Runners Knee

Runner’s knee or patellofemoral pain syndrome (PFPS) is a condition used to describe the knee pain found in runners. The pain is mostly as a result of chronic overuse of the knee joint. The condition mostly affects young adults with a history of increased training. 

Although the exact cause is unknown, problems between the kneecap and the lower end of the thigh bone have been suggested. Other conditions such as chondromalacia patella, iliotibial band syndrome, and plica syndrome may also sometimes be referred by runners knee. 

The condition is usually self-limiting and mostly present in recent runners or undertrained runners who have increased their running distance. There may be multiple causes of patellofemoral pain syndrome. Chondromalacia patella is due to the softening of the cartilage at the undersurface of the kneecap

Iliotibial band syndrome is due to friction of the iliotibial band. The band passes over with the outer surface of the lower end of the thigh bone (femur). Any tightness of the iliotibial band may cause friction with the outer surface of the femur.

Normal X-ray of the knee joint showing the various structures in the Anteroposterior and Lateral view Normal X-ray of the knee joint showing the various structures in the Anteroposterior and Lateral view 2

Normal X-ray of the knee joint showing the various structures in the Anteroposterior and Lateral view.

X-ray showing Skyline’s view of the patella.


Mostly the only symptom is described as anterior knee pain which has a gradual onset. Patients often describe a vague pain located in front of the knee. Often patients touch the sides of the kneecap encircling it when asked to point the location of the pain. Some patients just describe it to be chronic pain present diffusely in the knee.

The pain is aggravated on activities involving bending, squatting, kneeling, getting up from a chair, or navigating stairs. A few patients may complain of associated swelling of the knee and cracking/popping sound in the knees. Patients complain of difficulty to bend and straighten the knee. They find it difficult to walk or run secondary to pain and swelling.

Causes & Risk Factors

Some patients may have a history of preceding trauma or blow to the knee. The chronic overuse of the tendons and muscles is a major cause of pain in the runner’s knee. In the case of runners, a history of change of activity is usually present. Inadequate training before running is usually one of the most common causes of the condition. 

Runners may report a sudden increase in running distance. New runners may complain of pain with a history of running on concrete surfaces without adequate training. Training athletes may be affected due to strenuous overuse of the muscles around the knee. 

Malalignment of the knees due to deformities such as knock knees or bow legs is a cause of the runner’s knee. Excessive unequal pressure on the kneecap results in patellofemoral pain syndrome. Patellofemoral mal-tracking is another cause of pain in front of the knee. 

Flat feet deformity or other deformities of the foot and ankle may contribute to the symptoms of runner’s knee. Flat feet are caused by weak arches on the inner side of the foot. The unequal weight distribution leads to increased stress on the undersurface of the kneecap.

The weakness of the muscles of the thigh (Quadriceps) may result in increased strain over the kneecap causing pain. The increased strain from different causes results in bone bruises or swelling of the bone. The resulting synovial fluid irritation together with subchondral bone swelling causes pain and inflammation. 


The physician will take a detailed history of the events surrounding the knee pain. A thorough physical examination of the knee joint is done. The angles formed by the kneecap with the thigh bone are measured. 

Special physical tests are done to check for stability of the knee ligaments and meniscus. Sprains or tears of the anterior cruciate ligament, posterior cruciate ligament, medial and lateral collateral ligaments may also cause knee pain. Kneecap tracking and stability are also evaluated with physical tests.

Often, imaging tests are requested for further evaluation. Usually, an x-ray is done followed by an MRI. MRI gives information about the soft tissue structures inside the knee joint. Imaging tests are also useful to differentiate runners knee from other medical causes of knee pain. 


The management of the runner’s knee is mostly conservative. Conservative management involves adequate rest to the knee. Patients are advised to avoid activities that strain the knee joint. Activities such as squatting, kneeling, running, or sitting and standing for extended periods of time are to be avoided. 

Compression bandages are advised to help reduce swelling and provide support. Analytics in the form of NSAIDs such as ibuprofen or naproxen may be prescribed to help reduce pain and inflammation. Frequent icing with ice packs is advised to the patient. Leg elevation while sitting or laying down is advised to control swelling. 

