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All the Ins and Outs of Dreaded Runner's Knee

The first Sunday of every November, millions of spectators line the streets of New York City to cheer on friends, family and even perfect strangers who partake in the world’s largest marathon. As a participant myself in this year’s NYC marathon, I can attest to the pure thrill and joy that I and all my fellow runners felt when we crossed a finish line. But as a Doctor of Physical Therapy, I can also confirm the injuries that my fellow runners and clients endured while training for a marathon. And in all my years of practice, there is no injury that I see as often as runner’s knee.

What Exactly is Runner’s Knee?

Known medically as Patellofemoral pain syndrome (PFPS), runner’s knee is a broad term that’s used to describe pain felt in the knee. More specifically, the soreness occurs between the kneecap (patella) and the lower part of the thigh bone (femur). Now, the knee may be the body’s largest joint, but it’s also extremely complex and easy to injure. And all it takes for PFPS to rear its ugly head is for the two joint surfaces to contact in an irregular way over time and/or the forces exerted on the surfaces is more significant than it is used to. This, my friends, is when inflammation kicks in and the pain emerges.

How Do I know If I Have Runner’s Knee?

When you have PFPS, the pain may develop gradually and occur or intensify with activity, limiting your range of motion and tolerance for activity. You might also notice that the soreness is widespread across the front of your knee, making it hard to pinpoint one spot or source of pain.

Many of my clients who experience runner’s knee feel their symptoms worsen AFTER they finish an activity. And that activity just doesn’t limit itself to running; though it is extremely common in runners (affecting up to 15% of all runners at some point in their running career)[1], it can affect athletes in any sport and for many different reasons. Athletes who participate in activities such as cycling or hiking are more at risk for suffering from runner’s knee.

While knee pain during activities that bend or flex the knee is the main symptom of runner’s knee, other signs include:

  • Knee pain after sitting for prolonged periods

  • Knee pain when climbing or descending stairs

  • Knee pain after new or higher-intensity exercise

  • Rubbing, grinding, or clicking sounds of the kneecap accompanied with pain when you bend and straighten your knee

  • Swelling behind the kneecap

Misconceptions of Runner’s Knee

First off, let me say that as a Doctor of Physical Therapy, there is nothing that rustles my feathers more than all the misconceptions surrounding the treatment (or should I say mistreatment) of PFPS……and those of you who know me know that I’m a pretty even-keeled guy!

Some clients have come to me after years of suffering from knee pain, thinking that taping and bracing before setting off on a run will prevent the pain. K-tape, sports tape, and knee braces can help reduce knee pain while running by offloading some of the stress on the knee. BUT because they do not hit the cause of the injury, they are not long-term solutions to make the pain go away for good.

Same goes with the incorrect thought that icing or elevating the knee will help solve the runner’s knee issue. Sure, ice is a great way to temporarily treat the pain and elevating the foot on a chair will help with any swelling there may be. But just like knee braces or tape, these will only mask the issue and provide short-term, superficial results.

Other clients believe the common misconception that runner's knee is simply an overuse injury and if you reduce your mileage or rest for a few weeks, it will go away. Yes, relative rest IS a necessity during certain times (and I did address this earlier in the year). And yes, you will feel better if you stop the aggravating activity. Buuuuut, the pressure will continue along your kneecap and eventually everyday activities will bother it too like walking or going downstairs. To fix the problem, you need to remove the underlying issue. Avoiding use of your knee does not fix the problem. You need to figure out why your kneecap is creating friction when you move your knee.

So, What Does ACTUALLY Help Treat Runner’s Knee?

Runner’s knee can be an extremely frustrating source of knee pain, especially in active people. And it is an injury that can become chronic if not treated correctly. According to research, the most effective treatment for runner’s knee is in fact physical therapy. In fact, a study released in 2016 also showed that 73% of runners who completed performed physical therapy remained pain-free three years after their initial injury.1

So what happens during physical therapy treatments that allow for athletes to recover from runner’s knee, ensuring the problem doesn’t return, and getting their patients back to the sport they love? There are a few key things actually!

Learn the Right Exercises

For starters, the right professional will help you to learn exercises that will strengthen the hip and knee muscles, which will significantly reduce pain and improve function. As a Doctor of Physical Therapy, I’ll also be able to teach you how to incorporate the correct level of cross-training exercises into your fitness regimen, which will reduce the stress on your knees and help you recover faster from runner’s knee.

Use the Right Movements

An experienced Physical Therapist can also teach you optimal running form. Those suffering from runner’s knee may have poor running form, which is most likely putting extra stress on your knees and other joints. To fix this, you might consider having a trained professional watch your form or record you running so that you can make corrections. Once you are taught how to alter your biomechanics, any muscle imbalances will be mitigated so no more undue pressure is placed on your knee.

Try Custom-Made Orthotics

When looking to treat runner’s knee, you might spend all your time focusing on….well, the knee. However, a trained Physical Therapist also knows the importance of looking at the foot. Yup, often a simple change in footwear, or in this case custom insoles or orthotics can help to ease your knee pain.

Foot orthotics have been proven to be effective in helping to improve symptoms in runners with runner’s knee and help make their rehabilitation more successful. In my office, I have the machinery to produce custom-made orthotics that will significantly reduce the symptoms of runner’s knee

So What Do I Do Now?

So now you know what that nagging feeling in your knee is attributed to runner’s knee….now what? I definitely suggest seeking the help of a trained Physical Therapist to help you. As both a trained Doctor of Physical Therapy and avid runner, I will be able to guide you back to a healthy workout routine quickly and efficiently. Most patients see results within one to two visits and equipped with knowledge of the condition and how to best treat and prevent it, many can transition back into a running program without pain and manage any flare ups on their own.

Always feel free to reach out with any questions you may have; we would love to hear your goals and assist in any way to make sure you achieve them. Please give us a call at 516-387-0053. If you would like to read more of our blog posts, please CLICK HERE. If you would like to follow us along as we present more information about different topics related to endurance athletics, please give us a follow on our Instagram.


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