Summary

Runner’s knee (patellofemoral pain syndrome) is a common cause of pain around the front of the knee. It develops when the kneecap doesn’t track smoothly on the groove of the thigh bone.

At the White House Clinic, our physiotherapists can assess knee movement and surrounding muscle function to identify the cause of symptoms. Our treatments focus on restoring strength, improving movement patterns and supporting a safe return to activity.

An overview of runner’s knee

Runner’s knee is a condition affecting the joint between your kneecap (patella) and thigh bone (femur). It needs to be considered alongside ITB syndrome; the two conditions are related.

In a functional knee, the kneecap moves smoothly in a groove at the front of the femur as the knee bends and straightens. This allows the knee to absorb forces when walking, running or climbing stairs. If your kneecap doesn’t track correctly, pressure builds in the joint. This can irritate the tissues around the kneecap, leading to pain. Runner’s knee often develops gradually rather than after a single injury or impact.

Runner’s knee symptoms

The main symptom of runner’s knee is pain around or behind the kneecap.

People with the condition may experience:

• pain at the front or outside of the knee during or after activity
• discomfort when climbing stairs, squatting or kneeling
• pain aggravated by downhill running or running on uneven terrain
• pain after sitting for long periods with the knees bent
• grinding or clicking sensation in the knee
• tenderness around the kneecap, especially when you push down on it

Symptoms often worsen during activities that repeatedly bend the knee, such as running or squatting.

Causes of runner’s knee

Runner’s knee can develop from overuse, mal-tracking of the kneecap in the femoral groove, and chronic stimulation of the nerves in the surrounding tissues. When training is not structured, activities that strain the front of the knee (such as running, stair climbing, squatting, hill cycling, and high-gear cycling) may lead to injury.

Weak muscles in the hip and thigh will also influence how the knee moves. Tight quads or calves can alter movement patterns and increase pressure on the kneecap. Poor movement control or changes in training routine increase risk.

Training errors are a common cause of runner’s knee problems: from sudden increases in mileage, excessive training intensity, and hill work; and even worn-out or incorrect footwear.

When to see a physiotherapist

Rest and reducing activity should ease your pain. However, you should seek professional advice as soon as possible if symptoms worsen with activity or limit your everyday movements.

You can book directly with a physiotherapist at the White House Clinic. A physiotherapist will take a detailed history to understand your individual situation. They can assess your knee movement, muscle strength and activity to identify the underlying cause of symptoms. Using their findings, they can prescribe the correct exercises and suggest further treatment.

What to do if you have runner’s knee

If you develop runner’s knee, it may help to reduce activities that aggravate the pain while continuing gentle movement.

Replacing high-impact exercise with lower-impact activities can allow the knee tissues to heal. It’s important to slowly return to activity when symptoms improve, rather than do too much too soon.

Strengthening muscles around the hips and thighs can also support the knee joint and reduce stress on the kneecap. A bespoke plan will help prevent overtraining.

A physiotherapist can create a plan and guide you through exercises designed to restore strength, improve movement control and support your recovery.

Treatment for runner’s knee

Physiotherapy

Physiotherapy treatment at the White House Clinic aims to reduce pain from runner’s knee while addressing the underlying cause of the condition.

At the White House Clinic, a physiotherapist will assess the knee's range of motion and identify any muscle weakness, tightness, or movement patterns that may contribute to the problem.

Our rehabilitation programmes often focus on strengthening the quadriceps, glutes, and surrounding muscles to improve knee stability.

Plans can also focus on improving flexibility and correcting movement patterns to reduce pressure on the kneecap and aid long-term recovery.

Other options that physiotherapists have at their disposal include taping the knee, soft-tissue release, and acupuncture.

Injection Therapy

Injection therapy provides short-term relief for irritated and persistent knee pain. By reducing inflammation, injections help you perform rehabilitation exercises comfortably. Your physiotherapist can discuss this and, if necessary, recommend a referral.

Shockwave therapy

Shockwave therapy is a non-invasive procedure that aims to improve flexibility and reduce pain by using sound waves to stimulate healing and improve blood flow.

Who’s affected by runner’s knee?

Runner’s knee is most common in active individuals. It reportedly occurs in 19-30% of female runners and 13-25% of male runners.

However, while it is called runner’s knee, it isn’t an injury reserved for runners. Tennis, cycling, rugby, and HYROX trainging can all lead to the condition.

The issue arises when people have increased training levels before they’re ready, or when they return to exercise without gradually increasing volume. Muscle weakness, poor flexibility and changes in movement patterns increase the risk of runner’s knee.

Decreasing the risk of runner’s knee happening again

Runner’s knee is frustrating and painful. To reduce the risk of runner’s knee returning, you should slowly return to activity and follow a progressive plan to avoid overtraining.

Spend time in the gym strengthening the muscles around the hips and thighs to help support the knee joint and improve movement control. Don’t skip stretching or mobility, as good flexibility may also help lessen strain on the kneecap.

Following a progressive rehabilitation plan under a physiotherapist's guidance may help reduce the risk of runner’s knee returning and promote long-term knee health.

Further assessment and better prevention come from running video analysis, regular sports massage, and joining our Strength & Conditioning class for runners. We offer all of these services at the White House Clinic.

References

• ‍NHS
• ‍Runner’s World
• ‍NCBI‍