Runner's Knee

Runner’s knee, medically known as patellofemoral pain syndrome, describes pain arising from the kneecap tracking or loading unevenly against the groove in the thigh bone it sits in. Despite the name, it’s not limited to runners — it’s just as commonly seen with squatting, stair climbing, cycling, and even prolonged sitting with the knee bent, which is why some people notice it without doing any running at all.

It’s one of the most common knee complaints physiotherapists see, particularly among people who are increasing their training volume, returning to running after a break, or adding hills, speed work or trail running into a previously flat, steady routine.

What causes runner’s knee

The kneecap normally glides smoothly within a groove on the thigh bone as the knee bends and straightens. When the forces acting on it become uneven — commonly due to weakness through the hip and gluteal muscles, which affects how the whole leg aligns during movement — the kneecap can begin to track slightly off-centre or load unevenly against the groove, irritating the tissue underneath and around it.

Training factors are usually part of the picture too. A sudden increase in running volume, intensity, hill work, or a change in running surface, all increase load on the knee faster than the tissue has adapted to handle. Tightness through the surrounding muscles — particularly the outer thigh and calf — can also contribute by altering how the kneecap sits within its groove. In most cases it’s a combination of these factors rather than a single cause, which is why a generic stretch-and-rest approach often doesn’t resolve it on its own.

Symptoms

Runner’s knee typically causes a dull, aching pain around or behind the kneecap, rather than sharp pain in a single specific spot. It’s commonly worse with running, squatting, stairs — especially descending — and after sitting for a long period with the knee bent, sometimes called “movie theatre sign.” Some people also notice a grinding or crunching sensation with knee movement, though this alone isn’t a cause for concern.

When to see a physiotherapist

Most runner’s knee responds well to an assessment and targeted strengthening programme without needing imaging. It’s worth seeing Andrew earlier rather than later if pain is limiting your training, if you notice swelling, locking or a sense of the knee giving way, or if pain persists despite reducing your running load — these features warrant a closer look to rule out other causes of knee pain that need a different approach, such as a meniscal tear or ligament injury.

It’s also worth distinguishing runner’s knee from other common causes of anterior knee pain, since the treatment differs. Pain that’s sharply localised below the kneecap and worse with jumping can point toward patellar tendon irritation rather than patellofemoral pain, while pain on the outer side of the knee, particularly during longer runs, may suggest ITB syndrome instead. Andrew’s assessment includes specific tests to identify exactly which structure is involved before building your treatment plan.

Physiotherapy treatment for runner’s knee

Andrew’s assessment identifies exactly what’s driving the uneven loading in your case, then builds a treatment plan around it:

• Manual therapy and soft tissue work to ease tightness through the outer thigh, quadriceps and calf, and manage pain in the early stage
• Exercise rehabilitation — a targeted strengthening programme focused particularly on the hip and glutes, which is usually the single biggest factor in how the kneecap tracks, alongside quadriceps strengthening to support the knee directly
• Training load review — assessing your recent running volume, intensity and terrain changes to identify what triggered the current flare-up
• Running technique guidance, where relevant, to address movement patterns that may be contributing to the uneven load

Complete rest from running usually isn’t necessary and doesn’t address the underlying strength deficit — Andrew will guide how much running remains appropriate while you work through the strengthening programme, adjusting as your symptoms and capacity improve.

What to expect from treatment

Many cases of runner’s knee improve significantly within 6 to 8 weeks of a consistently followed strengthening programme, though this depends on how long symptoms have been present before starting treatment and how closely the programme is followed between sessions. Because hip and glute strength takes time to build, meaningful pain relief often comes before the underlying strength deficit is fully resolved — which is why continuing the programme after symptoms settle matters for preventing recurrence.

Preventing recurrence

Runner’s knee has a tendency to return if training load increases again without the strength gains to support it. Addressing the hip and quadriceps strength behind the original problem, rather than just resting until the pain settles, is what reduces the chance of it recurring once you’re back to full training. Andrew’s review of your training habits — how quickly you increase volume, intensity and terrain — is aimed at the same goal.