pain on inside front of knee

i have a pain/tenderness/soreness type feeling directly to the inside side of my patella when squatting, walking up or down stairs or even staying in a pushup position and tensing my quads. i also notice that if i look at my knee while squatting, i see what look like stretch marks pulling from my knee cap towards the inside of my knee.

i am not sure if i brought this on from doing too many step-ups and squats in one session after a period of leg inactivity, or if its something unrelated.

for a long time now, both of my knee caps also click/crack like a rock tumbler when doing anything that moves my leg from greater than 90 degree flexion to extension(deep squat, high step, etc.), even if its only a bodyweight load. i also get this clicking many times even with zero load, such as when lying on my back and bending and straightening my lower leg.

what is the problem and what do i do to get rid of this pain? same goes for the clicking/cracking

How long has the pain been going on? Anything specific you recall doing? Is the pain more along/under the patella itself or more towards the joint line of the knee?

If it is more toward the joint line, I'd be concerned with meniscal damage.

If it is more towards/under the patella, there are a variety of things it could be. Depending on your age, might be a CMP issue. With the clicking/cracking you describe, it is likely a plica band irritation and/or PFS. How are your quads, adductors, and hip flexors tissue health and length? Mobility in hips and ankles good?

Without any additional information, I would say to get some anti-inflammatories (whether you decide to go homeopathic/supplement or pharm in nature is your call). If you haven't been doing it already, definitely start up foam rolling your legs and hips and begin some mobility drills for your hips. Basic exercises I'd recommend would be some glute activation drills along with TKEs.

In addition to the above, if I recall correctly based off of your past posts, you have had some distance running in your training regiment in the past. If that is still included in your training, I would limit some of the volume there until this settles.

the clicking has been going on for years and never causes pain, but the pain just began about a week ago. the pain literally follows right along the inside side of my patella and patellar tendon(below the patella, not above it towards the thigh). if i extend my leg and really flex my quads hard, i get some pain directly under my patella also.

mobility in my hips and lower body in general is terrible although i have started stretching and am trying to improve. i will order a foam roller. do you have any suggestions as to which kind to buy?

could this be caused by an imbalance between hamstrings and quads? for lower body, aside from running, the only exercise i have been doing lately is deadlifting, and i guess due to my body type, i find it to be a MUCH more hamstring dominant exercise than quads. my glutes are definitely not well developed(typical white guy flat butt) despite being able to deadlift around 2x bw.

what is a cmp issue? i am in my late 20s.

For foam rollers, I recommend the following:
1) From EliteFTS - a 12"x6" roller. I own one since I am constantly traveling and it fits great into a suitcase and easy to bring to a gym. Also, for $10 it's a great price and very good quality. They also have a 36"x6" one as well if you prefer the full length foam roller.

2) From Perform Better: EVA Foam Rollers. Good quality, but personally prefer the next foam roller if going to order from Perform Better.

3) From Perform Better: PB Elite Molded Foam Rollers. My preference of foam rollers offered by Perform Better.

CMP = Chondromalacia patella. It is more common amongst adult population with years of grinding to the undersurface of the patella, but can be seen in younger populations as well.

As far as an imbalance between quads and hamstrings, it is possible, but I'd lean more towards a glute inactivity. And as you stated, you feel your glutes are relatively weak.

The deadlift SHOULD be a posterior chain (glute and hamstring) dominant exercise. If it isn't, then you are likely performing the exercise incorrectly. What is your current weight? Just trying to get an idea of numbers you are lifting for deadlifts. Also, if you do have inactive gluteals, the 2x bw lift may be due to compensation from overactive hamstrings or altered technique leading to more quad recruitment (example: starting the lift from more of a squat position than a hip hinge position).

Also, if you feel your glutes are inactive, than it makes sense that you would have medial knee pain. First, with inactive glutes, the knee will tend to fall into valgus more, placing more structural medial stress on the knee. Second, with the deadlift, if the glutes are not activating as they should, then the excess load will then get placed on the hamstrings. Once the hamstrings hit their max ability, then the adductor magnus (along with other hip extensors) will end up contributing as well. With the extra stress on the adductor magnus, it can create tension on the medial knee, as well as cause other adductors to have to activate more for stability purposes and cause more medial knee tension.

i weigh about 155 lbs. i definitely feel like the deadlift is primarily a hamstring exercise for me.

What do you perform in terms of glute activation exercises? If you hip flexors are overactive and tight, they will also cause an automatic inhibition of your gluteals, so make sure you are addressing any hip mobility restrictions as well.

i do nothing specifically for glutes. for the past month or so, due to work schedule, the only exercises i was performing that involved lower body were running, deadlifts, and using the versaclimber. before this hectic past ~4 weeks, i also used to do a lot of bodyweight squats, lunges and step-ups.

i think i overdid it last week when i added those bodyweight exercises back into my routine. i did a circuit of squats and lunges, pretty high volume...maybe i got too tight after the weeks of using my legs less than normal and not stretching, and then overdoing it on my first day back into a normal routine just flared up some kind of tendonitis issue compounded by improper tracking of my patella.