_edited.png){kind=logo}
Runner’s Knee (Patellofemoral Pain)
Runner’s knee, also known as patellofemoral pain, is a common cause of pain around or behind the kneecap. Despite the name, it does not only affect runners. It can develop in anyone whose activities regularly involve running, jumping, squatting, stairs, or repeated bending of the knee.
Dr. Michael Hoiles has created this resource to help you understand runner’s knee, common symptoms, treatment options, recovery expectations, and how progressive exercise and chiropractic care may help you return to activity.
Quick Facts
✔ Runner’s knee commonly causes pain around or behind the kneecap.
✔ Running, stairs, squatting, and prolonged sitting often aggravate symptoms.
✔ Changes in training volume or intensity can contribute to symptoms.
✔ Hip and knee strengthening are important parts of rehabilitation.
✔ Complete rest is usually unnecessary, although activity may need to be temporarily modified.
✔ Most people can gradually return to their normal exercise and activities.
Knee Anatomy
The knee is formed primarily by the femur (thigh bone), tibia (shin bone), and patella (kneecap).
The patella sits within a groove at the end of the femur and moves as the knee bends and straightens. The quadriceps muscles, patellar tendon, and surrounding muscles help control the knee during walking, running, squatting, jumping, and climbing stairs.
Patellofemoral pain develops when the tissues around the kneecap become sensitive to the loads being placed on them.
Runner's knee is one of several conditions that can cause knee pain, and the location and behaviour of symptoms can help distinguish it from other knee problems.
What Is Runner’s Knee?
Runner’s knee is a broad term commonly used to describe patellofemoral pain, which occurs around or behind the kneecap.
Symptoms often develop when the demands placed on the knee exceed what it is currently able to tolerate. This may occur following changes in running, training, exercise, or everyday activity.
It is usually not caused by one specific damaged structure.
Common Causes & Risk Factors
Runner’s knee often develops from a combination of factors, including:
-
Increasing running distance too quickly
-
Adding hills or speed training
-
Sudden increases in exercise
-
Returning to activity after time off
-
Reduced quadriceps strength
-
Reduced hip strength
-
Repetitive squatting or jumping
-
Changes in footwear or training surface
-
Inadequate recovery between workouts
Often, the issue is less about one abnormal movement and more about the knee being exposed to more load than it is currently prepared for.
Common Symptoms:
Symptoms may include:
-
Pain around or behind the kneecap
-
Pain while running
-
Pain going up or down stairs
-
Discomfort during squats or lunges
-
Pain after sitting for long periods
-
Pain when getting up from a chair
-
Aching after exercise
-
Clicking or grinding around the kneecap
Clicking or grinding by itself does not necessarily indicate that something is damaged.
Could My Knee Pain Be Coming From Somewhere Else?
Not all knee pain is runner’s knee.
Pain around the knee can also come from the patellar tendon, meniscus, ligaments, muscles, or other structures within the knee. Occasionally, symptoms may also be referred from the hip or lower back.
An assessment can help determine what is contributing to your symptoms.
Pain on the outside of the knee, particularly during running, may sometimes be related to IT band syndrome rather than patellofemoral pain.
How Is Runner's Knee Diagnosed?
Runner’s knee can usually be diagnosed through your history and a physical examination.
Assessment may include:
-
Location and behaviour of your pain
-
Knee range of motion
-
Hip and knee strength
-
Squatting and stepping movements
-
Single-leg control
-
Running mechanics when appropriate
-
Recent changes in training or activity
Imaging is not routinely required unless another condition or injury is suspected.
What Helps Runner’s Knee?
Treatment typically focuses on temporarily managing aggravating activities while progressively rebuilding strength and tolerance.
This may include:
-
Temporarily reducing running volume
-
Modifying hills or speed training
-
Strengthening the quadriceps
-
Strengthening the hip and glute muscles
-
Gradually progressing squats and lunges
-
Improving tolerance to stairs and running
-
Addressing mobility restrictions when relevant
-
Gradually returning to normal training
The goal is usually to keep you as active as possible while allowing the knee to adapt.
How Chiropractic Can Help
Chiropractic care for runner’s knee may combine exercise-based rehabilitation with treatment of contributing factors involving the knee, hip, ankle, or surrounding muscles.
Depending on the assessment, treatment may include:
-
Hip and knee strengthening
-
Joint mobilization
-
Soft tissue therapy
-
Mobility exercises
-
Movement retraining
-
Running or exercise modification
-
Progressive return-to-running advice
The goal is to improve the knee’s ability to tolerate the activities that matter to you rather than simply avoiding them.
