Runners Knee or Patellofemoral Pain Syndrome (PFP)

Last Updated: November 2, 2023

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Runners Knee, also known as Patellofemoral Pain Syndrome, is aching around the kneecap related to a misalignment of the kneecap from different imbalances.

Runners Knee Explained

Runner's knee, also known as Patellofemoral Pain Syndrome or PFP Syndrome for short, is when you experience aching pain in the front of the knee, either around or behind the kneecap or the patella.

The patellofemoral joint consists of the kneecap, the patella - the largest “floating” bone in the body - which sits on top of the front of the thigh bone, the femur.

The patella connects to the femur and shinbone (tibia) through the quadriceps and patellar tendon. The knee connects the femur and tibia at the joint.

There are about 20 muscles that hold the patella in place, keeping it centred and aligned. This whole structure is called the patellofemoral joint.

The patellofemoral joint acts like a mechanical pulley system for the quadriceps since the patella changes the direction of extension force through the knee’s range of motion.

Runner’s knee occurs when there is too much pressure on the patella or other surfaces surrounding the patella, or there is a muscular imbalance with the muscles supporting the patella resulting in a misaligned patella.

Runners knee occurs in up to 20% of the population and is more common in women and young adults, athletes whose sport involves a lot of knee bending and straightening, or those who are more sedentary.

Causes of runner’s knee

Two major areas of risk factors can lead to common symptoms of runner’s knee. An increase in training volume causes an overuse injury, the nature of certain sports, and their repetitive movements or biomechanical imbalances.


Certain sports with repetitive knee movement can make one more susceptible to runner’s knee injury. Overuse and overtraining in any sport can also lead to runner’s knee or other overuse injuries.

Runner’s knee is common in runners, cyclists, triathletes, cross-fitters, football, soccer, basketball, jumping sports and hikers.

Biomechanical issues

Muscular weakness and muscular imbalances in the glutes, quads, core and calves can also lead to a runner’s knees.

Tight muscles include a tight iliotibial band, tensor fascia latae, quads, hamstrings and calves. Tight thigh muscles pull on the patella directly, but other muscles will pull on the patella indirectly.


Poor ankle and hip mobility or ankle, hip and hip flexor stiffness may cause issues. These issues may also develop in athletes who run with a heel strike, have flat feet, or have hypermobile feet.

Symptoms of runner's knee

Symptoms of the runner’s knee include, but are not limited to:

  • Pain: Pain in and around the patella occurs most during activity or sitting for long periods with knees bent.
  • Sensations: Sensations or sounds of rubbing, grinding and clicking of the patella when you bend and straighten the knee.
  • Tenderness: If the patella is tender when touched, this is also a common symptom of a runner’s knee.

Diagnosis of runner’s knee

A healthcare practitioner will do a physical examination of the knee and look at the activity level and health history to diagnose runner’s knee.

Following a physical exam, x-rays, ultrasound, MRI scan, or blood tests may be used to evaluate the knee joint further, test inflammation levels, and rule out any other injuries, conditions and knee problems.

Treatment of runner’s knee

Working with a physiotherapist can be the best course of action to create a program to deal with and treat runner’s knee symptoms and prevent them from developing into patellofemoral osteoarthritis.

An effective program is multifaceted, including strengthening exercises, mobility exercises, stretching exercises, education, taping and other modalities. Treating and creating a recovery plan can include a few different areas.

Assessment and diagnosis

Getting the correct diagnosis and having a physiotherapist direct you in the right area is critical to identifying the relevant areas to focus on to manage a successful recovery and mitigate and lessen pain.

Manual therapy and treatment

Manual therapies can help manage pain, reset soft tissues and the nervous system, balance muscles and allow the joint to function more easily.

Massage, rolling out with a foam roller, dry needling and other hands-on modalities can help significantly. Focusing on the IT band, tensor fascia latae, hamstrings, glutes, quadriceps, and calves are some muscles that will help reduce pain in the knee joint.

Treatments such as taping techniques, a knee brace, compression sleeves, ibuprofen for inflammation, ice and elevation can also provide short-term relief.

Load management

Figuring out how to manage your load is critical to recovering and managing runner’s knee. At first, avoiding aggravating activities, reducing inflammation, and implementing manual therapy and foam rolling can help with the initial stages of recovery and add to your training regime for maintenance.

Certain aspects of training may cause flare-ups, like hill runs, mileage, old shoes, and needing to implement more cross-training. Figuring out which to eliminate temporarily is critical to dealing with knee pain.

Exercise program

A well-structured program working on rehab exercises, strengthening exercises, stretching exercises, mobility and manual therapy is crucial to working through managing load and slowing increasing back to normal function.

Movement retraining

A physiotherapist will also help you optimize movement patterns and re-train the body to move more efficiently with less pain to decrease re-injury chances.

Those who suffer from runner’s knee often struggle with muscle imbalances, relying more heavily on the quadriceps, the front thigh muscles, and hip flexors when moving than their posterior chain, including the glutes and hamstrings.

Prevention of runner’s knee and knee pain

“Logically, a preventative program that address some of the well understood risk factors could theoretically reduce a runner's risk of developing patellofemoral pain syndrome but that is still a relatively speculative conclusion given the lack of evidence”, says Nathan Liddle, a chartered physiotherapist and running injury researcher.


Preventing runner’s knee includes many of the same rehab exercises critical to preventing runner’s knee.

Prehab and rehab are often very similar, and the more you implement them into your routine and ensure you’re investing in equipment like quality shoes, the greater the likelihood of preventing overuse injuries.

Manual therapy

Seeking out manual therapy or using cold packs at home when you feel discomfort and pain is also important to prevent overuse—strengthening your lower body and core through strength training or plyometrics.


Nutrition is key to managing and preventing runner’s knee. With less processed foods, eating a whole diet rich in meat, fruits and vegetables, beans, whole grains, nuts, seeds, and small amounts of dairy helps decrease inflammation.

Ensure you get enough protein to rebuild muscles, help with recovery, and enough antioxidants and good fats to combat inflammation and stress.

A combination of these behaviors can help prevent runner’s knee pain and alleviate symptoms of runner’s knee if someone has a diagnosis.


Patellofemoral Pain Syndrome (Runner's Knee) | Johns Hopkins Medicine

Htt nljnp://www.kinfolkwellness.com.au/blog/2017/12/13/patello-femoral-pain-syndrome-adelaide


Patellofemoral Pain Syndrome (Runner's Knee) (for Teens) - Nemours KidsHealth.

Chondromalacia Patella | Arthritis Foundation

Hamstring length in patellofemoral pain syndrome

Five Tips for Preventing Runner's Knee

Nutrients That Help Your Running Injuries | Runner's World

Everything you need to know about patellofemoral pain syndrome (aka runner's knee)


The contents of this article are provided for informational purposes only and are not intended to substitute for professional medical advice, diagnosis, or treatment. It is always recommended to consult with a qualified healthcare provider before making any health-related changes or if you have any questions or concerns about your health. Anahana is not liable for any errors, omissions, or consequences that may occur from using the information provided.