Runner’s Knee, as the name suggests, or Patellofemoral pain syndrome (PFPS), is common among runners. It is, however, not limited to runners, because it can also affect any athlete who requires a lot of knee-bending such as walking, cycling and jumping.

The stress and strain of knee-bending activities can cause irritation where the patella (kneecap) sits on the femur (thighbone). The resultant pain (Runner’s Knee) may be acute and sharp, or it may become dull and chronic pain. Often the pain disappears during activity, only to return again afterwards. Runner’s knee is often the result of biomechanical issues, as well as weak quadriceps and tight hamstrings. When the quads are weak they aren’t able to support the patella, causing it to track out of alignment. Inflexible hamstrings can put undesirable pressure on the knee. In order to treat Runner’s Knee effectively, you need to correct the biomechanical issues, strengthen weak muscles and stretch tight muscles.

What are the Symptoms of Runner’s Knee?

  • Pain behind or around the patella/knee
  • Pain may be in one or both knees
  • Pain when you bend the knee (when walking, squatting, kneeling, running, traversing uneven terrain or even rising from a chair)
  • Pain that’s worse when walking downstairs or downhill
  • Swelling around the patella
  • Popping or grinding sensations in the knee

Causes of Runner’s Knee

It is difficult to pinpoint a single cause of Runner’s Knee. As we said, Runner’s Knee could be due to a biomechanical problem—the patella may be larger on the outside than it is on the inside, it may sit too high in the femoral groove, or it may dislocate easily. There may be worn cartilage in the knee joint which reduces shock absorption.
The arches in the feet also affect the knee. High-arched feet provide less cushioning, and flat feet which turn in or out excessively can pull the patella sideways.

In addition, there are muscular causes for Runner’s Knee.  These include tight hamstring and calf muscles which put pressure on the knee. Weak quadriceps muscles can cause the patella to track out of alignment, as there is a disproportional load on sections of the patella leading to abnormal wear patterns and pain.

Overuse or repetitive strain such as jumping and plyometrics can also irritate the patellofemoral joint.

Prevention and Treatment of Runner’s Knee

To prevent Runner’s Knee, run or exercise on softer surfaces, keep mileage increases less than 10% per week and gradually increase hill work in your programme. Visit a speciality running shop to make sure you’re wearing the proper shoes for your foot type and gait.

Strengthening your quadriceps will improve patellar tracking and stretching your hamstrings and calves will prevent excessive pressure on the knee. At the first sign of pain, cut back your mileage or activity. The sooner you lessen the knee’s workload, the faster the healing of Runner’s Knee begins. Avoid knee-bending activities, canted/sloped surfaces and downward stairs and slopes until the pain subsides. As you rebuild mileage, use a smaller stride on hills. Consider orthotics if new shoes don’t fix the problem. See a physiotherapist if the pain persists, to assist in the treatment and rehabilitation of Runner’s Knee or to rule out another condition.


Home Exercises for Runner’s Knee

Inner range quad exercise

Hamstring Stretch

Hold stretch 30 seconds, 2-3 times each leg




Calf Stretch

Hold the stretch for 30 seconds, 2-3 times per leg.




Strengthening your Quads

Straight Leg Raise:
Keep the knee straight and the foot flexed. Lift the leg up to 45°, repeat 15 times on each leg, twice a day.


Inner Range Quads:

  • Roll a towel under the knee so that it is slightly bent.
  • Fully extend the knee from this position, locking it for 3 seconds in the extended position.
  • Repeat 15 times on each leg. Twice a day.

This article has been submitted by Kate Lamprey, Practice Manager at Douglasdale and Fourways. Contact her directly or else use this quick online appointment form.