If you’ve ever felt that familiar ache in your knee after a workout, you’re not alone—many of our patients have struggled with runner’s knee (Patellofemoral Pain Syndrome). The good news is that there are effective strategies to prevent and manage it.
Patellofemoral Pain Syndrome (PFPS), is a common yet frustrating condition that affects many active individuals, not just runners. In this article, we’ll discuss how to know if you’ve got runner’s knee, who gets this condition, and discuss some basic fixes that you can implement at home to get yourself back to the activities you want to be doing!
What is runner’s knee (patellofemoral pain syndrome)?
Runner’s knee, medically known as Patellofemoral Pain Syndrome (PFPS), is a condition characterized by pain around or behind the kneecap, particularly where it meets the lower end of the thighbone (femur).
This pain often occurs during activities that involve repetitive knee bending, such as running, squatting, climbing stairs, or even sitting for prolonged periods. The condition is commonly associated with overuse, muscle imbalances, improper alignment of the patella, and factors like weak or tight muscles.
Individuals with flat feet or those who suddenly increase their physical activity level are also at higher risk.
Does this affect only runners?
It’s common for patients who aren’t runners to present with the symptoms of runner’s knee, which makes this diagnosis a bit confusing for some people. While runner’s knee is a prevalent issue among athletes, this condition can affect anyone who engages in activities that involve frequent knee bending and load-bearing.
The primary categories of folks who will experience this condition include:
Athletes who participate in sports like cycling, skiing, or basketball, as well as individuals who perform repetitive squatting, jumping, or stair climbing, are also at risk.
People who are less active but experience sudden increases in physical activity, or those with biomechanical issues such as flat feet or improper patella alignment, can develop runner’s knee.
Non-athletes who sit for extended periods with their knees bent may experience symptoms, making this a condition that can potentially affect a wide range of individuals, not just runners.
Causes of runner’s knee
Runner’s knee, or Patellofemoral Pain Syndrome (PFPS), is caused by various factors that contribute to the irritation of the tissues around the kneecap.
The causes of runner’s knee often involve a combination of:
- Overuse and repetitive stress
- Muscle imbalances or weak hips, which can also contribute to plantar fasciitis on the same side
- Biomechanical abnormalities such as misalignment of the patella, flat feet, or overpronation
- Sudden increases in activity level
- Previous knee injuries
Runner’s knee symptoms
As mentioned above, many of our “runner’s knee” patients aren’t actually runners, similar to how golfer’s elbow patients aren’t always golfers. So, what does runner’s knee feel like?
Examine your own symptoms, and get checked out if you think you might have this condition.
The symptoms of runner’s knee, or Patellofemoral Pain Syndrome (PFPS), include:
- Pain around or behind the kneecap: This pain is often described as a dull, aching sensation and can be felt where the patella meets the lower end of the thighbone (femur).
- Pain that worsens with activity: Activities that involve bending the knee, such as running, jumping, squatting, climbing stairs, or cycling, can aggravate the pain.
- Pain after sitting for prolonged periods: Sitting with bent knees for extended periods, often referred to as “theater sign” or “moviegoer’s knee,” can increase discomfort.
- Grinding or clicking sensation: Some people may experience a grinding, clicking, or popping sensation when bending or straightening the knee.
- Swelling around the knee: Mild swelling around the kneecap can occur in some cases.
- Pain when walking downhill or downstairs: The added stress on the knee joint during these activities can exacerbate pain.
- Tenderness around the patella: The area around the kneecap may be tender to the touch.
These symptoms can vary in intensity and may be felt in one or both knees. If you’re not sure, get checked out by a professional healthcare provider or physical therapist.
How to heal runner’s knee
1. Start with rest and activity modification
Resting the area is the best place to start. Avoid activities that exacerbate your knee pain (running, jumping, squatting, etc) and allow the tissues around the knee to heal.
If you’re well enough to exercise, switch to low-impact exercises for the time being. A classic substitution would be to temporarily discontinue running and switching to the stanionary bike. This way, you can maintain your desired fitness level without putting additional stress on the knee.
2. Apply Ice and Use Anti-inflammatory Medication
For the first week or so, apply ice to the knee for 15-20 minutes, several times a day, especially after activities that cause pain. This helps reduce inflammation and pain. Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, can help manage pain and inflammation.
