How to treat and prevent runner’s knee

What are the causes of this common running injury and how do you treat and prevent it?

Runner’s knee or patellofemoral pain syndrome (PFPS), is one of the most common running injuries amongst runners, and it is particularly prevalent in those who enjoy the longer distances.

It can disrupt your training and in the worst cases prevent you from running at all.

What are the symptoms?

Do you have a vague knee ache, but can’t quite pinpoint the area? Or do you feel pain when you run or walk, it could be heightened when running up and downhill, or even walking up and down stairs? Often it will even stiffen up and become sore after a period of sitting, you’re not sure if it’s swollen, you might even hear a clicking sound and occasionally feel unstable.

If you have a knee behaving in any of these ways, it is a sure bet that you have ‘Runner’s Knee’. In medical circles, the more common term is Patellofemoral Pain Syndrome (PFPS) and this refers to the anatomical structures that the pain is thought to originate from. Other interchangeable terms include ‘Anterior Knee Pain’ and ‘Chondromalacia Patellae’.

What causes PFPS?

The typical contributing factors include overuse or overtraining, and can also be caused by a change in the frequency or intensity of training.

Underlying biomechanical issues of the lower limb such as foot or knee/hip positioning may have an influence over pain at the patellofemoral joint.

Other factors such as excessive mobility of the kneecap and weakness of the muscles of the lower limb can also contribute to the development of the condition.

In some cases, it can be difficult to pinpoint one specific cause, because multiple factors can result in the development of PFPS and this is where an assessment by a qualified individual such as a sports physiotherapist is important to help runners determine the factors that may be contributing to the pain, and address accordingly.

Treatment and Prevention

If you have been diagnosed with patellofemoral pain the first thing to do is to get the pain under control. This is usually through relative rest from the activities that aggravate the knee pain. You may be advised to take non-steroidal anti-inflammatories such as ibuprofen for a short period to settle the pain and reduce swelling.

Taping of the knee can also help to reduce the pain especially during weight-bearing activities such as walking and running.

Working alongside your clinician you can begin to determine and address what could have contributed to the knee pain, this could include a change of surface or excessive mileage and whether you are running in suitable running shoes. A consultation with a podiatrist may be necessary to explore biomechanical issues at the foot.

Muscle imbalances may also have contributed to the development of PFPS, and if this the case, it must are addressed. Muscle imbalances are common in runners with PFPS and include weakness around the hips e.g. gluteal muscles and weakness of the quadriceps.
Some runners have a lack of flexibility on the outside of the knee and hip and this can contribute to PFPS, so flexibility exercises may be beneficial in addition to strength exercises.

While physiotherapy is beneficial, any programme developed needs to be individualised to the runner and tailored to what was found during the assessment. A home rehabilitation programme will usually be prescribed and yes your physiotherapist would like you to do them…please.

In some cases, there can be more chronic long-term cases of PFPS but this isn’t the norm. With the pain settled after your rehabilitation and you are back out running, it is recommended you keep up a general strength programme to help prevent Runner’s Knee from appearing again.

Kathleen Walker is a physiotherapist, runner and owner of Fast Track Physio. A lover of track, road and cross country, Walker has over 10 years of experience in treating all levels of runners, from beginners to elite.