runners knee pain

Runners Knee: The Ultimate Guide

Runners knee is one of the most common running injuries – so common that its been given it’s own name! 

For most people, its usually occurs as a sign that you need to slow down your training and better prepare your body to handle the stress of longer distances. But that’s easier said than done, especially if you don’t know much about it. 

In this article, we’re going to ‘run’ through everything you need to know about runner’s knee, including:

  1. What Is Runners Knee?
  2. Where Does Runners Knee Hurt?
  3. What Are the Symptoms?
  4. What Else Could It Be?
  5. How To Treat Runners Knee
  6. How To Prevent Runners Knee

What Is Runners Knee?

Simply put, its an overuse injury causing pain at the front, around or behind the kneecap. 

You don’t just have to be a runner to get it. Cyclists, swimmers, hikers and even those that just enjoy a short walk can get it too.

Where Does Runners Knee Hurt?

To describe where the issue is, Physios and Sports Therapists often divide the pain into ‘chondromalacia patellae’ or ‘patellofemoral pain syndrome’. 

Essentially that just means its either coming from the structures that surround the kneecap or the kneecap itself.

Pain in the Structures Surrounding the Kneecap (Patellofemoral Pain Syndrome)

runners knee location

In this case, the pain is often caused by inflamed tissues that surround the knee cap, particularly fat, bursa and synovial membrane.

These tissues work to lubricate the knee joint and provide extra cushioning between the bones. When there is an unusually high level of stress on the knees, e.g. you did your first longer run, these tissues get irritated and inflamed. 

Pain in the Kneecap (Chondromalacia Patellae)

chondromalacia patella

Pain in the kneecap is often paired with a grinding feeling when the kneecap moves. The good news is that because of the added grinding, it often sounds scarier than it is.

The surface under the kneecap (patella) is covered with a layer of smooth cartilage, which normally glides smoothly when the knee is bent. However, in some individuals, the cartilage can be excessively stressed e.g. you suddenly increased your running speed or distance, which can alter the smoothness.

Clinicians may classify the cartilage under the kneecap as follows:

Stage 1: Softening and swelling 

Stage 2: Blister type formations

Stage 3: Fragmentations

Stage 4: Wearing through more than 50%

It is important to note that softening of the cartilage does not always lead to wearing it thin. Furthermore, having a higher grade cartilage stage doesn’t always stop runners. Your body adapts for this and with the right rehab, many can continue to run without pain.

What Are the Symptoms?

The most common symptom is an aching pain around or behind the kneecap:

  • After being seated for a long time.
  • When getting out of a chair.
  • When going up and downstairs.
  • When kneeling or squatting.
  • When running.

Most runners notice this pain appear during a run which can then last into the night and/or the next day.

runners knee symptoms

What Else Could The Pain Be?

This knee pain can commonly be mistaken for patellar tendinopathy, meniscus involvement, ligament injury, baker’s cyst, and referred pain from the hip or spine. If in doubt, seek help from a qualified Physiotherapist or Sports Therapist.

How To Treat Runners Knee:

The good news is that most people recover after 6-12 weeks of Physio therapy or Sports Therapy treatment.

Generally speaking, treatment consists of exercises that focus on strengthening the muscles of the legs and hips without increasing the amount of pressure between the kneecap and the groove of the thigh bone.

Evidence supports:

Reducing your running distance. 

  • Consider shortening your runs to a pretty much pain-free distance.
  • If you are desperate to keep your weekly mileage ahead of an event you can try increasing the number of runs but reduce the distance and speed.
  • Shorten your stride and increase the number of steps (cadence) in your running to offload the knees.

Exercise your thigh muscles (quads) in a pain-free range

  • To begin with, you can try simply tensing your thigh with a straight leg.
  • Then if you are doing squats, for example, try to keep to mini ones (between 0 and 40 degrees) and increase the number as pain allows.

Build strength in your hips


  • Make sure your glutes, thigh and ITB (iliotibial band) stay flexible and mobile. You can use a foam roller to help with this.
  • These should also be pain-free when running (or at least no sharp pain should be felt).

What should I avoid?

  • Lunges, deep squats and weighted leg extension exercises. These can put a lot of stress through the knee. Sports with lots of jumping may also irritate it, to begin with.
  • There are many variations to achieving strength in the desired location without doing these particular exercises. You can always seek help from a physiotherapist or sports therapist for advice.
runners knee treatment

How to Prevent Runners Knee:

A common misconception can be that it is caused by ‘bad knee alignment’ or kneecap ‘maltracking’. For a long time, doctors and physiotherapists believed this was the case but we now have evidence to show this is not the case. Research has shown that people that have ‘less than ideal’ alignment are no more likely to develop knee pain than the ‘perfect knees’.

There was likely a time when you didn’t have knee pain but the anatomy of your knee was the same as it is today. The key to prevention is to ask why now? What has changed? What muscles fatigue when running that might put more stress on the knee? And what muscles are tight causing you to change the way you run?

If you can answers these with your Physiotherapist or Sports Therapist, you can find the answer and more importantly, the solution.

Our Conclusion:

Kneecaps come in many different shapes and sizes that move at slightly different angles. 

For most people, getting Runner’s Knee is simply a sign that they need to slow down their training and better prepare their body to handle the stress of long-distance running

Bottom line is, don’t run through your knee pain. Be respectful of your body, but also, don’t stop and become inactive. 

If you want advice on runners knee, our expert Physiotherapists and Sports Therapists can help to get you back on your feet!

Book an Appointment today or give us a call on 01273 711 399 for some free advice.

DISCLAIMER: All content within this column is provided for general information only and should not substitute for the medical advice of your own doctor or any other health care professional. S57 Health & Wellbeing Clinic is not responsible or liable for any diagnosis made by a user based on the content of this site.