Shockwave Therapy for Runner’s Knee
For some people with persistent or chronic knee pain that has not improved as expected with rehabilitation, shockwave therapy may be considered as an additional treatment option.
Shockwave therapy uses mechanical pressure waves applied to the painful area and may help reduce pain in selected cases. It is typically used alongside progressive strengthening and activity modification rather than as a replacement for exercise-based rehabilitation.
Whether shockwave therapy is appropriate depends on the specific cause of your knee pain, how long symptoms have been present, and your response to previous treatment.
Recovery Timeline
Recovery varies depending on how long symptoms have been present and the activities you are trying to return to.
-
Mild or recent symptoms: Improvement may occur within several weeks.
-
More persistent symptoms: Rehabilitation commonly requires several weeks to a few months.
-
Long-standing symptoms: A longer period of progressive strengthening and activity modification may be required.
Progress is often gradual, and temporary flare-ups do not necessarily mean further damage has occurred.
Can I Still Exercise With Runner's Knee?
In many cases, yes.
You may temporarily need to reduce activities that significantly aggravate your knee, such as running, deep squatting, jumping, or repeated stairs.
Other activities such as cycling, walking, strength training, or modified workouts can often be continued.
As symptoms improve and strength increases, running and other activities can gradually be reintroduced.
Exercises Commonly Recommended
Exercise selection depends on your symptoms and stage of recovery.
Early Stage
-
Wall sits
-
Glute bridges
-
Step-ups
-
Isometric knee extensions
Strengthening Stage
-
Squats
-
Split squats
-
Step-downs
-
Leg press
-
Hip abduction exercises
Return to Running
-
Single-leg squats
-
Single-leg strengthening
-
Hopping progressions
-
Running progressions
-
Sport-specific drills
Exercises should be progressed according to symptoms, strength, and activity goals.
Common Mistakes That Can Slow Recovery
-
Completely stopping activity for too long
-
Continuing the same running volume despite worsening pain
-
Returning to running too quickly
-
Focusing only on stretching
-
Ignoring hip and quadriceps strength
-
Increasing several training variables at once
-
Expecting symptoms to disappear immediately
When Should You Seek an Assessment?
-
Pain persists or continues to return
-
Running or exercise is becoming increasingly difficult
-
Pain is interfering with everyday activities
-
The knee repeatedly swells
-
You experience catching, locking, or giving way
-
You are unsure how to safely return to running
When Should I Worry?
-
Seek prompt medical assessment if knee pain follows a significant injury and you cannot comfortably bear weight, there is substantial swelling or deformity, or the knee becomes locked and cannot move normally.
-
Unexplained redness, warmth, significant swelling, or fever should also be medically assessed.
Frequently Asked Questions
Is runner’s knee the same as patellofemoral pain?
Runner’s knee is a common term used to describe patellofemoral pain around or behind the kneecap.
Do you have to be a runner to get runner’s knee?
No. It can affect anyone who performs activities involving repeated knee bending, squatting, stairs, jumping, or similar movements.
Can I keep running with runner’s knee?
Sometimes. Running volume or intensity may need to be temporarily reduced depending on your symptoms and how your knee responds afterward.
Are squats bad for runner’s knee?
No. Squats are often an important rehabilitation exercise, although the depth, resistance, and volume may initially need to be modified.
How long does runner’s knee take to improve?
Many cases improve over several weeks to a few months with appropriate activity modification and progressive strengthening.
Should I wear a knee brace?
Some people find temporary symptom relief from taping or bracing, but strengthening and appropriate activity progression are generally more important for long-term recovery.
Will runner’s knee cause arthritis?
Having patellofemoral pain does not mean that significant arthritis or permanent knee damage is occurring.
Summary
✔ Runner’s knee commonly causes pain around or behind the kneecap.
✔ Running, stairs, squatting, and prolonged sitting can aggravate symptoms.
✔ Changes in training load commonly contribute to the problem.
✔ Hip and knee strengthening are important parts of rehabilitation.
✔ Complete rest is usually unnecessary.
✔ A gradual return to running and exercise is generally recommended.
Ready to Get Back to Moving Comfortably?
If knee pain is limiting your running, workouts, sports, or everyday activities, an assessment can help identify what may be contributing to your symptoms and determine an appropriate rehabilitation plan.
Dr. Michael Hoiles is a Calgary chiropractor who provides evidence-informed care combining hands-on treatment, exercise-based rehabilitation, and practical advice to help people recover from injury, move better, and stay active.
Book an appointment today to start your recovery and get back to doing what you enjoy.
Related Conditions
You may also find these resources helpful: