Expert Physiotherapy, Chiropractic, and Orthotics Services for Optimal Health

Runner’s Knee: Symptoms, Causes & Treatment Options


Posted by Dr. Scott Wilson | 01-Jul-2024

Key Highlights:

  • Runner’s knee, or patellofemoral pain syndrome, is a common condition that affects not just runners, but anyone engaging in activities that stresses the knee joint.
  • The main symptom of runner’s knee is a dull, aching pain in the front of the knee, especially while walking, squatting, and running.
  • The causes of runner’s knee can include overuse, misalignment of the kneecap, weak thigh muscles, and foot problems.
  • Diagnosing runner’s knee involves a physical examination and may include imaging tests such as X-rays or MRI scans.
  • Treatment options include initial home care, physiotherapy, and, in severe cases, surgery.

Runner’s knee, or patellofemoral pain syndrome, is a common condition experienced by both runners and non-runners alike. The name itself is actually a broad term used to describe the pain resulting from several knee problems. Symptoms include a persistent, dull ache in the front of the knee, usually around or behind the kneecap that can worsen with activity. For some, the pain can become so significant, it compromises their daily activities. It can even be debilitating. However, the good news is that with the right care and attention, the condition can be managed and a full recovery is possible. In this article, we’ll take a closer look at patellofemoral pain syndrome or “runner’s knee”, including a review of the various symptoms, causes and treatment options. Here’s what you need to know.

What Exactly is Runner’s Knee?

Runner’s knee, or patellofemoral pain syndrome, is a common condition characterized by a dull ache to a debilitating pain around the front of the knee and kneecap. It’s often caused by overuse, improper knee alignment, or muscle imbalances, exacerbated by repetitive stress on the joint from running, squatting, or kneeling.

The Anatomy of the Knee

To better understand runner’s knee, it helps to understand the basic anatomy of our knees. The knee joint is a complex structure that connects our thigh bones (femur) to the shin bones (tibia) with ligaments, tendons, and cartilage.

There are four crucial ligaments that stabilize the knee joint. The anterior cruciate ligament (ACL) and the posterior cruciate ligament (PCL) prevent excessive forward and backward movement of the femur and tibia. And the medial collateral ligament (MCL) and the lateral collateral ligament (LCL) provide stability against side-to-side movements.

The kneecap (patella) is a small, triangular bone that sits in front of the knee joint. It plays a vital role in knee movement and provides leverage to the thigh muscles. The kneecap glides smoothly in a groove on the front of the femur, facilitated by a layer of cartilage. The cartilage, a smooth, rubbery tissue that covers the ends of the bones within the knee joint, acts as a shock absorber and allows the bones to glide smoothly during movement.

It’s the damage or deterioration of this cartilage that contributes to the development of patellofemoral pain syndrome or runner’s knee.

Recognizing the Symptoms of Runner’s Knee

While you may have various signs and symptoms, the most common symptom is pain. Typically, people suffering from runner’s knee will feel a dull ache or a sharp discomfort in the front of the knee. This pain can also radiate to the sides of the knee or behind the kneecap and is often aggravated by things like running, squatting, or climbing stairs.

In addition to pain, you may also experience swelling around the knee joint and a grinding or popping sensation during movement. Your thigh muscles, including your quadriceps, may feel weak or tight, contributing to the pain and causing a feeling of instability in your knee. Your iliotibial (IT) band, a thick band of tissue that runs along the outside of the thigh, can also become tight or inflamed, which leads to knee pain. Another common condition associated with runner’s knee is patellar tendonitis. This involves inflammation of the patellar tendon, the structure that connects the kneecap to the shinbone.

Understanding the Causes of Runner’s Knee

There are several factors that can contribute to the development of runner’s knee. These factors include biomechanical issues such as IT band syndrome, muscle tightness or imbalances, and structural misalignment in the knee. Overuse and training errors are also contributing factors, as are various foot related issues like flat feet or overpronation.

Biomechanical Issues and Misalignments

Biomechanical issues and misalignments in the knee joint can contribute to the development of runner’s knee. One common condition associated with runner’s knee is IT band syndrome. This involves tightness or irritation of the iliotibial band, a thick band of fascia (connective tissue) that runs along the outside of the thigh and extends from the hip to the knee. This tightness or irritation can lead to the pain and other symptoms mentioned above.

Tightness or imbalances in the muscles surrounding the knee, such as the quadriceps and hamstrings, can also affect patellar tracking and lead to patellofemoral pain syndrome. Additionally, misalignment of the kneecap, known as patellar maltracking, can also put excessive pressure on certain areas of the knee, leading to pain and discomfort.