Orthopedic shoes with arch supports are recommended for flat feet. Knee braces may be helpful to provide support. Quadriceps strengthening exercises at home or with the help of a physical therapist are beneficial to prevent runner’s knee. Strengthening exercises may be isotonic or isometric.

Surgical treatment is reserved for patients who don’t benefit from conservative management. Surgical management is usually done using an arthroscope. The procedure involves the insertion of a minute camera along with miniature instruments through keyholes. 

The camera is linked to an outside display for a live feed that the surgeon uses to guide the instruments. Surgical debridement using an arthroscope involves the shaving of a small fragment of the kneecap cartilage. Removal of the small part of the cartilage provides significant relief in most patients. 

The surgery can also be used to release tight structures on the outer part of the knee joint. The tight tendons may pull the kneecap out of its groove during the range of motion causing pain. In patients with the mal-aligned kneecap, a kneecap repositioning surgery may be performed. 

The repositioning surgery involves the removal of a small bone in front of the upper part of the leg bone. The bone along with the tendon is repositioned to allow better alignment between the kneecap and thigh bone.


Most patients report significant relief with conservative management. In a long time, the best medical advice in the treatment for runner’s knee remains physical therapy. Runners knee problem not amicable to conservative management may require surgical treatment from a sports medicine specialist.

