Runner’s knee is the everyday name for patellofemoral pain, an ache around or behind the kneecap. Despite the name it isn’t only runners: it’s common in anyone who runs, jumps, squats or climbs stairs, and in people who’ve recently stepped up their training or returned to sport. It’s usually a problem of load rather than damage, and it responds well to the right approach.
Understanding patellofemoral pain
The kneecap (patella) glides in a groove at the front of the thigh bone as the knee bends. Patellofemoral pain develops when the demands placed on that joint, through running, jumping, squatting or stairs, exceed what it’s currently conditioned to handle. Experts describe it as pain around or behind the kneecap that’s provoked by loaded knee bending.
Factors that commonly contribute include:
- A sudden increase in running, jumping or training volume, or a new surface or hills
- Reduced strength in the thighs and hips
- Footwear and running mechanics, in some people
- Long periods of sitting with the knee bent
- Returning to sport after time off
Symptoms we commonly see
- Ache around or behind the kneecap, often hard to pinpoint
- Pain going up or down stairs, squatting, running, or kneeling
- Pain after sitting for a long time with the knee bent, such as at a desk or in a car
- A grinding or clicking sensation in some people, which isn’t necessarily a problem on its own
- Pain that eases with rest but returns when you resume the aggravating activity
Our evidence-based approach
International expert consensus recommends exercise therapy as the foundation of treatment for patellofemoral pain, focusing on strengthening of both the hip and the knee, alongside education. Taping, foot orthoses and manual therapy can be added for short-term relief for some people. Our approach includes:
- Assessment of your knee, hip, ankle and foot, your strength and your training load, and screening for other causes of knee pain
- Education and load management, so you understand what’s irritating the knee and can keep active at the right level
- Progressive hip and knee strengthening, starting at a level the knee tolerates and building towards the demands of your sport
- Taping or insoles where they help you exercise more comfortably in the short term
- Running retraining and a graded return to running, hills and jumping
- VALD strength testing of the quadriceps and hamstrings, so you can see where you sit and track progress
- Strength standards and criteria rather than a date, to decide when you’re ready to return
See our knee pain page for other common knee conditions and how we tell them apart.
What to expect: recovery timeline
- Early or mild cases: often improve over several weeks once load is managed and strengthening begins
- Established patellofemoral pain: typically needs two to three months of consistent exercise for meaningful change
- Long-standing cases: can take longer, which is why starting early and staying consistent matters
When to seek help urgently
Get assessed promptly if your knee locks or won’t straighten, gives way, swells significantly after an injury, or is hot, red and swollen, or if you can’t put weight through the leg after a fall or twist.
References
- Collins NJ, et al. 2018 consensus statement on exercise therapy and physical interventions (orthoses, taping and manual therapy) to treat patellofemoral pain: recommendations from the 5th International Patellofemoral Pain Research Retreat, Gold Coast, Australia, 2017. Br J Sports Med. 2018;52(18):1170-1178.
- Crossley KM, et al. 2016 patellofemoral pain consensus statement from the 4th International Patellofemoral Pain Research Retreat, Manchester. Part 1: terminology, definitions, clinical examination, natural history, patellofemoral osteoarthritis and patient-reported outcome measures. Br J Sports Med. 2016;50(14):839-843.