Understanding Your Runner's Knee: A Physiotherapy Guide

What is Runner's Knee?

Runner’s knee, or Patellofemoral Pain Syndrome (PFPS), refers to pain associated with the tissues at the front of your knee or kneecap. This discomfort often arises from mechanical loads like squatting, running, jumping, hopping, or using stairs. It’s especially noticeable during activities where your knees move over your toes, and you might also hear crunching or clicking sounds around your kneecap.

Not All Runner’s Knees Are the Same

PFPS can vary based on its underlying cause, which is usually classified as an overload or insufficiency—or a combination of both.

Overloaded Knee:

An overloaded knee typically affects experienced runners who have a relatively strong knee but are temporarily exposed to more strain than it can handle. This condition often results from an increase in training volume, speed, downhill running, or changes in footwear. Such runners may experience pain due to overloading the tissues at the front of the knee.

To manage this type of runner's knee, effective strategies include moderating training loads and avoiding aggravating activities like deep squatting or intense downhill running. Adjusting footwear to a flatter shoe and maintaining strength and plyometric work that is pain-free can also be beneficial. A temporary reduction in running volume may be necessary.

Once pain stabilises and decreases, gradually rebuilding running intensity and assessing factors like running technique, cadence, and footwear can help alleviate symptoms further. A low cadence at high speeds can result in over striding, which will increase braking forces through the limb and potentially contribute to overloading the front of the knee.

Insufficient Knee:

An insufficient knee is often found in new runners or those who do not engage in effective strength training. It is also associated with previous injuries or surgeries on the limb. This type of runner’s knee indicates that the knee lacks the capacity to handle the demands of running, making it more susceptible to overload.

For new runners or those with insufficient knee capacity, a thorough assessment of hip, knee, and calf muscle strength, as well as springiness, is crucial. A robust plyometric and strength program, combined with careful load management, often yields significant improvements. While assessing running technique and cadence can be helpful, it may be less critical for beginners who are still adapting to running.

Conclusion

If you experience symptoms of runner’s knee, consider trying some of the strategies mentioned in this guide. However, if your knee pain persists despite self-care measures, it’s important to consult a physiotherapist or healthcare professional. A personalised treatment plan can address underlying issues and help you manage your runner’s knee effectively.

Author

James O’Leary (Physiotherapist)