Runner's KneePatellofemoral Pain & Recovery
Common running injury affecting the kneecap—learn causes, treatment, and how to get back to pain-free running.
What is runner's knee?
Runner's knee (patellofemoral pain syndrome) causes pain around or behind the kneecap. Common in runners, cyclists, and athletes who do repetitive knee movements.
Physiotherapy focuses on correcting movement patterns, strengthening hip and knee muscles, and gradual return to activity with proper load management.
Common causes and risk factors
Biomechanical factors
- Hip weakness: poor hip control affects knee alignment
- Overpronation: excessive foot rolling inward
- Muscle imbalances: tight IT band, weak glutes
- Training errors: sudden increases in distance or intensity
Activity factors
Running on hard surfaces, downhill running, and inadequate warm-up can contribute to runner's knee development.
What are the symptoms?
Common symptoms
- Knee pain around or behind the kneecap
- Pain with activity especially running, squatting, stairs
- Stiffness after sitting for long periods
- Swelling around the knee joint
- Clicking or grinding sensation in the knee
Activity limitations
- Difficulty running or jogging
- Pain with stairs and squatting
- Reduced training volume and intensity
How can physiotherapy help?
Treatment focuses on correcting movement patterns, strengthening weak muscles, and gradual return to running with proper load management.
Core components
- Biomechanical assessment and movement analysis
- Hip and glute strengthening exercises
- IT band and quadriceps stretching
- Running technique and form correction
- Gradual return-to-running program
Assessment & Diagnosis
Clinical Assessment
- Pain location and quality
- Range of motion testing
- Muscle strength evaluation
- Patellar tracking assessment
- Functional movement tests
Biomechanical Analysis
- Running gait analysis
- Hip and knee alignment
- Foot pronation assessment
- Core stability evaluation
- Movement pattern analysis
Special Tests
- Patellar grind test
- Clarke's test
- Single leg squat test
- Step-down test
- Functional hop tests
Treatment Phases
Phase 1: Pain Relief
Ice, rest, activity modification, and gentle mobility exercises
Phase 2: Strengthening
Hip and glute strengthening, core stability, and movement correction
Phase 3: Return to Running
Gradual running progression with technique focus and load management
Phase 4: Prevention
Maintenance exercises and ongoing technique refinement
Key Exercises
Hip Strengthening
- Clamshells (3 sets x 15)
- Side-lying hip abduction
- Single leg bridges
- Monster walks with band
Focus on glute medius and hip stabilizers
Quadriceps & VMO
- Straight leg raises
- Terminal knee extensions
- Wall sits (30-60 seconds)
- Step-ups (controlled)
Target vastus medialis obliquus (VMO)
Stretching & Mobility
- IT band foam rolling
- Quadriceps stretch
- Hip flexor stretch
- Calves and hamstrings
Address muscle tightness and imbalances
Running Technique Corrections
Common Issues
- Overstriding (landing too far ahead)
- Excessive heel striking
- Knee valgus (knees caving in)
- Hip drop or poor hip control
- Forward lean from the waist
- Arms crossing the midline
Technique Focus
- Midfoot landing under center of mass
- Shorter, quicker strides (180+ cadence)
- Upright posture with slight forward lean
- Knees tracking over toes
- Relaxed arm swing at 90 degrees
- Core engagement for stability
Return to Running Program
Progressive Running Protocol
Week 1-2
Walk/run intervals: 1 min run, 2 min walk x 10-15 min
Week 3-4
1 min run, 1 min walk x 20-25 min
Week 5-6
2 min run, 1 min walk x 25-30 min
Week 7+
Continuous running, gradually increase distance
Rule: If pain increases during or after running, reduce intensity or take an extra rest day.
Effective treatments
Exercise therapy
Hip strengthening and movement correction.
Manual therapy
Soft tissue work and joint mobilization.
Running analysis
Gait assessment and technique correction.
Load management
Gradual return to activity protocols.
Prevention strategies
Proper training, strengthening, and technique can prevent runner's knee and improve performance.
Training guidelines
- Gradual progression: increase distance by 10% per week
- Cross-training: include cycling, swimming, strength work
- Proper warm-up: dynamic stretching before running
- Surface variety: mix road, trail, and track running
- Recovery: adequate rest between training sessions
FAQs
How long does it take to recover?
Most runners see improvement within 4-8 weeks with proper treatment. Full recovery typically takes 2-3 months with gradual return to running.
Can I still run with runner's knee?
Initially, you may need to reduce or stop running. Cross-training and gradual return with proper strengthening usually allows safe return to running.
Medical Disclaimer
This information is for educational purposes only and should not replace professional medical advice. Always consult a qualified healthcare provider for diagnosis and treatment.