Runner’s Knee


Runner’s knee, more scientifically called patellofemoral pain syndrome (PFPS) is a condition which affects the cartilage on the underside of the knee cap (patella) and the structures which support it, as it moves up and down over the groove on the femur (thigh bone) when you bend and straighten your knee. The injury happens to both top runners and amateurs alike, with some statistics showing it accounts for nearly 50% of all running injuries.


  1. Tenderness around or behind your knee cap
  2. Pain that is aggravated by downhill running
  3. Dull pain when running on uneven terrain
  4. Pain when you push on the patella bone.


Injury occurs when there is ‘mal-tracking’ of the patella in the femoral groove and a chronic stimulation of the pain nerves in the surrounding area. The ‘mal-tracking’ may be due to a number of factors such as alignment of your leg, and abnormal muscle forces. Poor strength and flexibility in the hips, hamstrings and quadriceps have all been shown to contribute to this problem. However, training errors are the primary culprit. This can include an accelerated build-up of mileage, as well as excessive high-intensity running or hill work. Worn out or inappropriate footwear is also cited as a possible cause.


The first line of treatment for PFPS is rest, along with the use of ice and non-steroidal anti- inflammatories (NSAIDs), which may help reduce pain and swelling in the short term. Taping can also reduce pain, again in the short term

Research shows that strengthening the hip/ buttock muscles, specifically the hip abductors and the gluteus muscles, can reduce pain in PFPS. Exercises for this may include squats, lunges, crab walking and bridging. Improving flexibility in the leg, especially the hip flexors is essential.

Physical therapy is also an important component for reducing pain around the knee and mobilising the joints and soft tissue structures.

Remember that cutting back on mileage, or even taking a complete break from running, will be important. A graduated progression back into training can be discussed with your therapist as you work through your rehab programme. Some runners find that uphill running or simulating hills on a treadmill is less painful. Uphill running has the added value of working your glutes. Strong gluteal muscles help control hip and thigh movement, preventing the knee from turning inwards. Cycling, elliptical training and swimming are other ‘knee-friendly’ activities for cross-training.


It is important to be proactive with prevention measures, especially if you’ve suffered from runner’s knee in the past. Implementing a regular strength and flexibility routine should be the focus. Strengthening the hips, glutes, quads and hamstrings improves overall stability and helps the kinetic chain function better – reducing load on the knee and aiding support of the joint. Listen to your body and respond at the first sign of discomfort. Runner’s knee is an injury that worsens if you continue to run on it.

Building mileage slowly will ensure you remain healthy. Do not increase your mileage by more than 5-10% from one week to the next. Avoiding excessive downhill running is also a good thing to do if you’re hoping to skirt injury.

Download this handout for examples of great exercises to help rehab this condition.


The information contained in this article is intended as general guidance and information only and should not be relied upon as a basis for planning individual medical care or as a substitute for specialist medical advice in each individual case. ©Co-Kinetic 2017

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