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Runners Knee

Alice Baquie

Alice Baquie

· 4 min read

If you are a runner, inevitably someone has said something along the lines of:

"Oh No! Your poor joints. How do your knees hold up?" Or "Are you worried that you'll cook your knees and have arthritis when you're old?"

LUCKY for us runners, there have been some absolute legends out there doing the hard yards on the research comparing the knees of runners and non runners in terms of log term wear and tear on the knee structural integrity....

The jury is out and it turns out running does NOT increase the likelihood of having "over used rusty/arthritic knees." In fact in some cases, the subjects who had been running for years had less arthritic degenerative changes than subjects who didn't run and were largely sedentary.

Having said that, there IS a knee condition that is close to my heart and can side line you from running called patellofemoral pain or RUNNERS KNEE. It doesn't mean you are going to have "bad knees when you're old" but if you ignore this condition it can kneecap your training for months (pun intended) and take the buzz out of running. Been there.

Firstly with a huge gamut of knee conditions out there, let us define what Runners Knee is....

What is Runners Knee?

This knee condition is one of the most common injuries in runners and other athletes alike and causes pain behind and around the knee cap. It’s medically known as patellofemoral pain syndrome or more commonly as “runner’s knee” thanks to the prevalence of it among us runners.

The hallmark of runner’s knee is persistent pain/aching around or behind the kneecap (patella), especially where it meets the lower part of the thighbone (femur.) This is exacerbated by running and noticed on hills/stairs and sometimes even when sitting stationary.

I am incredibly passionate about this injury as I myself have struggled through the perils of patellofemoral knee pain and I have worked out what REALLY WORKS!

The brilliant thing is, unlike many knee injuries, this one can be fixed conservatively without surgery. That is not to say it's an easy quick fix because that is not true. Getting back running pain free and mechanically stable after having this injury takes patience and a consistent rehab plan and I can assure you it will be worth it!

How do we know if we have Runners Knee?


The pain of runner’s knee is caused by irritation of the soft tissues and lining of the knee within the joint: (underneath the knee cap and on the surface of the underlying femur.)

Pain: Runners knee is often sharp and felt UNDER the knee cap when performing impact activities which lessens as soon as the activity finishes. It can also then be described as a dull ache when sitting for prolonged periods of time with the knee at 90degrees which then dissipates when you standing/walking around.

Other symptoms: include swelling and popping/grinding/crunching in the front of the knee often which is often noted when going from a sit to stand position or up and down stairs.

Causes of Runners Knee:

This may be multi faceted and not due to all of the below, but Runner's Knee is normally caused by one or more of these below factors:

1) An increase in mechanical load (more running km's or more impact activities)

2) Muscle imbalances which cause malracking of the patella. Eg: weak glutes, weak inner quadraceps muscles- (VMO), and tight lateral quads and hamstrings is the 'perfect storm' in overloading the PFJ

3) Anatomical variances such as a shallow trochlear groove (where the kneecap sits on the femur) which can mean deviation in the patella tracking causing friction can be more likely. This is how we are born and we cannot change it but it can be a predisposing factor.

4) Mechanics above and below the knee: Pelvic instability (above) and over pronation at the foot (below) can overload the knee joint an increase the knee joint impact load.

5) Running mechanics: Over striding when running results in more impact force going through the knees and lower limb. More impact load means more potential for joint irritation and overload within the knee joint. Simple run technique tips can help reduce the knee joint load.

6) Changes in external load: Excess hills (especially the downward impact load), more speed work (greater forces going through the lower limb) and/or changes in footwear such as a higher drop can overload the knee also.

How can I get back running without pain?

This is the million dollar question. The good news is, you can leave the knee surgery to other conditions (unless in extreme cases) and opt for "conservative management" as guided by a physiotherapist.

This sounds easy enough, but sticking to a management plan consistently to get the long term benefits can be tough. As someone that has tried ALL the knee pain management strategies, I can assure you there is no quick fix or magic bullet.

What I can say is, it DOES get better and you will be able to get back amongst the trails and hills in good time. You won't look back if you perform your rehab correctly and ALSO keep on top of it moving forward.

The truth is unfortunately due to the nature of this particular knee pain (often mechanical and anatomical induced), it needs to be regularly kept under wraps to make sure you don't end up back in the pool or on the sidelines watching your jogging mates. Consistent lower limb strength and conditioning should be a part of every running training regime.

Through trial and error, here is some of the areas I think we need to focus on when dealing with Runners knee AND (more importantly) getting BACK running after battling this injury set back....

Treatment Strategies:

-LOAD MANAGEMENT (reduction in running is nearly always necessary to settle the patellofemoral joint in the early phase of rehab)

-Dry needling: (from a physiotherapist for Trigger point relief)

-Icing: (especially if the inflammation is quite advanced, this may help settle swelling and inflammation)

-foam rolling/spikey ball: manual trigger point release

-deep tissue massage: (quads, glutes, hip flexors and adductor release can help)

-taping: (Kinesio tape works well for runners knee pain)

-exercises: (trunk, hip and lower limb focused)

-running mechanics analysis: (video analysis to check your mechanics and how you can reduced impact load at the knee.)

So what works? Honestly, all of the above. I also genuinely feel you can do most of this yourself at home with minimal equipment.

The very FIRST thing to note is that when embarking on an injury management plan, is that getting pain under control is the first and foremost thing to tackle. The body is very clever and will not be successful at strength and conditioning until your symptoms are at "discomfort" instead of "sharp pain". This does not take long. I usually recommend one full week off 'impact activities' which is enough for the symptoms to settle (not FIX the problem). After a 'de-load week' you can start your rehab!

The SECOND thing is to identify an easy self-test which you can easily repeat to work out how you are fairing along your 'knee-hab' journey.

My favourite test for Runners Knee is the simple hop test. All you need to do is hop 10 times on the painful leg and rate the pain out of ten.

Then, through regular intervals throughout your rehab you can work out how you are progressing with symptoms and work out your return to running plan. I like less than 2/10 for at least 1 week before adding any extra impact load to a home rehab regime.

The THIRD thing is not to think you have fixed your knee when you start your graded return to running. You need to continue your strength and conditioning management strategies ongoing so as to not fall back into mechanical overload and imbalances which can lead you back down the pain pathway. Been there. Stay vigilant.

What does my Runners Knee Rehab look like?

For an extensive rehab guide to address your Runners Knee pain, I have just the remedy for you!

I have developed a Knee Rehab Plan for Runners Knee which details the practical rehab components or assessing, diagnosing, treating and progressing with Runners Knee.

Full access available on the APP.

Happy running,


Alice Baquie

About Alice Baquie

Alice has been a physio for fourteen years and specialises in injury prevention and management for runners. Alice has represented Australia in distance running and gymnastics so has sound knowledge of athletic performance and understands the importance of strength conditioning and mobility to help keep the body moving effectively to mitigate injuries.

Alice, otherwise known to her wonderful pilates community as AB is a fun loving inclusive person always ready to chat and have a laugh and has hosted 1000’s of online classes which attract people from all around the world, including 25 Aussie Olympians.