3. Stretching and Strengthening Exercises
In general, this is where a physical therapist comes in, although if the injury is getting better nicely, it’s very possible to utilize DIY physical therapy techniques. With stretches, focus on stretching the muscles around the knee, including the quadriceps, hamstrings, calf muscles, and iliotibial (IT) band. This helps improve flexibility and reduces tension on the patella.
In physical therapy, we have preferred methods for stretching and mobilizing these areas, although you can use your stretches of choice for these particular muscle groups if you’re attempting to rehab the injury on your own.
The next step is to begin the process of strengthening the quadriceps, hip abductors, and core muscles to improve knee stability and alignment. Exercises such as straight-leg raises, step-ups, and hip bridges are effective. We’ve got a whole presentation on hip and knee pain exercises published on our site that you may find helpful.
4. Improve knee alignment, footwear, and utilize supportive devices (if needed)
If flat feet or overpronation contribute to knee pain, consider using custom orthotics or supportive insoles to correct foot alignment. Additionally, wear shoes with good arch support and cushioning, especially during physical activities. Replace worn-out shoes to ensure they provide adequate support.
Knee braces or taping can also be useful as the joint returns to full health. A patellar tracking brace or kinesiology taping (see our full article on how kinesio tape works) can provide support and help keep the patella in proper alignment during activities.
6. Seek physical therapy, if needed
If the injury doesn’t resolve on it’s own, seek professional help from a physical therapist. Physical therapy works very well for basic joint injuries like patellofemoral pain syndrome.
A physical therapist can provide a tailored exercise program, manual therapy, and guidance on correcting movement patterns that may be contributing to knee pain. Additionally, we can provide guidance on which particular strengthening exercises and stretches would be the most beneficial for you.
7. Return to activity gradually
While we certainly don’t intend to “nocebo” anyone from physical activity, we do recommend a slow progression back into a basic exercise routine. If you’re a runner or athlete, practice just a small amount of your sport and wait a day to see how your knee responds. If the experiment goes well, try it again a couple days later.
Once pain subsides, gradually return to physical activities. Start with low-impact exercises and slowly increase the intensity and duration. Avoid sudden increases in activity level.
Remember that there’s no setback that can’t be made worse by reinjuring the same body part! If you’re in your sport for the long-haul, take care of yourself well during this reintroduction period.
Runner’s knee recovery time
How long runner’s knee lasts can vary depending on the severity of the condition, the individual’s overall health, and the effectiveness of the treatment plan. Generally, it can take anywhere from a few weeks to several months for runner’s knee to heal.
Typical healing timeline
- Mild Cases: For mild cases where symptoms are managed promptly with rest, ice, and rehabilitation exercises, recovery might take around 4 to 6 weeks.
- Moderate Cases: For more moderate cases, where there is significant pain or irritation, healing may take 2 to 3 months. Consistent adherence to a physical therapy program and activity modification is crucial during this period.
- Severe Cases: In cases where runner’s knee is persistent or associated with significant biomechanical issues, recovery could take 3 to 6 months or longer. This timeline may also involve more intensive physical therapy, potential use of orthotics, and careful management of physical activities.
Note that this timeline provides a rough estimate and individual variance is to be expected. For best results, adhere to your treatment plan and maintain the necessary lifestyle modifications.
It’s important to be patient and allow the knee to heal fully before returning to high-impact activities to prevent recurrence or further injury. If symptoms do not improve or worsen over time, seeking further medical evaluation is advised.
Reinjury prevention
Preventing runner’s knee involves a combination of strengthening, flexibility, proper footwear, and smart training practices. Strengthening key muscles, particularly the quadriceps, hip abductors, and core, supports knee stability and ensures proper patellar tracking.
Regular stretching of the quadriceps, hamstrings, calves, and iliotibial (IT) band helps maintain flexibility and proper knee mechanics. Wearing supportive shoes and replacing them when they show signs of wear is crucial, especially for those with flat feet or overpronation, who may benefit from custom orthotics.
Gradually increasing activity levels, maintaining good running form, and incorporating low-impact cross-training activities can help prevent overuse injuries.
By listening to your body and addressing any early signs of discomfort with rest and modified activities, you can significantly reduce the risk of developing runner’s knee and keep your knees healthy.
