Understanding Runner’s Knee AKA Patellofemoral Pain Syndrome
Runner’s Knee, also known as Patellofemoral Pain Syndrome (PFPS), is a condition I frequently see in both athletes and everyday clients. While the name might suggest it’s exclusive to runners, it can affect anyone who puts repetitive stress on the knee. Often, people diagnosed with PFPS don’t fully understand what it means or how to manage it.
What Is Runner’s Knee?
Patellofemoral Pain Syndrome refers to pain around or behind the kneecap, typically aggravated by activities that place repetitive load on the knee. These can include running, squatting, jumping, or going up and down stairs. It can even occur from prolonged sitting, termed “movie theater sign”.
PFPS is usually diagnosed when all other possible diagnoses are ruled out, like meniscus tears, ACL tears, and more. Old theories believed that PFPS was due to “poor tracking” of the kneecap along the thigh bone, and treatment focused heavily on VMO, or vastus medialis oblique (a quadriceps muscle) strengthening or taping to improve kneecap alignment. This has not been shown to be significantly more effective than general strength training and load management.
Instead, the condition is often the result of overloading the joint without proper strength, mobility, or recovery in place.
Quick Anatomy Breakdown
Patello-: Refers to the patella, or kneecap
Femoral: Refers to the femur, or thigh bone
The patellofemoral joint is where these two bones meet at the knee joint.
What Causes Runner’s Knee?
Despite the name, Runner’s Knee can affect anyone, not just runners. Common contributing factors include:
Overuse of the knee muscles and joints without a proper strength base
Weak hip and glute stabilizers, leading to more stress at the knee
Tightness in the quads, calves, or hamstrings, leading to movement compensations.
Poor mobility in the ankle or foot, leading to more stress at the knee.
Training errors, like ramping up mileage or intensity too quickly. The good ol’ “too much too soon.”
Increased uphill or downhill running
Running form issues or improper footwear
These factors place excess stress on the knee joint, especially when the body isn’t adequately prepared for the activity.
Symptoms of Runner’s Knee
Aching or sharp pain around or behind the kneecap
Pain worsens with stairs, kneeling, squatting, or sitting for long periods
Occasional grinding, popping, or catching
Tenderness along the front of the knee or patellar tendon
How We Treat It
As a physical therapist, I focus on evidence-based rehab strategies to address Runner’s Knee. The two pillars of effective treatment: strength training and activity modification.
Strengthening & Mobility
I commonly guide clients through exercises that will build a strong foundation of lower body strength. This focuses on the glutes, quadriceps, hamstrings, etc, both through strength training, power training, and plyometrics to allow the body to prepare for any activities thrown at it.
While strength training is a big part of treating and preventing PFPS, it’s also important to train your flexibility and mobility to allow the body to move without limitations, which may add stress to other parts of the body.
I always check for proper mobility at the hips, knees, and ankles. I find that most people have limitations at the hip and ankle. These are two areas I always target when treating a client with Runner’s Knee.
Here are just a few of many exercises and mobility drills I prescribe to my clients to combat Runner’s Knee.
Foam Rolling and Lacrosse Ball Smash
Piriformis
TFL Smash
Calf
IT Band
Anterior Tibialis
Quadriceps
Hamstrings
Mobility & Stretching
Pigeon Stretch
ITB Stretch
Hamstring Stretch
Couch Stretch
3 Position Ankle DF Stretch
Strengthening
Single Leg RDL
Lateral Step Down
Single Leg Depth Drop
Fire Hydrant
Single Leg Bridge
Calf Raises
Skater Squat
Additional Rehab Strategies
I’ll never tell someone they need to stop running or performing their favorite activities. They may just need to temporarily reduce activity volume to allow symptoms to calm down.
Example: If you usually run 5 miles, reduce to 1–2 miles during a flare-up
Strengthen the entire kinetic chain, especially the hips and core
Physical therapy modalities, including Dry Needling, Shockwave, and more
Reassess footwear and consider orthotics if needed
Return to activity gradually, with proper warm-ups, cooldowns, and rest days
Final Thoughts
Runner’s Knee can be frustrating, but it’s highly treatable. With the right blend of strength work, activity modifications, and rehab, you can get back to running or your favorite activities without pain.
If you’re dealing with persistent knee pain, don’t ignore it. Early intervention can make all the difference.
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