Runners Knee

If knee pain becomes severe enough to interfere with everyday activities, or if it’s accompanied by swelling, tenderness, or redness, it is critical to seek medical assistance.

At Complete Orthopedics, our experienced knee specialists are adept at managing knee pain through both non-surgical and surgical approaches. We assess symptoms, determine the cause, and recommend appropriate treatment plans, including surgical options if needed.

We are based in New York City and Long Island and collaborate with six hospitals, providing top-tier knee surgery and extensive orthopedic services. Appointments with our orthopedic surgeons can be made online or via telephone.

Learn about common causes of knee pain and explore available treatments, including scenarios where surgery is the recommended option.


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.



Recovery from Runner’s Knee, or Patellofemoral Pain Syndrome (PFPS), involves a comprehensive approach that includes rest, rehabilitation exercises, and possibly medical interventions. The goal is to alleviate pain, restore normal function, and prevent future recurrences. Here’s a detailed outline of the recovery process:

Initial Rest and Pain Management

  • Rest: It’s crucial to reduce activities that trigger knee pain, especially high-impact exercises like running and jumping. Switching to low-impact activities such as swimming or cycling can help maintain fitness without aggravating the knee.
  • Ice and Compression: Applying ice packs to the knee for 15-20 minutes several times a day can help reduce swelling and pain. Using a compression bandage can also provide support and reduce swelling.
  • Medications: Over-the-counter pain relievers such as ibuprofen or acetaminophen can be used to manage pain and inflammation.


Physical Therapy

  • Strengthening Exercises: Strengthening the muscles around the knee, particularly the quadriceps, hamstrings, and hip abductors, can help improve the stability of the patella and distribute force more evenly during movement.
  • Stretching: Tight muscles can contribute to the misalignment and stress on the knee. Regular stretching of the hamstrings, quadriceps, and calves is important.
  • Patellar Taping or Bracing: Taping or using a brace can help stabilize the patella and distribute pressure more evenly across the joint.


Gradual Return to Activity

  • Incremental Increase: As pain decreases, gradually reintroduce activities. Start with walking or gentle jogging before moving to more strenuous activities. It’s important to listen to your body and not rush this process.
  • Technique Modification: Changes in running or sports techniques can reduce stress on your knees. Consider working with a sports therapist or coach to modify your technique.


Preventive Measures

To prevent runner’s knee, it’s important to:

  • Maintain a healthy weight to reduce stress on the knee.
  • Warm up and cool down properly during workouts.
  • Incorporate strength training into routine workouts to ensure the muscles around the knee are strong and balanced.
  • Wear appropriate footwear that offers good support and cushioning.


When to Seek Medical Help

If knee pain persists despite rest and home treatments, or if the pain interferes with daily activities, it’s advisable to consult a healthcare provider. Persistent pain could indicate a more serious condition that requires professional treatment.


Runner’s knee is a common issue among athletes, particularly those involved in running and jumping sports. By understanding the symptoms, causes, and treatment options, individuals can effectively manage the condition and prevent its recurrence. Maintaining muscle balance, proper knee alignment, and appropriate training routines are crucial for avoiding this painful condition.


Do you have more questions? 

What specific exercises help strengthen the muscles around the knee?

Exercises like straight-leg raises, wall sits, and step-ups can strengthen the quadriceps, hamstrings, and glutes, providing better support for the knee.

Can runner’s knee lead to more serious conditions if untreated?

Yes, prolonged misalignment and stress can lead to chronic pain and degeneration of the knee joint, potentially causing long-term damage.

Are there specific stretches recommended for preventing runner’s knee?

Stretching the hamstrings, quadriceps, and calves regularly can help maintain flexibility and reduce tension around the knee.

How long does it typically take to recover from runner’s knee?

Recovery can vary but generally takes 4-6 weeks with proper treatment and rest, depending on the severity.

What are the signs that my running shoes are not suitable?

Signs include uneven wear patterns on the soles, lack of support or cushioning, and discomfort while running.

Can runner’s knee be completely cured?

With proper treatment and preventive measures, most people can fully recover from runner’s knee and return to their activities without pain.

Is ice or heat better for treating runner’s knee pain?

Ice is generally recommended for reducing inflammation and pain after activities, while heat can help relax and loosen tissues during recovery phases.

How can I modify my running technique to prevent runner’s knee?

Focus on maintaining a shorter, more frequent stride, avoid overstriding, and run on softer surfaces whenever possible.

Are there any dietary considerations that can affect runner’s knee?

Maintaining a healthy weight can reduce stress on the knee, and a diet rich in anti-inflammatory foods may help manage symptoms.

What role do orthotics play in managing runner’s knee?

Orthotics can help correct foot imbalances such as flat feet or high arches, which might contribute to knee misalignment.

Should I stop running if I have runner’s knee?

It’s advisable to reduce or stop running until the pain subsides and gradually reintroduce activity as symptoms improve.

How do I know if my knee pain is runner’s knee or something else?

Runner’s knee typically presents as pain around the kneecap exacerbated by activities like running or climbing stairs. A doctor can provide a diagnosis.

Can weightlifting cause runner’s knee?

Yes, particularly exercises that place a lot of stress on the knees, such as squats or lunges, if not performed correctly.

What preventive exercises can I do at home?

Leg lifts, hamstring curls, and bridging can all strengthen the leg muscles and support the knee.

How often should I replace my running shoes?

Generally, every 300-500 miles, depending on your running style and the shoe quality.

What is the best surface to run on to avoid runner’s knee?

Soft, even surfaces like grass or synthetic tracks are better for reducing impact compared to hard surfaces like concrete.

Can yoga help with runner’s knee?

Yes, yoga can improve flexibility, balance, and strength, which are beneficial for knee health.

What are the first aid steps if I feel knee pain while running?

Stop running, apply ice to reduce inflammation, and rest the knee. Consult a physician if pain persists.

Are compression sleeves or braces effective for runner’s knee?

They can help provide support and stability to the knee, potentially alleviating pain.

How does body weight impact runner’s knee?

Excess weight increases stress on the knees, potentially worsening or triggering pain.

What are the best pain relief methods for acute runner’s knee episodes?

Over-the-counter pain relievers, ice applications, and rest are commonly recommended

Can swimming be a good alternative exercise for someone with runner’s knee?

Yes, swimming is a low-impactexercise for those with knee issues as it places no impact on the joints.

What types of footwear are recommended to prevent runner’s knee?

Shoes that offer good arch support, cushioning, and stability are ideal. It may also be helpful to consult a specialist to find the best fit for your running style and foot type.

Can improper running form lead directly to runner’s knee?

Yes, improper form, such as overstriding or poor foot landing, can increase stress on the knee joint and lead to pain.


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.

My profile page has all of my educational information, work experience, and all the pages on this site that I've contributed to.