Overuse and Training Errors

Overuse and training errors are fairly common causes of runner’s knee. Engaging in repetitive activities that stress your knee joint, such as running or squatting, for long periods of time without proper rest or recovery can lead to overuse injuries.

Also, training errors, such as abruptly increasing the intensity or duration of workouts, using improper technique and not warming up, cooling down or resting enough, can also contribute to the development of runner’s knee. It’s important to listen to your body so that your muscles and joints have time to adapt.

Other Contributing Factors

In addition to overuse and training errors, other factors can contribute to the development of runner’s knee. Excess weight puts additional stress on the knee joint. Muscle weakness or imbalances, particularly in your thigh muscles, can affect patellar tracking and stability in the knee. Flat feet or overpronation, where your foot rolls inward excessively during walking or running, can alter the alignment of your leg and knee, increasing your risk of developing runner’s knee.

Diagnostic Approaches for Runner’s Knee

Getting a formal diagnosis for runner’s knee is important for confirming the condition, determining the underlying cause and developing an appropriate treatment plan. Your healthcare provider may begin with a physical examination, assessing your knee’s range of motion and stability, and looking for signs of inflammation. They may also ask about your health history and any activities that may contribute to the development of runner’s knee. In some cases, imaging tests such as X-rays, MRI scans, or CT scans may be recommended to assess your knee’s internal structures and to identify any abnormalities.

Clinical Evaluation and History Taking

As part of your clinical assessment for runner’s knee, your healthcare professional will conduct a comprehensive evaluation, starting with questions about your health history, medical conditions, and physical activities. They’ll also ask about the nature and location of your pain, factors that aggravate or alleviate your symptoms, and any other accompanying symptoms. During your physical examination, they will look for tenderness and assess your range of motion, muscle strength, and flexibility. They’ll also conduct a biomechanical analysis focusing on your posture, gait, knee alignment, and even your footwear, to identify any structural issues.

Imaging Tests and Their Role

Imaging test can play a crucial role in diagnosing runner’s knee and identifying any abnormalities in your knee joint. X-rays may be used initially to assess the bony structures and rule out any fractures or degenerative changes. In some cases, MRI (magnetic resonance imaging) or CT (computed tomography) scans may be requested to help identify structural abnormalities or misalignments and to provide detailed images of the soft tissues, including the cartilage, tendons, and ligaments. These imaging techniques, combined with a clinical evaluation, can help to ensure an accurate diagnosis and determine the most appropriate treatment options based on the unique aspects of your condition.

Comprehensive Treatment Options

Runner’s knee, while painful and even debilitating, can be effectively managed with a comprehensive approach to treatment. Depending on the nature of your condition, this may include initial home care strategies, physiotherapy and rehabilitation exercises, and possibly even advanced medical interventions.

Initial Home Care Strategies

In most cases, home care is what many people rely on for initial pain reduction and healing. Ideally, this means employing the RICE technique (Rest, Ice, Compression and Elevation). Resting your knee is crucial for allow soft tissues to heal. This means avoiding activities that exacerbate your pain, such as running or squatting. Applying ice to your knee for 20-30 minutes every 3-4 hours can help reduce pain and swelling. Using an elastic bandage or knee sleeve, to provide compression and support can help reduce swelling. Finally, elevating your leg by placing a pillow under it when you’re sitting or lying down can also help reduce swelling. These initial steps not only provide a measure of relief, they can also help pave the way for professional care as needed.

Physiotherapy and Rehabilitation Exercises

Physiotherapy and rehabilitation exercises can have a significant impact on your ability to manage and recover from runner’s knee. Your physical therapist can develop a personalized treatment plan based on your unique needs.

Pain management tactics might include rest, activity modification, and ice therapy, along with potential use of over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs), like ibuprofen, to relieve pain and reduce inflammation. Manual therapy techniques like massage, joint mobilization, and trigger point release may also be included to help reduce muscle tightness and improve circulation. Your plan will also include a mix of stretching and flexibility exercises to target the quadriceps, hamstrings, calves, and iliotibial band, while strengthening exercises focus on the quadriceps, hip abductors, and core muscles. Finally, they may recommend biomechanical corrections including a gait analysis, proper footwear recommendations, and potential use of orthotics. Education on training modifications, proper warm-up and cool-down routines, and cross-training, along with progress monitoring and a home exercise program, may round out your comprehensive care program.

Advanced Medical Interventions

In some severe cases, advanced medical interventions, such as knee surgery, may be necessary. Typically, this only happens when more conservative, non-invasive treatments haven’t worked. The specific type of surgery depends on the underlying cause of the condition and may involve repairing damaged cartilage, realigning the kneecap, or addressing other structural issues.

