Pain around or behind the kneecap when you run, walk down stairs or sit for a while is one of the most common complaints in runners. It is often called runner's knee, and the medical name is patellofemoral pain.
The encouraging news is that it usually responds well to the right exercise. The surprising part is where that exercise often needs to start, which is not always the knee itself. Here is what runner's knee is, what actually helps, and when it is worth seeing a physio.
- What is runner's knee?
- Why does the front of the knee start to hurt?
- Why does the fix often start at the hip?
- What actually helps runner's knee?
- Do I have to stop running?
- When should you see a physio?
- Helping You Perform at Your Best
What is runner's knee?
Patellofemoral pain is pain at the front of the knee, around or behind the kneecap, where the kneecap meets the thigh bone. It is typically an overuse problem rather than a single injury, and it is different from knee osteoarthritis or a ligament tear.
It often shows up during or after running, going up or down stairs, squatting, or after long periods sitting with the knee bent, sometimes called the "theatre sign".
Why does the front of the knee start to hurt?
Runner's knee is usually about load rather than damage. When the demand on the kneecap joint outpaces what it is currently used to, the area can become irritated and sensitive. Common contributors include:
- A sudden jump in running distance, speed or hills
- Limited strength or control through the hip, thigh and knee
- Reduced recovery, with not enough easy days between hard sessions
It is rarely one single factor. It is usually a combination stacking up, which is why a focused plan works better than chasing one quick fix.
Why does the fix often start at the hip?
This is the part that surprises people. The way the hip controls the leg has a big influence on how the kneecap is loaded. If the hip muscles that steady the pelvis and control the thigh are not pulling their weight, the knee can cop more than its share.
The research backs this up. A systematic review with meta-analysis found that combining hip and knee strengthening was more effective than knee strengthening alone for reducing pain and improving activity in people with patellofemoral pain. In short, training the hip as well as the knee gets better results.
What actually helps runner's knee?
The core of management is exercise, guided by a sensible approach to load. A typical plan includes:
- Strengthening the hip and knee together, not the knee alone
- Adjusting running load for a while rather than stopping completely
- Building back up gradually as symptoms settle
- Addressing technique or training habits where relevant
Many people improve well with a structured programme tailored to their goals and their running.
Do I have to stop running?
Often not completely. For many runners it is about modifying for a period rather than stopping altogether. That might mean reducing distance or hills, adjusting pace, or spacing out harder sessions while you build strength. A physio can help you find the level that keeps you moving without flaring the knee.
When should you see a physio?
See a physio if your knee pain is limiting your running, not settling, or you want a clear plan to get back to your goals. It is also worth getting assessed if the knee locks, gives way, swells noticeably, or follows a specific injury, as these may point to something other than patellofemoral pain.
Helping You Perform at Your Best
Runner's knee can be frustrating, especially when it interrupts your training and the events you are working towards.
At Ace Sports Medicine in Upper Mount Gravatt, our physiotherapists and exercise physiologists provide personalised care for runner's knee and running injuries across Brisbane's southside. Your first appointment includes an assessment and a starter plan so you know your next step.
Need support for front-of-knee pain? Book an appointment with the Ace Sports Medicine team today.
