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A male athlete pausing in their run to hold their knee in pain.

Runner’s knee


Runner’s knee is a common overuse injury. It is experienced as a dull pain felt over, under, or around the kneecap (patella). It is also known as the patellofemoral pain syndrome (PFP).  Runner’s knee often happens in runners and other athletes from overuse. But it can also affect other people due to structural defects of their legs or feet that cause poor biomechanics and alignment issues.

Runner's Knee Main Points

  • Runner’s Knee is characterized by pain around, under, or in front of the kneecap.
  • It is caused by overuse, misalignment of the kneecap, and/or poor support of the feet and knees.
  • Treat the pain, swelling, and inflammation with the RICE method (Rest, Ice, Compression, Elevation) plus pain medications.
  • To achieve full pain-free recovery, treat the cause of runner’s knee.
  • If the patellar misalignment is from muscle imbalance, targeted exercise is necessary. If it’s from overuse, training modifications are needed. It lessens intensity while maintaining fitness.

Causes of Patellofemoral Pain Syndrome

During knee movement, the underside of the patella runs along the groove of the lower end of the thigh bone (femur), called the trochlear groove. 

Any combination of the following factors can wear down the tissue between the patella and the trochlear groove. Here are some causes of the runner’s knee:

1.) Repetitive movements such as running, squatting, and jumping that lead to overtraining.

2.) Misalignment of the patella to the trochlear groove due to:

  • Structural defects like flat feet 
  • Weak thigh muscles that cause other muscles to pull the patella too far on one side, such as a weak vastus medialis obliquus (VMO) or weak IT band (lateral quad muscle)
  • Weak thigh abductors and external rotators cause other muscles to rotate the leg inward
  • Tight hamstrings that cause the quadriceps to overwork
  • Tight Achilles tendons that cause the quadriceps to overwork
  • Traumatic injury

3.) Poor support to the feet and knees

  • Low-quality running shoes that offer poor foot support
  • Poor form in running or walking causes the knee to bend over the foot line.

Symptoms and Diagnosis

Any, or the combination, of the causes above can lead to pain and worsening in the knee. Here are the common symptoms experienced by individuals with runner’s knee:

  • Pain when walking or going down the stairs
  • Pain that worsens after sitting for a long time with the knees bent
  • Pain that worsens after activities that bend and bear weight on the leg, such as running, jumping, or squatting.
  • Kneecap is tender to touch
  • Discomfort on or around the knee, especially with knee movement
  • Clicking or grinding sound of the kneecap when bending or straightening the knee
  • Swelling around or behind the kneecap area

Runner’s knee can look like other conditions, and a proper diagnosis is essential to treat the knee accurately. The doctor will begin with a patient interview and review their medical history. A physical knee examination will be performed next. They will test for knee pain in specific movements and check for swelling in the knee.

They may also order imaging studies and other tests for your knee joint:

  • X-rays can rule out fractures or signs of arthritis.
  • MRIs can reveal ACL, PCL, or meniscus tears.
  • CT scans can detect abscesses, tumors, or patterns of fracture.
  • Doctors may also order a blood test for infection or inflammation.

Runner's Knee Treatment Options

knees bandaged in compression wraps.

Different factors cause different types of scoliosis. Below, we start with the most common type of scoliosis.

  • Rest: take a few days off from activities that increase your knee pain. If you still want to exercise after the pain and swelling have subsided to maintain your strength and endurance, try activities that don’t bear weight on your knee, like swimming.
  • Ice: Ice reduces swelling and inflammation. It also numbs the pain. Wrap an ice pack on a clean, thin towel and apply it on the knee for 15-20 minutes every 40 minutes.
  • Compression: Neoprene knee sleeves can minimize swelling and stabilize your knee. Avoid wrapping it too tightly as it can cause swelling on the lower leg and foot.
  • Elevation: During the first 48 hours, sit or lie down with your leg elevated to reduce swelling in the knee.
  • Pain Medication: Take proper dosages of over-the-counter pain medication to help reduce pain and swelling. Please consult your doctor if you have to take other prescribed medications.

Runner's Knee FAQ

Most people, especially athletes, worry about being hindered by their injuries. Without proper treatment that directly addresses the causes of runner's knee and due diligence, their full recovery can take far longer.

The average recovery time for runner's knee is 4-6 weeks. But the recovery for each person will depend on the following:


Cause of Runner's Knee
The cause of runner's knee must be confirmed to treat it effectively. As of 2018, evidence-based treatment has proven the following:

  • If the person has a structural defect like an overpronation of the foot, they may need orthotics and shoe modifications.
  • If the cause of runner's knee is muscular imbalance, the person may need physical therapy rehabilitation. They may need strength training of weak hip abductors, external rotators, ITB, or VMO. At the same time, they will need to include stretching and mobility training for the hamstrings and Achilles tendons. 

Physical therapy is also essential for managing pain through taping, manual therapy, and/or other interventions combined with prescribed exercises. Physical therapy and exercises are prescribed after pain and swelling have subsided.


Severity of the Injury
If runner's knee is intervened early with proper treatment and training modifications that address its causes, a person can return to pain-free recovery in two weeks. However, if a person powers through their injury for weeks, they can worsen it and require a longer recovery time.

If you need to rule out more severe conditions and are unsure whether your knee pain is from runner's knee, your doctor can examine you for other injuries in the knee joint, such as ACL tears or fractures.


Schedule a visit to the doctor if a forceful impact caused the knee injury or shows the following signs and symptoms:

  • Significant swelling
  • Redness
  • Warm and tender to touch
  • Severe pain
  • Fever

Please go to urgent care if a forceful impact causes your knee pain and exhibits the following:

  • A popping noise when the knee was injured
  • Unable to bear weight on the knee
  • Excruciating pain
  • Sudden swelling
  • The joint looks deformed

Yes, you can still run with this injury. After proper treatment addresses the causes of your injury, your training or activity must be modified to prevent pain from returning. Low-impact cross-training exercises like yoga, cycling, and pool running maintain fitness and improve endurance and aerobic capacity.

Losing Weight

According to a study by Arthritis & Rheumatism, losing a pound of weight can remove four pounds of pressure on the knees. That means if a person loses 10 pounds, they remove 40 pounds of pressure on their knees.


Proper Stretching and Strengthening

Before starting the training or other main activities, stretching exercises for the hamstrings and Achilles tendons must be done first. Targeted training of VMO, ITB, and hip rotators and abductors can also be added for maintenance.


Warm-ups and Cooldowns

Gradually increasing the activity level allows the muscles to adapt to good blood flow. Finishing the activity with light jogging and stretches allows gradual recovery and avoids a tense state.


Proper Footwear 

Proper footwear can correct the alignment of the kneecap to the trochlear groove. Quality running shoes can correct flat feet and absorb shock upon heel strike.


Proper Running Form

A proper running form keeps the core tight to prevent leaning too far forward or backward. Keeping knees bent when they momentarily bear the weight while running is vital for proper shock absorption and injury prevention.

Expert Care for Runner's Knee at Proliance Puget Sound Orthopaedics

Runner’s knee can hinder a person from the activities they love and from their activities of daily living. At Puget Sound Orthopedics, we treat patients with holistic care, involving other disciplines to promote full recovery and wellness. With the best up-to-date practice techniques that are timely and cost-effective, we aim to improve our patients’ musculoskeletal health and education. Contact us today to receive the same leading-edge and compassionate care.

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