Knee pain, patello-femoral syndrome, runner's knee, sports injuries, physiotherapy, PFPS

Runner’s knee

Runner’s knee is one of the most common and debilitating injuries experienced by runners. But with correct treatment and advice, recovery can be experienced in most cases.

Approximately 40% of all injuries seen in a sports injury clinic involves the knee. Runner’s knee, also known as patellofemoral pain syndrome (PFPS) or anterior knee pain, accounts for approximately 16.5% of all running injuries.

Runner’s knee is when the cartilage between the knee cap and the knee joint becomes irritated and enflamed, resulting in pain at the front of the knee. It is often described as a “catching” pain which can be anything from mild to severe. It can affect one knee or both, and is twice as common in women than men.

Runner’s knee is generally recognized as an overuse injury, however, there is often a bio-mechanical error like poor running style, incorrect running shoes or muscle imbalances as the underlying  reason for developing pain at the front of the knee (see “establishing the cause” below).

Runners are not the only victims this type knee pain – they can also occur with cycling, swimming, netball, football, basketball, and volleyball.


Avoiding development of knee pain is the obvious key and there are a few things you can do to help avoid knee injuries.PFPS, runner's knee, patella-femoral pain, patella-femoral joint syndrome

  1. Keep your quadriceps, hamstrings and ITB flexible. Use a foam roller combined with dynamic and static stretching is the most effective way to achieve this.
  2. Also keep your quadriceps strong. Squats, sit to stands, lunges are all good methods to help strengthen your quads. Cycling is also a good way to strengthen your quads.
  3. Carry out a regular recovery routine. Ice baths or direct icing is a great natural way to reduce joint irritation.
  4. Keep your weekly mileage increase to 10% or less and increase hill work gradually.
  5. Make sure your shoes are correct for your foot type (visit a specialist running shoe shop where you can get advise and try out shoes).
  6. Change your running shoes before they get too worn and make sure you wear in the new pair before using them in earnest.


If pain does develop, follow the advice suggested in the treatment section. At the same time establish and remove the cause. If you are not sure what is causing your pain discuss this with your specialist sports Physiotherapist.


Establishing the cause

This is often easier said than done!
These are the most common causes for knee pain:

  • Too big an increase with the weekly or individual run mileage (more than 10%).
  • Too great an increase of intensity (speed work or intervals).
  • Poor recovery/preparation/warm up.
  • Bio-mechanical changes (for example, changes to stride length or strike action).
  • Tight and/or weak quadriceps. Tight glutes or ITB.
  • Changes in footwear (make sure you are wearing the correct shoe for your foot type).
  • Changes in training surface (for example, grass to tarmac).
  • Training structure (for example, going from long steady runs to excessive interval or hill training).



  1. At the first sign of pain, cut back your mileage. The sooner you lessen the knee’s workload, the faster healing begins.
  2. Avoid knee-bending activities, tarmac and cambered roads, uneven ground, downward stairs and slopes until the pain subsides. As you rebuild mileage avoid steep downhill’s and reduce your stride length going uphill.
  3. Take more rest days from running and replace with active recovery (spinning, aqua jogging etc).
  4. Ice 15-20mins x 3 times daily.
  5. Ibuprofen 400mg x 3 daily.
  6. Have someone check your stride length. If you have a long stride or over-stride, reduce the length.
  7. Once your pain has gone, begin strengthening your quads.
  8. Consult a specialist sports Physiotherapist if your pain persists for more than 2 weeks.

Phil Mack
Consultant Sports Physiotherapist

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