Runner’s knee is a common reason for runners to see a physiotherapist. Its medical name is patellofemoral pain, and it describes an ache around or behind the kneecap that tends to creep in when training ramps up.
It rarely points to damage inside the joint, and it usually responds well to the right mix of load management, strength work and small changes to how you run. This guide from the physiotherapists at Tylurs com explains why it happens, what treatment involves and how to build back up to running safely.
What is runner’s knee?
Your kneecap (patella) sits in a groove at the lower end of your thigh bone (femur). Each time you bend and straighten your knee, it glides up and down this groove, acting like a pulley for the quadriceps, the big muscles at the front of your thigh. The joint between the two bones takes a lot of force when you run, squat or walk downstairs.
Runner’s knee develops when the tissues around this joint become sensitive because the load on them has outpaced what they are currently conditioned to handle. It is best thought of as an overload problem rather than wear and tear.
Despite the name, it is not limited to runners. Cyclists, footballers, dancers, hikers and active teenagers get it too, and so do people who have recently done a lot of squatting, kneeling or stair climbing.
What causes runner’s knee?
There is rarely a single cause. Usually it is a combination of how much you are doing and how well prepared your body is for it.
Training load spikes
The most common trigger is a sudden change in training. That might be adding distance quickly, a new hilly route, extra speed sessions, preparing for a first half marathon or returning after a break at your old level. Muscles, tendons and joint surfaces all adapt to load, but they need time to do it, and a sudden jump gives them none.
Hip and quadriceps weakness
Strong quadriceps help control the kneecap and absorb force as you land. Weakness in the muscles around the side and back of the hip (mainly the gluteal muscles) can let your thigh drift inwards as your foot strikes the ground, which may add stress to the front of the knee. Physiotherapists often find reduced hip and thigh strength when they test people with this problem. It is not always clear whether weakness is a cause or a result of pain, but either way it is something you can change.
Running mechanics
Overstriding, where your foot lands well ahead of your body with a fairly straight knee, increases the load through the front of the knee. A low step rate, a heavy landing and the knee collapsing inwards on each stride are other patterns a physiotherapist looks for. Downhill running is particularly demanding on this joint.
Other contributors
A sudden change of footwear, flat feet, carrying extra body weight, a previous knee injury, poor sleep and not enough recovery between sessions can all play a part. In teenagers, growth spurts are a common factor.
Symptoms: how runner’s knee usually feels
Typical signs include:
- a dull ache around, behind or just beside the kneecap, often hard to pinpoint
- pain going up and especially down stairs
- pain when squatting, kneeling or lunging
- aching after sitting for a long time with your knees bent, such as in a car or cinema, which eases when you straighten your legs and move
- pain that builds during a run, particularly downhill, or appears afterwards
- clicking or grinding under the kneecap, which is often harmless on its own
It can affect one or both knees and usually comes on gradually rather than from a single moment of injury. Swelling is usually minimal.
It may be something else if the pain is sharp and pinpoint just below the kneecap, which can point to tendinopathy, or if it is on the outside of the knee and starts at a predictable point in each run. A knee that swelled quickly after a twist, locks or gives way suggests a different problem. Our guide to knee pain covers other common causes, and it is worth remembering that pain felt in the knee sometimes comes from the hip.
How physiotherapy treats runner’s knee
Exercise is the main treatment. Physiotherapists usually combine hip-focused work with knee-focused strengthening rather than training the knee on its own, and add advice on how much running your knee can currently cope with. Most people do not need a scan or any invasive treatment.
A thorough assessment
Your physiotherapist will ask about your weekly distance, recent changes, routes, shoes and other sports, and what brings the pain on. They will look at how your knee and hip move, test your strength and watch how you control a step-down or single-leg squat. They may also watch you run or jog, either in person or on video.
Load management, not complete rest
The aim is to reduce the load that aggravates your knee, not to stop all activity. That might mean shorter, slower and flatter runs, fewer runs each week, or swapping some for cycling or swimming for a while. For a sore knee after activity, a cold pack can take the edge off; our guide to ice or heat for injury weighs up the two.
Hip and knee strengthening
A typical programme runs two or three times a week and progresses over roughly 6 to 12 weeks. It might include:
- Side-lying leg raises or clams to strengthen the outer hip
- Side planks, starting from your knees
- Glute bridges, building to single-leg bridges
- Wall sits at a comfortable depth, and sit-to-stands from a chair
- Step-downs from a low step, keeping your knee in line with your foot
- Split squats and leg press, later progressing to single-leg squats and hopping
Knee-bending exercises usually start in a shallow, comfortable range and go deeper as your knee settles. Muscles only get stronger when they are challenged, so the last few reps of each set should feel like hard work.
