Patellofemoral Pain (Runner's Knee)

Overview

Patellofemoral pain is a dull, aching pain felt around or behind the kneecap (patella). It is one of the most common knee complaints we see, particularly in runners, gym-goers and students who have recently increased their activity. It is often called "runner's knee", although you do not need to run to get it.

The kneecap glides in a groove on the thigh bone each time the knee bends. When the load through this joint rises faster than the tissues can adapt — or when the kneecap tracks slightly off-centre because of muscle imbalance — the joint surface becomes sensitive. There is rarely any structural damage, and scans are usually normal.

Pain is typically worse on stairs (especially going down), squatting, kneeling, running downhill and after sitting with the knee bent for a long time — the so-called "cinema sign". Most people improve with a progressive strengthening programme over a few months, although symptoms can linger if training errors are not addressed.

Causes and risk factors

• A sudden increase in running distance, hill work or squat volume
• Weak hip muscles (gluteals) allowing the knee to drift inward
• Weak or poorly timed quadriceps, particularly the inner thigh portion
• Tight calves, hamstrings or the outer thigh (ITB)
• Flat feet or excessive pronation changing the knee's alignment
• Long hours sitting with knees bent
• Worn-out trainers or a sudden change in footwear

How we may be able to help

We start with a thorough assessment of the whole lower limb — hip strength and control, kneecap tracking, foot posture and how you squat, step down and (if relevant) run. Understanding your training load is just as important as examining the knee itself.

Physiotherapy is the main treatment. Research consistently shows that combined hip and knee strengthening gives the most consistent results for patellofemoral pain, so you will receive a structured programme that progresses as the knee settles. We also advise on how to modify running or gym training rather than stopping altogether, and manual therapy or soft-tissue work may help ease tight tissues around the knee.

Kinesiology taping of the kneecap can reduce pain in the short term for some people, which makes it easier to keep exercising. If your foot posture appears to be a significant contributor, a 3D foot scan and custom orthotics may be considered. Interferential therapy is occasionally used as an adjunct when pain is high.

What you can do at home

• Reduce — but don't stop — the activities that aggravate it; aim for a level that leaves no extra pain the next morning
• Avoid long periods with the knee bent; stand and straighten it every 30 minutes
• Start simple hip strengthening: side-lying leg raises and bridges
• Replace trainers that have lost their cushioning (typically every 500–800 km)
• Run on flatter routes and avoid steep downhills until symptoms settle
• Use a wrapped ice pack for 10–15 minutes after activity if the knee feels sore