Runners Knee

Runner’s knee is one of the most common causes of anterior knee pain and accounts for approximately 25% of all knee injuries seen in sports injury clinics.

Runner’s knee is also known as “patellofemoral syndrome” or “anterior knee pain” and refers to pain below and around the knee.

It causes friction on the back of the knee due to problems with the way the knee cap moves, and is often associated with weak VMO muscles.

Symptoms tend to come on gradually and come and go depending on your activity. Runner’s knee is not the only cause of knee pain due to running and despite the name, it affects both active and sedentary people such as office workers.

Here we’ll look at the causes, symptoms, treatment options and recovery process from runner’s knee, frequently asked questions like can I run with runner’s knee, as well as other knee conditions that are commonly misdiagnosed as patellofemoral syndrome.

Also Read: Best Knee Wrap for Baker’s Cyst

What is runners knee?

Runner’s Knee Biomechanics: The patella rests in a small groove at the end of the “trochlear groove” of the femur. The patella slides up and down between the grooves as you bend and straighten your knee.

In runner’s knee, there is a problem with the way the patella (cap) moves. This puts extra pressure on the cartilage, causing anterior knee pain.

The knee cap sits in a groove, known as the patella or trochlear groove, on the front of the knee, the femur, the thigh bone.

In this groove it can glide, tilt and rotate upwards, downwards and sideways.

The knee cap is lined with very thick cartilage to protect against large forces passing through the bone.

There are many things that prevent the patella from moving properly, all of which increase the force and friction that passes through the knee, causing patella femoral syndrome.

Causes of runners knee

Common causes of runner’s knee include:

Muscle weakness: Muscle weakness reduces the support around the knee causing more weight to pass through the knee. Also, if the muscles on one side of the knee are weak and the muscles on the other side are too strong, the knee joint will move slightly to one side, causing friction.

Muscle tightness: If the muscles around the knee are tight, they will pull it up a little and possibly a little to the side, increasing kneecap pain and friction.

Abnormal foot position: An abnormal foot position, such as flat feet, causes the foot to roll inward, which changes the path through the knee, increasing stress on the knee.

Increased Q Angle: This refers to the angle of the femur. Increasing the Q angle puts more stress on the knee

Anatomy: Problems with the groove and/or shape of the knee may cause the two to not line up properly, which can limit movement and cause friction, predisposing you to patellofemoral syndrome.

Symptoms of patellofemoral syndrome

Runner’s knee usually comes on gradually – it’s not triggered by a specific event. People describe it as a non-defining pain around the knee, especially below and next to the patella.

This helpful video from ClearDoc explains what happens to the patella in patellofemoral syndrome.

Patellofemoral syndrome can also cause a grinding/clashing noise associated with leg movement – known as crepitus and caused by friction in the knee. Sometimes, the front knee may swell.

Runner’s knee pain comes and goes rather than being constant, but usually worsens with:

Prolonged activity: such as long distance running, sports, skiing especially when going downhill

Stairs: Especially coming down

After sitting for a long time: such as at the cinema, office workers, long distance driving. Knee pain when you first get up and then ease into movement.

How to treat runners knee

Treatment for runner’s knee aims to reduce knee pain and swelling and address leg muscle imbalances. The most common treatments for patellofemoral syndrome are:

1. Strengthening exercises

Strength training is a great way to treat runners knee

Strengthening exercises are important with patellofemoral pain syndrome because people with runner’s knee often have weak glute (hip) and quads muscles. Strengthening these muscles will reduce the weight passing through the knee and thus reduce knee pain.

In the knee strengthening section you will find a whole range of exercises that can help improve strength and stability and thus reduce runner’s knee pain.

Also, exercises that specifically target the muscles that control the knee cap make a huge difference in the way the knee glides in the patellar groove—see the knee exercises section for more information.

2. Expand

Another important part of runner’s knee treatment is stretching. Reducing any muscle tension through simple stretching exercises will also improve how the knee cap glides in the patellar groove, reducing friction on the knee.

Any tightness around the kneecap muscle will pull it slightly out of place causing increased friction and stress on the knee cap, leading to runners kneecap.