Running retraining
Small changes to how you run can take pressure off the kneecap. The most useful is often a modest increase in cadence, meaning the number of steps you take per minute. Count your steps for a minute on an easy run, then aim for roughly 5% more at the same speed: from 160 to about 168, for example. Shorter, quicker steps mean the knee bends less and absorbs less force on each landing.
Other cues include landing more softly and letting your foot land closer to under your body. Introduce changes a few minutes at a time within a run, and only keep them if they help.
Taping and insoles as short-term helpers
Kneecap taping or off-the-shelf insoles can reduce pain for some people in the short term, making it easier to exercise. They are aids rather than a fix, used alongside strengthening and then gradually phased out.
Hands-on treatment
Soft tissue work or gentle joint mobilisation, part of our manual therapy service, can ease pain and help you move more comfortably. It works best alongside exercise rather than on its own.
A return-to-running plan
Before you start, you should be able to:
- walk briskly for 30 minutes without your pain increasing
- go up and down stairs with little or no pain
- do 10 slow step-downs or single-leg squats on each side with good control
- hop gently on the spot 10 times on each leg with no more than mild discomfort
Run on alternate days, on flat ground, at an easy pace where you could hold a conversation. Keep up your strength work twice a week throughout.
| Stage | Example session | Move on when |
|---|---|---|
| 1 | 5 rounds of 1 minute jogging, 2 minutes walking | Two sessions with pain at 3 out of 10 or less, settled by the next morning |
| 2 | 5 rounds of 2 minutes jogging, 1 minute walking | The same rule |
| 3 | 3 rounds of 5 minutes jogging, 1 minute walking | The same rule |
| 4 | 20 minutes of continuous easy running | Two comfortable sessions |
| 5 | 30 minutes continuous, adding a fourth run each week if you want to | One to two comfortable weeks |
| 6 | Reintroduce longer runs, then hills, then speed work, one change at a time | Ongoing |
If your knee flares above 3 out of 10 or is still sore the next morning, drop back a stage for a few sessions. Repeating a stage is normal, not a failure. Cleveland Clinic says most people need a month or two to recover from runner’s knee. For some it lingers or returns, which is why keeping up your strength work matters.
Preventing runner’s knee from coming back
- Build gradually. Increase one thing at a time, whether that is distance, frequency, speed or hills, and plan easier weeks into your training.
- Keep strength training all year. Two short sessions a week targeting your hips, thighs and calves are a worthwhile investment for any runner.
- Ease into hills and downhill running. They load the kneecap more than flat routes.
- Change shoes gradually. Mix new and old pairs for a few weeks rather than switching overnight.
- Protect your recovery. Sleep, rest days and eating enough all affect how well your tissues adapt.
- Act on early warning signs. A niggle that lasts beyond a run or two is a signal to ease off for a few days, not to push on.
Physio tip: if your knee aches after a run, do not just ask what you did today. Look back over the last two to three weeks. Runner’s knee usually reflects a gradual build-up of load, not one bad run.
When to get your knee checked
See a physiotherapist or GP if:
- the pain has not improved after two or three weeks of easing off and self-care
- your knee aches at rest or wakes you at night
- it is affecting your work, sleep or daily life
- you keep having flare-ups each time you build your running back up
When to seek urgent medical help
NHS advice on knee pain is to get urgent medical advice the same day, from an urgent care service, if:
- your knee is very painful
- you cannot move your knee or put any weight on it
- your knee is badly swollen or has changed shape
- your knee locks, gives way or clicks painfully
- you have a very high temperature or feel hot and shivery, with redness or heat around your knee
Go to your nearest emergency department if the pain follows a serious fall or accident and you think you may have broken a bone. A child or teenager with knee pain and a limp should also see a doctor promptly.
Book runner’s knee physiotherapy at Tylurs com
If runner’s knee keeps interrupting your training, a clear plan makes a real difference. At Tylurs com, our sports injury rehabilitation service combines a detailed assessment, a strength programme built around your running and a staged return that fits your goals, whether that is a comfortable parkrun or a marathon.
Not sure what to expect? Our guide to your first physiotherapy appointment explains how it works. When you are ready, book your running injury assessment.
This page is for general information and does not replace a personal assessment. If you have severe, sudden or worsening symptoms, seek medical advice promptly.