Runner's knee is one of the most common reasons runners end up sidelined. It usually shows up as a dull ache around or behind the kneecap that builds during a run, flares on stairs and can linger after sitting for a long time. Despite the name, it affects plenty of non-runners too, including people who cycle, play court sports or squat regularly.
The encouraging part is that runner's knee usually responds well to a sensible mix of load management and strengthening. Understanding what drives it can help you keep moving while your knee settles.
What is runner's knee?
Runner's knee is the common name for patellofemoral pain, sometimes called patellofemoral pain syndrome. It describes pain coming from the joint between the kneecap (patella) and the thigh bone (femur). As you bend and straighten your knee, the kneecap glides in a groove at the end of the thigh bone, and the forces through this joint increase with deeper bending and faster movements.
Rather than a structural injury, patellofemoral pain is generally thought of as the joint and surrounding tissues becoming sensitive when they are loaded more than they are currently ready for. You can read more on our runner's knee page.
What does it feel like?
Runner's knee tends to have a fairly recognisable pattern. Common features include:
A dull ache around, under or behind the kneecap
Pain going up or down stairs, especially down
Discomfort with squatting, kneeling or lunging
Pain when running, particularly downhill or on longer runs
An ache after sitting with your knees bent for a long time, such as in a car or cinema
Occasional clicking or grinding without other symptoms, which is often harmless
Pain on the outside of the knee is more likely to be ITB syndrome, which is managed a little differently, so it is worth having the source of your pain properly assessed.
What causes it?
The most common trigger is a change in load. A sudden jump in weekly distance, adding hills or speed work, a new training program or a change in footwear can all tip the knee over its current capacity. Our blog on why runners get injured explores training load in more detail.
Other factors that may contribute include reduced strength in the quadriceps and hip muscles, the way your knee moves inward when you land, foot mechanics, and limited recovery or sleep. Often it is a combination of these rather than one single cause.
How is it diagnosed?
Runner's knee is usually diagnosed through a conversation about your symptoms and training, plus a physical assessment. Your practitioner may watch you squat, step down or hop, test strength around the hip and knee, and check the knee for swelling or other signs.
Scans are not usually needed for typical patellofemoral pain. Imaging may be considered if symptoms do not follow the expected pattern, if there was a specific injury, or if progress stalls despite good management.
How is runner's knee treated?
Exercise therapy is a cornerstone of care, and research suggests that combining hip and knee strengthening may help reduce pain and improve function for many people. Treatment is usually built around a few key areas:
Load management: temporarily reducing distance, hills or speed so the knee can settle, rather than stopping completely
Strengthening: progressive exercises for the quadriceps, glutes and hip muscles
Running technique: for some runners, small changes such as slightly increasing step rate may reduce load on the kneecap
Short term support: taping or foot orthoses may help some people manage pain while they build strength
A running assessment can help identify training or technique factors that may be worth adjusting. Our physiotherapists can guide you through a program that suits your goals.
When can I get back to running?
Many people can keep running in some form while they recover, as long as pain stays at a mild, manageable level during and after the run and settles by the next morning. Flat routes, shorter distances and softer surfaces may be easier to tolerate early on.
From there, distance and intensity are usually built back gradually. Recovery time varies, and some people improve within a few weeks while others need a few months of consistent work, particularly if symptoms have been present for a long time.
When should you see a GP or seek urgent care?
Seek prompt medical review if your knee locks, gives way, or swells quickly after a twist or fall, or if you cannot bear weight. A hot, red, swollen knee, especially with fever, needs urgent assessment. Children and teenagers with knee pain and a limp should also be checked promptly, as hip problems can sometimes be felt in the knee.
What can you do at home while it settles?
Small, practical changes during the week can make the knee easier to live with while you work through a rehab program.
- Use a simple pain scale during and after runs. Mild discomfort that settles by the next morning is generally fine, while pain that builds or lingers is a sign to ease back.
- Keep up fitness with lower load options such as cycling, swimming or deep water running.
- Break up long periods of sitting with your knees bent, as this position often aggravates the front of the knee.
- Take stairs one at a time or use the handrail on sore days.
- Be consistent with the strength exercises you have been given, since steady practice tends to matter more than intensity.
How can you lower the chance of it coming back?
Once your knee is feeling better, try to keep some strength work in your weekly routine, even just two short sessions. Build distance and speed gradually, plan lighter weeks into your training, and rotate running shoes before they are worn out. If you play other sports as well, our article on common sports injuries and our sports injury treatment page have more general tips.
Frequently asked questions
Does runner's knee mean I have arthritis?
Not necessarily. Patellofemoral pain is common in younger, active people and is not the same as osteoarthritis. Clicking or grinding on its own is very common and is usually not a cause for concern.
Should I stop running completely?
Complete rest is not usually required. Reducing the load to a level your knee tolerates, while strengthening, is generally more helpful than stopping altogether.
Will new shoes help?
Shoes can play a part, especially if your current pair is very worn or you recently changed styles. For most people, though, shoes are only one piece of the puzzle alongside training load and strength.
Getting help on the Gold Coast
If knee pain is getting in the way of your running or daily life, The Good Joint in Mermaid Beach can assess your knee and help you build a plan to return to the activities you enjoy. Find out more about our approach to knee pain, or book online and call 07 5651 6594 with any questions.
Related reading: What causes shin splints and how do you get back to running? and Does exercise help knee osteoarthritis?
