Runner’s knee is an ache around or behind the kneecap that often builds after a jump in training. In this Tylurs com guide we explain what causes it, how physiotherapy treats it and a stage-by-stage plan to get you back to running with confidence.
Key takeaways
- Runner’s knee (patellofemoral pain) is an overload problem, not wear and tear.
- Sudden training spikes, hip and thigh weakness and overstriding are common contributors.
- Treatment centres on load management, hip and knee strengthening and small running tweaks.
- A staged return-to-running plan with a simple pain rule keeps progress on track.
What is runner’s knee?
Its medical name is patellofemoral pain. Your kneecap glides in a groove at the end of your thigh bone, acting as a pulley for the quadriceps, and this joint takes a lot of force when you run, squat or walk downstairs. Runner’s knee develops when the tissues around it become sensitive because load has outpaced what they are conditioned to handle.
It is not limited to runners: cyclists, footballers, hikers and active teenagers get it too.
What causes runner’s knee?
- Training load spikes: adding distance quickly, a new hilly route, extra speed sessions or returning after a break at your old level.
- Hip and quadriceps weakness: weak glutes can let your thigh drift inwards on landing, adding stress to the front of the knee.
- Running mechanics: overstriding, a low step rate, heavy landings and lots of downhill running.
- Other factors: sudden footwear changes, a previous knee injury, poor sleep and growth spurts in teenagers.
Symptoms
Typical signs include a dull ache around or behind the kneecap, pain on stairs (especially going down), pain when squatting or kneeling, aching after sitting with bent knees, and pain that builds during a run. Clicking under the kneecap is often harmless on its own.
It may be something else if pain is sharp and pinpoint just below the kneecap, or if the knee swelled quickly after a twist, locks or gives way. Our guide to knee pain covers other common causes, and MedlinePlus has a clear overview of anterior knee pain.
How physiotherapy treats runner’s knee
Exercise is the main treatment, and most people need no scan or invasive treatment.
Assessment and load management
Your Tylurs com physiotherapist asks about weekly distance, recent changes, routes and shoes, tests hip and knee strength and watches a step-down, single-leg squat or short run. The aim is to reduce aggravating load, not stop all activity: shorter, slower, flatter runs, or some cycling or swimming for a while. For a sore knee after activity, our guide to ice or heat for an injury weighs up the options.
Hip and knee strengthening
A typical programme runs two or three times a week for roughly 6 to 12 weeks:
- side-lying leg raises or clams for the outer hip;
- side planks, starting from your knees;
- glute bridges, building to single-leg bridges;
- wall sits and sit-to-stands at a comfortable depth;
- step-downs, then split squats and single-leg squats.
The last few reps of each set should feel like hard work, because muscles only strengthen when challenged.
Running retraining
A modest increase in cadence often helps. Count your steps for a minute on an easy run, then aim for roughly 5% more at the same speed, for example from 160 to about 168. Shorter, quicker steps mean less force through the knee on each landing. Taping or off-the-shelf insoles can ease pain short term, and hands-on treatment can help you move comfortably, but both work best alongside exercise.
A return-to-running plan
Before you start, you should be able to walk briskly for 30 minutes without more pain, manage stairs comfortably and hop gently 10 times on each leg. Run on alternate days, on flat ground, at an easy conversational pace, and keep up strength work twice a week.
| Stage | Example session | Move on when |
|---|---|---|
| 1 | 5 rounds of 1 min jog, 2 min walk | Two sessions with pain 3/10 or less, settled next morning |
| 2 | 5 rounds of 2 min jog, 1 min walk | The same rule |
| 3 | 3 rounds of 5 min jog, 1 min walk | The same rule |
| 4 | 20 minutes continuous easy running | Two comfortable sessions |
| 5 | 30 minutes continuous | One to two comfortable weeks |
| 6 | Add longer runs, then hills, then speed, one at a time | Ongoing |
If your knee flares above 3 out of 10 or is sore the next morning, drop back a stage. Cleveland Clinic says most people need a month or two to recover.
Preventing it from coming back
- Build gradually, changing one thing at a time.
- Keep two short strength sessions a week all year.
- Ease into hills and change shoes gradually.
- Protect sleep, rest days and fuelling.
- Treat a niggle lasting beyond a run or two as a signal to ease off.
Physio tip: If your knee aches after a run, look back over the last two to three weeks, not just today. Runner’s knee usually reflects a gradual build-up of load.
When to get your knee checked
See a physiotherapist or GP if pain has not improved after two or three weeks of easing off, aches at rest or at night, or keeps flaring each time you build up. Get same-day urgent advice if the knee is very painful, badly swollen, locks or gives way, you cannot bear weight, or you feel feverish with a hot, red knee. A child or teenager with knee pain and a limp should see a doctor promptly.
Book runner’s knee physiotherapy
Our sports injury rehabilitation service combines a detailed assessment, a strength programme built around your running and a staged return that fits your goals. Not sure what to expect? Read our guide to your first physiotherapy appointment, browse more running advice on the physiotherapy blog, or start at the Tylurs com homepage. When you are ready, book your running injury assessment.
Questions readers often ask
Can I keep running with runner’s knee?
Often, yes, in a modified form. If pain stays mild during your run, does not change how you run and has settled by the next morning, you can usually continue with shorter, slower runs on flat ground. If pain builds or lingers into the next day, pause and cycle or swim instead.
Is runner’s knee the same as patellar tendinopathy?
No, although both cause pain at the front of the knee. Runner’s knee is usually a vague ache around or behind the kneecap, worse on stairs. Patellar tendinopathy tends to be sharper, at one spot just below the kneecap, especially when jumping. They need different loading programmes, so get it checked.
Will new running shoes fix runner’s knee?
Shoes alone rarely fix it. A comfortable shoe that suits your foot is sensible, but a sudden switch to a very different style can shift load and cause new niggles. Some people get short-term relief from insoles. Managing training load and building hip and thigh strength make a much bigger difference.
Is clicking or grinding under my kneecap a sign of damage?
Usually not on its own. Clicking, cracking and grinding from the kneecap are common, including in people with no pain, and do not mean the joint is wearing out. Mention them to your physiotherapist, but they are rarely a concern. Noises with swelling, locking or the knee giving way should be checked.
References
- Knee pain (NHS)
- Anterior knee pain (MedlinePlus, US National Library of Medicine)
- Patellofemoral pain syndrome (PFPS) (Cleveland Clinic)
