It starts as an ache around the kneecap. It’s worse on the downhill stretch of your run, worse on the stairs at work, and worst when you stand up after a long meeting or a movie. Then one day it shows up two kilometres into an easy run and doesn’t leave.
That’s runner’s knee, or patellofemoral pain if you want the clinical name. It’s the most common reason runners come to see me, and the good news is that most people don’t need to stop running to get on top of it. They need to change what they’re doing, not quit doing it.
What Runner’s Knee Actually Is
Your kneecap sits in a groove at the end of your thigh bone. Every time you bend your knee under load, the kneecap presses into that groove. Running, stairs, squatting and sitting with your knees bent all load it.
Runner’s knee is what happens when that joint is asked to handle more load than it’s currently ready for. The tissues around the kneecap become sensitive, and activities that used to be comfortable start to hurt. It’s an irritation problem, not a damage problem. Scans are usually normal, and the joint itself is typically healthy.
That matters, because it changes the goal. You’re not trying to fix something broken. You’re trying to calm the knee down and then build its capacity back up, so the load you want to put through it is no longer too much.
The Usual Suspects
Runner’s knee rarely has a single cause. In practice it’s almost always some combination of these:
- A jump in training. More kilometres, more hills, more speed work, or a new race block, usually all at once. This is the most common trigger by a long way.
- Strength that hasn’t kept up. Weak quads and hips mean the knee absorbs more of each landing. Strength is the knee’s shock absorber.
- Running mechanics. A long stride with the foot landing well out in front of you increases the load on the front of the knee.
- Life outside running. Long days sitting, a new job with lots of stairs, poor sleep, or a stressful stretch can all lower how much load your knee tolerates.
Should You Keep Running?
Usually, yes, with adjustments. Complete rest tends to calm the pain in the short term, but it also lets your knee lose capacity, so the pain comes straight back when you return. The better approach is to find a level of running your knee tolerates and build from there.
A simple guide: some discomfort during a run is acceptable if it stays mild (no more than about 3 to 5 out of 10), settles within 24 hours, and isn’t worse the next morning. If any of those fail, the run was too much. Scale back the next one rather than stopping altogether. There’s more on this rule in Should You Train Through Pain?
Practical ways to reduce load while you keep running:
- Cut back weekly volume for a few weeks, rather than dropping runs entirely
- Swap hills and stair workouts for flatter routes, like the Seawall, until things settle
- Keep easy runs truly easy, and pause speed work
- Shorten your stride slightly (more on this below)
What Actually Fixes It
Strength training is the main treatment. The research on runner’s knee is consistent: exercise that targets both the hips and the quads works better than almost anything else, and it’s what produces lasting results. Early on, that might be wall sits, step-ups to a low box, glute bridges and side-lying hip work. As the knee settles, it progresses to split squats, single-leg work, and heavier loading.
The key is that the exercises have to get harder over time. A band routine you do for six months without progressing won’t build the capacity a marathon build needs.
A small change in cadence can help a lot. Increasing your step rate by about 5 to 10 percent, without trying to run faster, shortens your stride and has been shown to reduce the load on the knee with each step. A free metronome app or the cadence setting on your watch is enough to practise it. Make the change gradually, on easy runs first.
Short-term helpers. Taping the kneecap or using foot orthoses can reduce pain for some people in the early weeks, which makes it easier to keep training. They’re useful for getting through a flare, but they don’t replace the strength work.
When to Get It Assessed
Book an assessment if:
- The pain has lasted more than a few weeks despite cutting back
- It’s affecting stairs, sitting or sleep, not just running
- You have a race coming up and need a plan you can trust
See a doctor promptly instead if your knee is swollen, locks or gives way, or if the pain started with a twist, fall or impact. Those point to something other than runner’s knee.
How I Treat Runner’s Knee at GroundSwell
An assessment looks at your training history, how your knee responds to different loads, your strength, and how you move, including watching you run when it’s useful. From there you get a plan with two parts: how much running to do right now, and a strength program built in the gym at Groundwork Athletics that progresses as your knee improves.
The goal isn’t just to get the pain to settle. It’s to leave you with a knee that handles the training you want to do. If you’re also dealing with an Achilles that’s been grumbling, the return-to-running framework for Achilles tendinopathy follows the same principles.
Read more about running and endurance physiotherapy at GroundSwell, or book an assessment online.
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