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No one likes going to the doctor. But these people make it painless. I go for knees, hips and shoulders. At almost 70 Complete Orthopedics keeps my active life style running smoothly. Whether chasing my Grandson and even surfing again, I highly recommend them!!
Thomas Slavin
15:02 02 Mar 23
Dr. Kuo knowledgeable and competent surgeon- very good experience and more importantly great result.
Joseph McCoy
21:23 25 Feb 23
Dr Vaksha was so kind and helpful. He took extra time with us and explained things so thoroughly. Highly recommend. Office very clean.
Susan Bosinius
20:20 19 Feb 23
Dr Vaksha, is a great doctor very professional knows what he talking about. Treat patient with upmost respect. Thank You
Troy Spencer
16:46 19 Jan 23
Dr. Karkare is an amazing doctor, very caring and attentive, the girl at the front desk is very kind and helpful. .elizabeth .thank you so much .
blanca ventura
21:32 26 Oct 22
Been going to this place before my accident and after I had my knee surgery. So happy how I been treated and how well I am getting. Thank you all and specially Dr. VAKSHA for everything and getting back on track.
Ita Opico
19:01 25 Oct 22
Love this place From the minute I called I was treated kindly. When I arrived The Dr saw me right away he was compassionate and ordered the appropriate tests for me. I came back in for my follow up and had the same great experience.
Christine Rostock
21:28 23 May 22
Dr Vaksha and Dr karkare are 2 of the best orthopedic doctors around my wife Susan had a very serious broken ankle in March of 2019 she didn't think she was going to walk again Dr vaksha did an excellent surgery on her ankle he said it was his toughest he ever did he put a lot of hardware in her ankle and told her she would be alright she made remarkable recovery thanks to his surgery as of now she regained 100 percent use of her ankle she would highly recommend him to anyone. My own experience with Dr karkare has been wonderful he takes his time with you listens to what you have to say and prescribes various treatments and is very caring I would highly recommend him to anyone I would give both doctors a 10 plus rating we are very happy with them the best.
Harry Jones
23:31 19 May 22
Complete orthopedics is a wonderful place to go when you hurt or injured a great staff and wonderful doctors very knowledgeable and helpful I would recommend this place to all of my family and friends that is in me of orthopedic care I give them 10 thumbs up
Wayne Pemberton
17:39 18 May 22
The staff is very professional and helpful. Dr. Vaksha is excellent. He takes time to listen and offer suggestions to help you get better. I’m very thankful and happy to be a patient here at Complete Orthopedics.
Phoenix Rising
19:54 16 May 22
Dr.Karkare is the best. He listens to everything and explains everything I recommend him to everyone. I am so happy he is my doctor.
Myrna James
00:48 13 May 22
Dr.Kuo is amazing very attentive,caring,and passionate and staff is awsome too.Thank you for everything Dr.kuo.
Erick Murillo
23:17 12 May 22
I was in a car accident November 1 I was referred to Dr. Vaksha For shoulder surgery . I he was amazing he made me feel very comfortable and explained everything that was going to happen from surgery all the way through my physical therapy highly recommend Dr. Vaksha
Yolanda Ojeda
19:37 09 May 22
My appointment with Dr. Vaksha was amazing. Dr. Vaksha was very thorough and kind. I would refer this office to anyone who needs a great orthopedic doctor.
John Senechal
19:54 05 May 22
Scheduling my appointment was quick and easy. The staff was super friendly and down to earth. I was seen on time. The appropriate test, “x-rays” were taken before the conversation with doctor, something I really liked, test for analysis and conversation was done upfront. Dr. V had a great personality and was no BS, straight forward diagnosis and a play on next steps. I am happy I found them and would refer them to friends and family.
00:46 03 May 22
I have seen Dr. Kuo two times already and he's awesome along with his staff. Very friendly office and I'm glad to be a patient here.
Camaris A
20:01 28 Apr 22
Amazing team!! Very caring, profesional, and friendly!! Dr. Kevin Kuo, you are the best, very passionate, caring, and helping thank you for getting me better and being so kind to me! Elizabeth you the best thank you for you help always and you big smile and positive actitud❤️🙏🏼
breidy valerio
19:01 22 Apr 22
The staff is truly exceptional, they make you feel comfortable and welcomed. The doctors are amazing,always professional, compassionate and great listeners.
Elizabeth Collado
03:25 09 Apr 22
What a great place! The place is clean and organized.The staff is wonderful. Setting up physical therapy is right there as well.I'm so glad I found this place.
Donna Anne
22:45 05 Apr 22
This was my 1st time breaking something in my 27 years on this planet. I was recommended here by a friend Dr. Vashka helped me from day 1 and still continues to check in on me and my healing ankle. Would highly recommend
tyron davis
16:06 01 Apr 22
Brand new office, same great doctors! Rooms are clean, plenty of parking, physical therapy attached, Dr. Karkare and his staff are awesome. Thank you!
Emily B
02:49 24 Mar 22
Dr.VAksha is the best, I love the way he treats me as his patient, he is caring,understanding and very attentive to my needs
Mirna Caballero
14:53 03 Mar 22
Great staff. Dr. Vaksha is awesome and takes the time to listen to his patients. He is very compassionate. I would highly recommend this office.
Bebe Doyle
01:24 23 Feb 22
After suffering from a severe ankle injury Dr. V was able to help me heal and return back to work completely to a job where I stand for 12 hours a day. The office is very clean and I appreciated the reminders of my appointments via phone call and through text. The patient portal made it easy for me to access all my documents including work notes. The office staff is wonderful and Rebecca was able to schedule me with a busy schedule and awesome at answering all of my questions including referring me to a great physical therapy office. I highly recommend this office to anyone who’s looking for knowledgeable and kind orthopedic office.
