Runner's knee, or patellofemoral pain syndrome (PFPS), is pain around or behind the kneecap. It occurs when the patella does not track smoothly in the groove at the front of the thigh bone during movement. Despite its name, it affects cyclists, hikers, and anyone who does repetitive knee-bending activities.
- Dull, achy pain around the front of the knee
- Pain that worsens going up or down stairs
- Pain after sitting for long periods with knees bent (the "movie theatre sign")
- A grinding or clicking sensation when bending the knee
- Mild swelling around the kneecap
Weak hip abductors and external rotators allow the thigh to rotate inward, pulling the kneecap out of alignment. Weak quadriceps, particularly the VMO (inner quad), fail to keep the patella centred.
Sudden increases in mileage, hill training, or speed work without adequate recovery overload the structures around the knee. Running on hard surfaces or wearing worn-out shoes compounds the problem.
Flat feet (overpronation), high arches, and a wide pelvis can all alter knee mechanics. A physiotherapist can assess your gait and identify these contributing factors.
In the first 1-2 weeks, focus on reducing inflammation. Apply ice for 15-20 minutes, reduce or modify running volume, and avoid stairs and deep squats. Anti-inflammatory medication can help manage pain, but it does not address the underlying cause.
A comprehensive approach addresses the root cause, not just the knee:
- Strengthening - hip-focused exercises (clamshells, side-lying leg raises, banded walks) and quadriceps work (terminal knee extensions, wall sits)
- Flexibility - stretching the IT band, quads, hamstrings, and calves
- Patellar taping - McConnell taping to improve patella tracking during activity
- Gait retraining - cadence adjustments and foot strike modifications
- Load management - a gradual return-to-running plan based on pain response
If pain persists beyond 2 weeks of self-management, if you experience giving way, locking, or significant swelling, or if you cannot bear weight on the affected leg, seek professional assessment promptly.
