Runner’s Knee, known clinically as Patellofemoral Pain Syndrome (PFPS), is one of the most common causes of anterior knee pain in active individuals. The condition does not only affect runners, but also hikers, gym-goers, and people involved in repetitive knee-loading activities like stair climbing (Collins et al., 2018).

PFPS describes pain around or behind the patella, often triggered by activities that load the knee joint particularly in a flexed position. This pain is thought to result from excessive stress on the patellofemoral joint due to poor movement mechanics, muscular imbalances, or overuse (Witvrouw et al., 2014).

Understanding the Knee’s Anatomy

The patella sits within the trochlear groove of the femur and glides up and down as the knee bends and straightens. This movement is guided by the quadriceps, hamstrings, gluteal muscles, and hip stabilisers. Weakness or imbalance in these muscle groups can alter patellar tracking, increasing pressure on the joint and leading to irritation (Bolgla & Boling, 2011).

Common Symptoms

People with Runner’s Knee may experience:

• A dull, aching pain around or behind the kneecap.
• Pain is made worse by running, jumping, climbing stairs, squatting, kneeling, or prolonged sitting with the knees bent (Crossley et al., 2016).
• A grinding, clicking, or instability sensation in the knee.
• Mild swelling or puffiness around the kneecap.

Why Does Runner’s Knee Happen?

PFPS is usually caused by a combination of factors:

• Overuse or training errors: sudden increases in running distance, speed, or frequency without proper rest.
• Muscle weakness or imbalance: especially in the glutes, quadriceps, and hip stabilisers (Barton et al., 2015).
• Tight soft tissue: such as the iliotibial band, hamstrings, or calves
• Poor biomechanics: e.g. knee valgus or excessive foot pronation (Neal et al., 2019).
• Inappropriate footwear: worn-out shoes or poor arch support.
• History of injury: previous knee or hip injuries may increase risk.

Preventing Runner’s Knee

You can reduce your risk of PFPS by:

• Increasing training gradually.
• Regularly strengthening your glutes, quads, hips, and core.
• Stretching and mobilising tight muscles.
• Warming up before exercise and cooling down afterwards.
• Wearing supportive, well-fitted footwear.
• Avoiding “pushing through” pain.

How Physiotherapy Helps

Physiotherapy is highly effective for PFPS and can:

• Strengthen the quadriceps and hip muscles to improve knee control and reduce pain.
• Improve flexibility of tight tissues through targeted stretching (Witvrouw et al., 2014).
• Use taping techniques to improve patellar alignment (Bolgla & Boling, 2011).
• Provide movement retraining to improve running and squatting mechanics.
• Offer education on activity modification to promote recovery.

Research consistently shows that programmes combining hip and knee strengthening are more effective than knee-focused exercises alone for reducing pain and improving function in the condition (Barton et al., 2015; Neal et al., 2019).

Runner’s Knee is a treatable condition, especially if addressed early. Preventing Runner’s knee involves a combination of good training habits and whether you’re training for a marathon or just looking to stay active, don’t let knee pain hold you back. With a proper assessment, a tailored rehab plan, and the right guidance, most people make a full recovery and return to pain-free movement.

 References

Barton, C.J., Lack, S., Hemmings, S., Tufail, S. and Morrissey, D. (2015) The ‘Best Practice Guide to Conservative Management of Patellofemoral Pain’: incorporating level 1 evidence with expert clinical reasoning. British Journal of Sports Medicine, 49(14), pp.923–934.

Bolgla, L.A. and Boling, M.C. (2011) An update for the conservative management of patellofemoral pain syndrome: A systematic review of the literature from 2000 to 2010. International Journal of Sports Physical Therapy, 6(2), pp.112–125.

Collins, N.J., Barton, C.J., van Middelkoop, M., Callaghan, M.J., Rathleff, M.S., Vicenzino, B. and Crossley, K.M. (2018) 2018 Consensus statement on exercise therapy and physical interventions for patellofemoral pain: International Patellofemoral Pain Research Retreat, Manchester, UK, 2017. British Journal of Sports Medicine, 52(18), pp.1170–1178.

Crossley, K.M., Stefanik, J.J., Selfe, J., Collins, N.J., Davis, I.S., Powers, C.M., McConnell, J. and Vicenzino, B. (2016) Patellofemoral pain consensus statement from the 4th International Patellofemoral Pain Research Retreat, Manchester. Part 1: Terminology, definitions, clinical examination, natural history, patellofemoral osteoarthritis and patient-reported outcome measures. British Journal of Sports Medicine, 50(14), pp.839–843.

Neal, B.S., Lack, S.D., Lankhorst, N.E., Raye, A., Morrissey, D. and van Middelkoop, M. (2019) Risk factors for patellofemoral pain: a systematic review and meta-analysis. British Journal of Sports Medicine, 53(5), pp.270–281.

Witvrouw, E., Callaghan, M.J., Stefanik, J.J., Noehren, B., Bazett-Jones, D.M., Willson, J.D., Earl-Boehm, J.E., Davis, I.S. and Powers, C.M. (2014) Patellofemoral pain: consensus statement from the 3rd International Patellofemoral Pain Research Retreat held in Vancouver, September 2013. British Journal of Sports Medicine, 48(6), pp.411–414.