When to Seek Professional Support

While mild cases of runner’s knee can often be managed with self-care measures, if your pain persists or worsens despite rest and conservative treatments, you should speak to a healthcare professional. If your pain is accompanied by other concerning symptoms, such as fever, severe swelling, or difficulty bearing weight on the affected leg, you should seek help right away. These may indicate a more serious underlying condition that requires prompt evaluation and treatment.

Prevention Strategies and Tips

Prevention strategies play a crucial role in reducing the risk of developing runner’s knee. By focusing on proper footwear, training techniques and strengthening and flexibility exercises, you can help protect your knees and maintain your overall knee health.

The Importance of Proper Footwear

Proper footwear plays a significant role in preventing runner’s knee and maintaining overall knee health. Choosing the right shoes can provide support, cushioning, and stability to your feet and knees during physical activities. Shoe inserts, such as arch supports or orthotics, can help correct biomechanical factors that contribute to runner’s knee. They provide additional support and improve foot and knee alignment and can also help distribute pressure more evenly, reducing the strain on specific areas.

Training Modifications and Techniques

Proper training modifications and techniques can help prevent overuse injuries and reduce your risk of developing knee pain. Engaging in appropriate warm-up exercises, using gradual and controlled progressions in training intensity, and avoiding sudden changes in workout routines, such as adding intense moves like squats or lunges, can also prevent excessive stress on your knee joints. It’s always important to listen to your body and watch for signs of discomfort or pain during exercise.

Strengthening and Flexibility Exercises

Exercises that focus on strengthening and flexibility are key for preventing runner’s knee. Strengthening exercises, particularly targeting your quadricep muscles, help stabilize your kneecaps and prevent imbalances. Examples include leg presses, squats, and step-ups. Flexibility exercises, such as gentle stretches and range-of-motion exercises, help improve the flexibility of muscles and tendons around your knees, reducing the risk of strain and injury. In both cases, the key is focusing on proper technique.


Runner’s knee can be a painful and even debilitating condition, but understanding the symptoms, causes, and treatment options can make a significant difference with both prevention and managing the condition. With proper care, including hands-on physiotherapy, strengthening and flexibility exercises, and medical interventions if needed, recovery is possible. Of course, because “an ounce of prevention is worth a pound of cure”, focusing on proper footwear, training modifications & techniques, and targeted exercises is essential for avoiding future occurrences.

If you or someone you know is struggling with runner’s knee, or knee pain in general, we can help. Contact us today and let us show you why, at Physiomed…Healthier Starts Here.

Frequently Asked Questions About Runner’s Knee Pain:

How long does it typically take to recover from runner’s knee?

Recovery time for runner’s knee can vary depending on the severity of the condition and other individual factors. In most cases, with appropriate treatment and adherence to a physiotherapy rehabilitation program, you can expect to see improvements within a few weeks to a few months.

Can runner’s knee lead to more serious conditions if untreated?

If left untreated, runner’s knee can potentially lead to more serious conditions such as chondromalacia patella, osteoarthritis, or arthritis. These conditions can further damage your knee joint and resulting in chronic pain, reduced mobility, and functional limitations. This is why preventive measures and appropriate treatment are so important.

How can I tell runner’s knee from other types of knee pain?

Runner’s knee typically presents with pain around or behind the kneecap, whereas other conditions like iliotibial band syndrome may cause pain on the outside of the knee. A healthcare professional can perform a physical examination and use additional diagnostic tests to provide a more accurate diagnosis.

Dr. Scott Wilson

Dr. Scott Wilson is the Founder & Chairman of Physiomed; one of Canada’s largest franchised networks of inter-disciplinary healthcare clinics. A graduate of Canadian Memorial Chiropractic College, Dr. Wilson founded Physiomed in 1994 and has since grown Physiomed to over 30 clinics in Southern Ontario and British Columbia. With hundreds of practitioners from over a dozen disciplines, Dr. Wilson and Physiomed have helped over 100,000 Canadians with physiotherapy, chiropractic, massage therapy, orthotic therapy, compression therapy and clinical conditioning as part of a program of rehabilitation and health optimization. In addition to helping patients improve their physical and mental well-being, Dr. Wilson has also mentored hundreds of practitioners to provide better care while enjoying more fulfilling careers. He is also a keynote speaker on many health related topics including how physiotherapy, chiropractic and health & wellness treatment can help with stress, weight loss, and unlocking the true potential within to achieve lasting physical well-being.

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