Patellofemoral Pain Syndrome: Why Your Knees Hurt When Running

Knee pain is one of the most common reasons people stop running. It can be frustrating when something that should make you feel strong instead leaves you hobbling home. A large percentage of this pain comes from a condition called patellofemoral pain syndrome, often nicknamed runner’s knee.

If you’ve noticed pain at the front of your knee, especially around or behind the kneecap, you may be dealing with this condition. The good news is that with the right diagnosis and treatment, most runners make a full recovery.

What Is Patellofemoral Pain Syndrome?

Patellofemoral pain syndrome (PFPS) refers to irritation in the joint where your kneecap (patella) glides over the femur (thigh bone). When this joint doesn’t track smoothly, stress builds up around the cartilage and tissues, leading to pain.

It’s not usually a case of permanent damage, but rather irritation caused by poor movement patterns, weakness, or overload.

Symptoms of Runner’s Knee

You might have patellofemoral pain syndrome if you notice:

• Aching or sharp pain at the front of your knee.

• Pain around or behind the kneecap.

• Pain that worsens with running, squatting, stairs, or sitting for long periods.

• Clicking, popping, or grinding sounds when bending your knee.

• Stiffness after sitting still for too long.

These symptoms often creep in gradually rather than suddenly, making them easy to ignore until the pain becomes constant.

What Causes Patellofemoral Pain Syndrome?

There isn’t just one cause. PFPS is usually the result of a combination of factors, which is why it’s so common in runners.

Biomechanical factors

• Flat feet or foot posture problems causing the knee to rotate inward.

• Tight calf muscles limiting ankle movement.

• Weak glutes or hips leading to poor control of the leg.

Training factors

• Sudden increases in running distance, speed, or hill training.

• Running on hard or uneven surfaces.

• Worn-out or unsupportive shoes.

Anatomical factors

• Kneecaps that naturally sit higher, lower, or slightly tilted.

• Muscle imbalances between the quadriceps and hamstrings.

Risk Factors For Runners Knee

You’re more likely to develop PFPS if you are:

• A runner or athlete in sports that involve repetitive jumping.

• Someone with flat feet or feet that pronate significantly in running.

• Wearing shoes that don’t provide enough support.

• Returning to running after time off, without gradual load.

• A teenager or young adult, it’s more common in people under 40.

How Is Runners Knee Diagnosed?

At My Family Podiatry, we’ll start with a full assessment:

• Locating the pain and testing for tenderness.

• Checking how your kneecap moves in its groove during movement.

• Analysing foot posture and gait.

• Assessing hip and thigh strength.

• Looking at footwear wear patterns.

In most cases, imaging isn’t required. A thorough clinical exam tells us enough to begin treatment.

Treatment Options for Runner’s Knee

1. Footwear and Orthotics: Worn-out or unsupportive shoes can make knee pain worse. We’ll look at your footwear and may recommend custom orthotics to correct poor alignment and reduce pressure on the kneecap.

2. Strengthening Exercises: Building hip and quadriceps strength is critical. Targeted exercises help control kneecap movement and reduce irritation.

3. Training Modifications: You may need to reduce mileage, avoid steep hills, or change surfaces while symptoms settle. Gradual progression back to normal running is part of the plan.

4. Shockwave Therapy: For persistent pain that doesn’t settle with standard care, shockwave therapy can be used to stimulate healing and reduce pain around the knee joint.

5. Manual Therapy: Stretching, massage, and soft tissue release can reduce tightness in calves and quads that may be pulling on the kneecap.

How Long Does It Take to Recover From Runners Knee?

Recovery depends on severity, but most people improve within 6–12 weeks when they follow a structured plan. For runners, a full return to pain-free training often takes a bit longer, but the key is consistency.

Can Runner’s Knee Be Prevented?

Yes! Prevention focuses on strength, footwear, and training habits.

• Rotate running shoes regularly.

• Keep hip and glute muscles strong.

• Avoid rapid jumps in mileage or intensity.

• Run on softer surfaces when possible.

• Stretch calves and quads regularly.

Why See a Podiatrist for Knee Pain?

It may surprise some people that podiatrists treat knee pain, but the feet play a huge role in how forces travel up the legs. Poor foot posture is often the missing piece in ongoing knee pain. By addressing alignment and gait, we treat the cause, not just the symptoms.

Patellofemoral pain syndrome is one of the most common running injuries, but it doesn’t have to stop you. With the right assessment and a tailored plan, you can strengthen your knees, correct your foot posture, and get back to running without constant pain.

If knee pain is holding you back, book a running assessment with My Family Podiatry today and let’s get you moving pain free.

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