When Running Becomes a Pain in the Knee
You're mid-run, feeling strong, then that ache starts behind your kneecap. Again.
Patellofemoral pain, also often known as runner’s knee, is the most common cause of anterior knee pain in runners. It can turn an enjoyable training session into a frustrating hobble home.
Understanding why this pain occurs, how to manage it, and when it’s okay to keep running can make all the difference between a short-term niggle and a long-term issue.
What Is Runner's Knee?
Runner’s knee is a musculoskeletal injury and the most common source of pain at the front of the knee in runners. It typically worsens with activities that increase load on the front of the knee, such as:
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Squatting or lunging
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Climbing stairs or running hills
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Sitting for long periods with bent knees
The main culprit is usually a sudden change in running volume, intensity, or terrain, which places excessive stress on the kneecap and surrounding tissues. While it may sound simple, managing this fine balance between load and recovery is where most runners run into trouble.
Step 1: Managing Your Load
The first step in treatment is finding your comfortable running threshold. You want training where pain stays mild and doesn’t flare up significantly afterwards.
A small amount of discomfort is acceptable, but soreness that lingers for days is a sign that you’re overdoing it.
Ways to modify load include:
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Reducing running speed, distance, or frequency
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Choosing flatter terrain to limit stress on the knee
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Using taping or orthotics to improve reduce load on the knee joint
For runners with significant pain, a short rest period from running may be necessary before gradually reloading the knee. For milder cases, running can often continue with careful adjustment.
Step 2: Targeted Physiotherapy Treatment
Treatment varies depending on how sore or irritable the knee is:
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For more painful cases: hands-on physiotherapy techniques such as trigger point therapy or joint mobilisations can help reduce irritation and improve mobility.
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For mild to moderate symptoms: the focus shifts to a graded strengthening program to improve muscle capacity and reduce load on the knee.
Key muscle groups to strengthen include:
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Quadriceps and hamstrings
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Gluteal and hip stabilisers
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Calf muscles
Strengthening these areas not only reduces pain but also builds resilience to help prevent recurrence.
Step 3: Preventing Runner’s Knee from Returning
The best approach to prevention is to be proactive. Consistency in both load management and strength training is key:
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Avoid sudden spikes in training volume or intensity. Increase weekly mileage gradually to give your body time to adapt.
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Incorporate resistance training 2–3 times per week. This keeps the muscles of your legs and hips strong enough to handle the demands of running.
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Prioritise recovery. Adequate sleep, balanced nutrition, and regular rest days are essential to allow tissues to repair and adapt.
Keep Running Smarter, Not Harder
Runner’s knee doesn’t have to sideline your training. With the right balance of load management, strengthening, and recovery, most runners return to full training stronger than before.
If knee pain is limiting your running, early sport physiotherapy intervention keeps you on track.