Runner's Knee (Patellofemoral Pain Syndrome)

Dr James Tan

Senior Consultant Knee Surgeon

Orthopaedic Surgery, Sports & Exercise Medicine

MBBS (S’pore), MRCS (Edinburgh), MMed (Orthopaedics), FRCS Orthopaedics & Trauma (Edinburgh)

Runner's knee, medically known as patellofemoral pain syndrome (PFPS), is a common knee condition that causes pain around the front of the knee or behind the kneecap. Despite its name, this condition can affect not only runners but also anyone who participates in activities that put repeated stress on the knees, such as cycling, jumping, squatting, or climbing stairs.

This condition occurs when the kneecap (patella) does not move smoothly along the groove of the thigh bone (femur) during movement, leading to irritation of the surrounding tissues. While runner's knee is not usually a serious condition, it can interfere with daily activities and sports performance if not managed properly.

Understanding Runner's Knee

The knee joint is a complex structure made up of bones, cartilage, muscles, tendons, and ligaments. The patella sits in a groove at the end of the femur and moves up and down as the knee bends and straightens. In patellofemoral pain syndrome, the patella may shift slightly out of alignment or the surrounding tissues become irritated, causing pain.

Runner's knee is classified as an overuse injury because it commonly develops after repetitive activities that stress the knee joint. It is one of the most frequent complaints among athletes and active individuals.

Causes and Risk Factors of Runner’s Knee

Runner's knee can result from several contributing factors, and often more than one factor is involved. Common causes include:

  • Overuse: Repetitive stress from running, jumping, or squatting can irritate the knee joint.
  • Muscle imbalances: Weak quadriceps, hamstrings, or hip muscles can cause the kneecap to track incorrectly.
  • Poor biomechanics: Flat feet, overpronation, or misaligned hips and knees can increase stress on the patellofemoral joint.
  • Direct trauma: A fall or a blow to the kneecap can trigger irritation.
  • Tight muscles: Stiff hamstrings, calves, or iliotibial (IT) band can pull on the kneecap, affecting its movement.
  • Sudden activity changes: Increasing exercise intensity or mileage too quickly without proper conditioning.

Individuals who are physically active, particularly runners, cyclists, or those participating in sports requiring frequent jumping, are at higher risk of developing patellofemoral pain syndrome.

Symptoms of Runner’s Knee

The hallmark symptom of runner's knee is pain around or behind the kneecap. The pain is often described as dull or aching and may worsen with:

  • Running, especially downhill
  • Climbing or descending stairs
  • Squatting or kneeling for prolonged periods
  • Sitting with bent knees for a long time (moviegoer’s sign)
  • Jumping or engaging in high-impact activities

Other possible symptoms include a popping, grinding, or crackling sensation in the knee, known as crepitus, particularly during movement. Swelling is less common but may occur in some cases.

How is Runner’s Knee Diagnosed?

Diagnosing runner's knee typically involves a physical examination and a review of the patient’s activity history. A knee doctor may perform the following:

  1. Physical exam: Assessing knee alignment, muscle strength, and joint stability.
  2. Movement evaluation: Observing how the kneecap tracks during activities like squatting or walking.
  3. Imaging tests: X-rays may be ordered to rule out other conditions such as arthritis or fractures. MRI scans are sometimes used to check for cartilage or soft tissue problems if symptoms persist.

Accurate diagnosis is needed to rule out other causes of knee pain and develop an effective treatment plan.

Non-Surgical Treatment Options

Most cases of patellofemoral pain syndrome can be treated successfully without surgery. Non-surgical treatments focus on relieving pain, correcting underlying causes, and preventing recurrence.

  • Rest and activity modification: Temporarily reducing high-impact activities allows the knee to recover.
  • Ice therapy: Applying ice for 15–20 minutes after activity can help reduce inflammation and discomfort.
  • Medications: Over-the-counter anti-inflammatory drugs can provide short-term relief.
  • Physiotherapy: A structured program that includes stretching, strengthening, and correcting movement patterns is the cornerstone of treatment. Strengthening the quadriceps, hips, and core muscles helps improve knee alignment and stability.
  • Orthotics and footwear: Supportive shoes or custom insoles may help correct foot alignment and reduce stress on the knees.
  • Taping or bracing: Patellar straps or taping techniques can help improve kneecap tracking and reduce pain during activity.

Runner’s Knee Surgery

Surgery for runner's knee is rarely required and is only considered in severe or persistent cases where conservative treatments fail. Surgical options may include:

  • Realignment procedures to correct abnormal kneecap tracking
  • Cartilage repair if damage is found
  • Removal of inflamed tissue or bone spurs if they contribute to irritation

Even in surgical cases, physiotherapy and rehabilitation remain crucial for a successful recovery.

Preventing Runner's Knee

Prevention focuses on reducing stress on the knees and maintaining proper biomechanics. Strategies include:

  • Gradually increasing activity intensity and duration to avoid overloading the knees
  • Wearing appropriate, supportive footwear for your activity
  • Maintaining a healthy body weight to minimize joint strain
  • Strengthening the quadriceps, hamstrings, hips, and core to improve joint stability
  • Stretching the legs regularly, especially the IT band, hamstrings, and calves
  • Avoiding running on hard surfaces or steep inclines for prolonged periods

By combining proper conditioning with awareness of early warning signs, most cases of runner's knee can be prevented or managed effectively.

Living with Runner's Knee

While runner's knee can be frustrating for active individuals, it is typically manageable with conservative treatment. Recovery timelines vary, but many patients experience improvement within 4 to 6 weeks with consistent therapy and activity modifications.

Long-term management may include cross-training with low-impact exercises like swimming, cycling, or elliptical workouts. Returning to running or high-impact sports should be gradual and guided by a doctor or physiotherapist to prevent recurrence.

FAQs About Runner’s Knee (Patellofemoral Pain Syndrome)

Most cases improve within 4 to 6 weeks with rest, physiotherapy, and activity modifications. Chronic or severe cases may take several months for full recovery.

It is best to reduce or stop high-impact activities until the pain improves. Continuing to run through pain may worsen the condition. Cross-training with low-impact activities is often recommended during recovery.

Runner's knee rarely causes permanent damage if managed early. However, ignoring symptoms can lead to chronic pain or cartilage wear over time.

Yes, stretching tight muscles, especially the hamstrings, calves, and IT band, can relieve pressure on the kneecap and reduce symptoms when combined with strengthening exercises.

Seek medical advice if the pain persists for more than a few weeks, worsens despite rest and home care, or is accompanied by significant swelling or instability.

Runner’s Knee Specialist in Singapore

Dr James Tan is a skilled orthopaedic surgeon specialising in knee injuries, including cartilage and meniscus surgeries. Dr Tan is a graduate of the National University of Singapore and a fellow of The Royal College of Surgeons in Edinburgh. He has also received specialist training at the Department of Sports Orthopaedics, Technical University of Munich. With extensive experience treating athletes from Singapore's national teams and professional leagues, Dr Tan is committed to achieving optimal outcomes for his patients.

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