Visit the knee stretches section for simple tests to see if muscle tightening can help with your patellofemoral syndrome pain and exercise.

3. Knee braces

Knee braces can be helpful with patellofemoral pain syndrome

Another useful treatment tool for runners knee is the knee brace. Braces can help improve support around the knee and position of the patella, which reduces pain associated with patellofemoral syndrome.

There’s a whole range of styles, but generally the best for Runner’s Knee are those with a hole in the front that doesn’t put extra stress on the knee.

You can find lots of advice on how to find the right brace for you in the Knee Brace Guide section.

4. Orthotics

If your runner’s knee is partially related to altered foot biomechanics, using orthotics can really help. Orthotics are special insoles that can be worn in your shoes to correct your foot position and Q angle and therefore reduce the forces transmitted through the knee.

Your doctor may refer you to an orthotist to evaluate your foot and provide appropriate insoles, or to check out our favorite orthotics on our sister site.

5. Rest and Pacing

Runner’s knee often develops after increased activity levels. You may be advised to rest for a few days to allow your knee pain to subside, and then gradually increase the amount of exercise you do or return to non-impact exercises such as swimming.

Remember, pain doesn’t always come during an activity, it often develops later that day or overnight, so start slowly and build up gradually.

6. Regular ice

Applying ice after activity can really help reduce patellofemoral syndrome pain and swelling. It helps reduce any inflammation and bleeding in the joint which helps reduce pain and speed up healing.

Visit the Ice Treatments section for tips on how to use ice safely and effectively, and the Ice Wraps section for our top tips on the best way to apply ice.

7. Avoid prolonged postures

If your runner’s knee hurts after sitting for long periods of time, try to avoid keeping your feet still.

At work, get up and walk around every thirty minutes or so, or if that’s not possible, walk your legs back and forth a few times. Another thing that can help reduce runner’s knee symptoms is to use a standing desk so you don’t sit all day.

This keeps the joint loose and lubricated which can help reduce patellofemoral syndrome pain.

8. Analgesics

Over-the-counter pain relievers and non-steroidal anti-inflammatories such as Advil/Ibuprofen can be effective in reducing pain associated with runner’s knee. Always consult your doctor before taking medicine.

9. Surgery

It is very rare that patellofemoral syndrome requires surgery. However, if the above treatments don’t work, surgery may be indicated to release the hard structure around the knee or to remove bits of bone that are irritating the knee cap. This is known as lateral release surgery.

The exact treatment will depend on the cause of your patellofemoral syndrome, so it is recommended that you visit a health professional who can properly assess what is causing your problem.

Runner’s knee recovery

Depending on how quickly you start treatment and how active you are, recovery from runner’s knee can take anywhere from six weeks to six months.

It usually takes a few weeks of strengthening and stretching exercises to improve muscle strength and length, so don’t give up.

Also, don’t be tempted to increase your activity level too quickly. Pace yourself so you don’t make your knee worse – check out our top tips on exercising.

If you want to continue exercising, try low-impact activities like swimming and cycling. If you want to run, make sure you have good running shoes and try to avoid running on concrete as hard surfaces put more stress on the knees.

Common misdiagnosis

There are several other conditions that cause anterior knee pain and are often misdiagnosed as runner’s knee:

  • Chondromalacia patella: where there are actually changes in the cartilage lining the knee
  • Jumper’s Knee: Inflammation of the patellar tendon just below the knee
  • Iliotibial Band Syndrome: Irritation of the ITB on the outside of the leg

Although these conditions may have similar presentations, patellofemoral syndrome has important subtle differences so check out these other categories.

Want To Know More?

Several inquiries are frequently made regarding Runner’s Knee. You can discover answers to the most frequently asked questions about patellofemoral syndrome in the FAQ area, including: How can I know if I have it? Braces—do they really work? Can I still run, then?

Visit the knee pain diagnosis section if you need assistance determining what is wrong with your knee and the cause of your pain and Runners Knee doesn’t seem quite like your issue.

Listed below are some articles that could be of interest to you:

  • Patellofemoral Pain Syndrome
  • Tendonitis
  • Plica Syndrome
  • Meniscus Tears
  • Osgood Schlatters
  • Swelling On Top Of Knee




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