Elizabeth Birchwell
21:31 28 Jan 21
The staff here are great, I was seen at the time of my appointment and was well taken care of!
Shaun Berry
18:14 07 Jan 21
They are an excellent practice. The front and back office people are amazing and so helpful. Rebecca is such a kind and understanding person. I had an issue with paperwork and she cleared it right up. Dr. Karkare is very knowledgeable, helpful, and caring.
Matt S.
19:31 18 Nov 20
Rebecca K. - What a true burst of sunshine. Very friendly and definitely an asset to the practice!
Laura Aston
18:17 17 Nov 20
Great experience, the Doctor is nice but the staff is incredible. I worked with Linda, who was profession and assisted me beyond what any person has done at other practices. Complete Ortho should be complimented for having such a person on their staff.I highly recommend this place!!!
Joe Allen
17:26 17 Nov 20
Linda and Becca they are so good ever time I come they are very nice I would tell everyone I no to come to this office..
Barbara Victor
16:45 17 Nov 20
I was rear ended in an auto accident , Dr Vashka was recommended by a friend of mine .I was experiencing Back , neck , and shoulder pain . After a thorough examination and given exercises to do at home , I am feeling much better , and I ended up avoiding surgery . The staff at Complete Ortho is extremely attentive and show great care when making an appointment and are very friendly and i never waited more than 5 minutes for my appointment . So I would strongly recommend Complete Orthopedics for any aches and pains that one might be experiencing.....
Bill Becht
04:44 17 Nov 20
It was the afternoon of Friday Sept. 24. We were in Pt. Jefferson and my wife, Mary Ann, broke her hip. We went to Mather Hospital and it was determined that she would have to have an operation to have it repaired. This would be her third time under the knife in the past year. It just so happened that we were very fortunate enough to have Dr. Karkare, who was on standby, perform the surgery. He put in a rod and two screws in her hip. She spent a few days in the hospital and then went to Gurwin rehabilitee for another few weeks.It has now been almost six weeks and we both worked the election the other day. If it wasn’t for Dr. Karkare’s expertise she never would have been able to work. She is able to walk with a walker and is doing physical therapy three times a week.We can not thank the doctor enough for the compassion and dedication that he puts into his work. It allows Mary Ann do the things that she likes to do, even on a limited basis for a while. I know that with her will, perseverance and the great work that the surgeon performed she will be back on her feet in no time.Sincerely:John V. PlumpEast Northport, NY 11731
Jack Harris
14:36 06 Nov 20
In the year of 2018 I was referred to Dr. Karkare because I was experiencing severe knee joint pain. After exhausting physical therapy and trying to labor through the pain, I had to make a quality of life decision. Total knee replacement was the only viable option. Dr. Karkare made my decision easy as he walked me through the whole process from surgery to recovery.On 12/13/19 ( Friday the 13th) I enter Lenox Hill Hospital in great hands. From the time I entered Dr. Karkare’s office for the first time until now, his staff has been amazing. Andrea the medical coordinator walked me through all the paper work and necessary preparations for the surgery. Courtesy and kind would be an understatement. Dr. Karkare went over and beyond from the wellness checks and phone calls all to assure me that I was important to him. This was the right decision no pain and no limp. Complete Orthopedics should be your choice!
Kenneth Randolph
22:18 25 Sep 20
Dr. Vadshka has a great bedside manner. He really takes his time and explains treatment options.
T Lee
12:33 09 Sep 20
I suffered with pain in both knees for years. My orthopedic doctor kept recommending knee replacement . I fought it for years, as I was just afraid. When I had no choice and could barely walk , it was recommended I see Dr. Karkare. We set up a consultation and my wife and I left his office feeling totally confident and comfortable with moving ahead with the surgery. He explained everything to us, and the office staff set everything up for us and made the process easy. So about one month after our initial meeting I had the first knee done. I was up walking mere hours after the surgery, and on the workout machines the next morning. I went home two days after the surgery, and yes walked my daughter down the aisle at her wedding only one week after the surgery without even a cane! Three months later I had the other knee done and went home the very next day. Dr. Karkare put my fears to rest . I would highly recommend him. His expertise gave me my life back. Thank you Dr. Karkare.SincerelyVito Congro
Ethel Congo
23:58 12 Aug 20
Dr Rhodin really cares for his patients. When I see him he makes sure to review my progress in detail.
Micki Cahill
15:03 08 Feb 20
My mom had a total hip replacement by dr karkare. He is the BEST orthopedic doctor.Her incision is almost invisable.She is going back for her other hip next week. The office staff is the best, love Andrea.You wont find a better doctor.
Ryan Brigandi
21:06 13 Jul 18
There is no better Orthopedic doctor you will find. Broke my ankle three places on a Saturday. Called Dr. Karkare. He had is team ready at the hospital and operated on me within 6 hours after my injury. Now After 3 months of great care by him and his staff, I am walking to normalcy.
Spacecom Tel
04:13 23 Mar 18

My name is Dr. Suhirad Khokhar, and am an orthopaedic surgeon. I completed my MBBS (Bachelor of Medicine & Bachelor of Surgery) at Govt. Medical College, Patiala, India.

I specialize in musculoskeletal disorders and their management, and have personally approved of and written this content.

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