had resolved. However, when I tried walking lunges again, the same sharp pain underneath my left kneecap returned, so I stopped the exercise. I have also played football on and off over the years. There has been no major traumatic injury that I can recall. The problem has essentially been present since the 2023 hack squat incident and is reproducible with certain loaded movements. I would appreciate your assessment of what could be causing this and whether you think I need any imaging, such as an X-ray or MRI, or whether physiotherapy/strengthening would be more appropriate.