A burning pain experienced when kneeling often indicates irritation or inflammation within the knee joint’s protective structures. This common musculoskeletal complaint results from the unique pressure kneeling places on the front of the knee. The knee joint relies on soft tissues, including fluid-filled sacs and tendons, to function smoothly. When these tissues become compressed or strained, they can send pain signals, often described as a sharp or burning sensation, especially when direct force is applied to the kneecap.
The Most Common Culprit: Prepatellar Bursitis
The most frequent cause of burning pain specifically upon kneeling is prepatellar bursitis, sometimes referred to as “Housemaid’s Knee.” This condition is associated with occupations requiring repetitive kneeling. Bursae are small, fluid-filled sacs that act as cushions between bone and soft tissues, reducing friction. The prepatellar bursa is located directly in front of the kneecap (patella), sitting between the skin and the bone.
Chronic, repetitive pressure, such as extended time spent kneeling on hard surfaces, can irritate this bursa, causing it to produce excess fluid and become inflamed. This inflammation results in noticeable swelling that feels soft and squishy directly over the kneecap. The distended bursa is compressed every time the knee bears weight in a flexed position, which triggers the burning or sharp pain when kneeling. Acute cases can also be caused by a direct blow or fall onto the knee, leading to a rapid onset of pain and swelling.
In addition to swelling and localized tenderness, the area may feel warm, which is a sign of inflammation. If bacteria enter the bursa through a scrape or puncture wound, the inflammation can become septic. Septic bursitis is a serious condition that may involve fever and chills. Prepatellar bursitis is the most common form of bursitis in the knee due to the bursa’s vulnerable position just beneath the skin.
When the Burning Signals Nerve or Tendon Issues
While bursitis is the most common diagnosis, a burning sensation can also point to issues involving nerves or tendons near the knee. True burning, tingling, or numbness often suggests nerve irritation, a condition known as neuropathy. The infrapatellar branch of the saphenous nerve, a purely sensory nerve, runs near the front and inside of the knee and is susceptible to compression or injury.
This nerve can become entrapped by surrounding tissues or scarred tissue following trauma or surgery, leading to sharp, burning pain, particularly with activities like squatting or kneeling. The pain from this nerve issue is typically felt on the inner aspect of the knee, distinguishing it from the central pain of prepatellar bursitis. Patellar tendonitis, often called Jumper’s Knee, is another condition that can cause burning pain.
Patellar tendonitis involves inflammation or damage to the patellar tendon, which connects the kneecap to the shinbone. Repetitive stress from activities like running or jumping causes micro-tears in the tendon, leading to pain and possible swelling just below the kneecap. Kneeling or getting up from a squat can be especially painful because the movement stretches the inflamed tendon, causing a burning sensation below the kneecap rather than directly on it.
Seeking a Diagnosis and Initial Care Steps
A medical professional typically begins the diagnosis with a physical examination and a detailed history of your symptoms, including when the pain occurs and its exact location. They will palpate the area to check for the characteristic superficial swelling and tenderness of bursitis or the specific tenderness of a tendon issue. Observing your knee’s range of motion is a standard part of the assessment.
Imaging tests may be used to confirm a diagnosis or rule out other issues, such as a fracture. An X-ray checks for bony problems, while an ultrasound or MRI visualizes soft tissues like the bursa or tendon to check for damage. If infection is a concern, the doctor may aspirate the bursa using a fine needle to draw out a fluid sample for lab analysis.
For immediate, initial care, the R.I.C.E. protocol (Rest, Ice, Compression, and Elevation) can help manage pain and swelling. Avoiding activities that cause pain, like kneeling or high-impact exercise, is necessary to allow the tissue time to heal. Applying ice to the affected area for 15 to 20 minutes several times a day helps reduce inflammation. Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may provide short-term relief from pain and swelling.
Professional Treatment Pathways
Once a specific diagnosis is confirmed, professional treatment can be tailored to the exact cause. For many cases of tendonitis and chronic bursitis, physical therapy (PT) is the primary intervention. PT focuses on strengthening the muscles around the knee and improving flexibility to stabilize the joint and reduce strain on the affected tissue.
In the case of patellar tendinopathy, a therapist often prescribes eccentric strengthening exercises, such as decline squats, which are effective in rebuilding the tendon’s load tolerance. For persistent inflammation that does not respond to conservative care, medical procedures may be necessary. Corticosteroid injections deliver a powerful anti-inflammatory medication directly into the inflamed bursa, providing relief.
If the bursa is severely swollen, a doctor may aspirate the excess fluid to relieve pressure. For chronic, debilitating cases of bursitis or nerve entrapment that fail to improve after months of conservative treatments, surgical intervention may be considered. This could involve a bursectomy to remove the problematic bursa or a surgical procedure to decompress an entrapped nerve.