Understanding Patellofemoral Pain Syndrome (Runner’s Knee)
Patellofemoral pain syndrome, commonly referred to as runner’s knee, is a prevalent condition characterized by pain around or behind the kneecap (patella). Initially, it may present as a minor discomfort during activities such as climbing stairs, squatting, or prolonged sitting. Over time, this discomfort can escalate into persistent pain and stiffness, impacting daily activities like walking, resting, or even sitting. Patients often report additional symptoms, including popping or grinding sounds in the knee and occasional instability, where the knee feels like it “gives out” during movement. This condition, while manageable, requires timely intervention to prevent long-term complications.
Causes of Patellofemoral Pain Syndrome
The knee is a complex and highly functional joint, making it susceptible to various forms of stress and injury. Patellofemoral pain syndrome arises when the patella does not glide smoothly within the femoral groove of the thighbone (femur). This improper tracking, or malalignment, causes the patella to rub against the femur, leading to irritation, inflammation, and, in severe cases, damage to the cartilage on the underside of the kneecap. The condition is one of the most common reasons patients seek physiotherapy, affecting a wide range of individuals, from adolescents experiencing growth spurts to older adults with age-related joint changes.
Runner’s knee is particularly prevalent among athletes and those with active lifestyles, though it is not exclusive to them. Activities that involve repetitive knee bending, high-impact jarring, or weight-bearing movements—such as running, jumping, or squatting—are primary triggers. Sports commonly associated with this condition include running, basketball, volleyball, netball, tennis, skiing, and cycling. Additionally, occupations that require prolonged kneeling, such as tiling, carpet laying, or plumbing, significantly increase the risk of developing patellofemoral pain.
Specific Risk Factors
Several factors contribute to the development of patellofemoral pain syndrome:
- Overuse: Sudden increases in the intensity, duration, or frequency of physical activity can overload the knee joint.
- Biomechanical Imbalances: Tight quadriceps, iliotibial band, or weak hamstrings and inner thigh muscles can pull the patella off-center, disrupting its alignment.
- Footwear and Surface Changes: Wearing inadequate or worn-out shoes or training on uneven or hard surfaces can exacerbate knee stress.
- Trauma: A twisting injury or complications following knee surgery may initiate or worsen symptoms.
- Excess Body Weight: Additional weight places greater mechanical stress on the knee, accelerating wear and tear.
- Foot Mechanics: Flat feet, overpronation, or insufficient arch support can alter knee alignment during movement.
- Hip and Core Weakness: Poor hip stability or weak core muscles can lead to compensatory movements that strain the knee.
First Aid and Self-Care
Patellofemoral pain syndrome typically develops gradually, with symptoms worsening over time if left unaddressed. Early intervention is critical to managing symptoms and preventing progression. Initial self-care strategies include:
- Rest: Avoid aggravating activities, such as running or jumping, to allow the knee to recover.
- Ice Therapy: Apply ice packs for 15 minutes every 2–3 hours to reduce inflammation and alleviate pain.
- Anti-Inflammatory Medications: Over-the-counter options like ibuprofen can help manage pain and swelling, but consult a healthcare provider before prolonged use.
- Compression and Elevation: Using a compression bandage and elevating the leg may help reduce swelling in acute cases.
If symptoms persist or intensify, seeking professional care is essential. No referral is required to consult a physiotherapist, and early treatment can significantly improve outcomes.
Professional Treatment Options
Manual therapy is a highly effective, evidence-based approach to treating patellofemoral pain syndrome. A therapist will conduct a thorough assessment to identify the underlying causes of the condition, such as muscle imbalances, poor movement patterns, or structural issues. Treatment plans are tailored to the individual and may include the following:
- Taping or Bracing: Temporarily taping or strapping the kneecap can help realign the patella, reduce pain, and support proper tracking.
- Manual Therapy: Techniques such as soft tissue massage and joint mobilization are used to reduce swelling, improve circulation, and restore normal joint mechanics.
- Exercise Prescription: A structured program of stretching and strengthening exercises targets muscles that support the knee, including the quadriceps, hamstrings, and hip stabilizers. These exercises evolve as the patient progresses, gradually increasing in intensity to match recovery.
- Gait and Movement Analysis: Assessing and correcting posture, gait, or sport-specific techniques can prevent recurrence by addressing faulty movement patterns.
- Orthotic Support: Custom orthotics or appropriate footwear may be recommended to correct foot mechanics and improve knee alignment.
For clients who wish to maintain fitness during recovery, low-impact activities such as swimming, deep-water running, or using elliptical trainers are excellent options. These exercises minimize stress on the knee while preserving cardiovascular health and muscle strength.
In cases where biomechanical or structural issues persist, additional interventions may be considered. For example, patients with flat feet may benefit from arch supports or custom-made orthotics. In rare instances, such as severe cartilage damage or advanced arthritis, surgical consultation may be necessary. However, over 90% of patients with patellofemoral pain syndrome achieve significant symptom relief within six weeks of starting therapy.
Prevention and Long-Term Management
Preventing recurrence of patellofemoral pain syndrome requires a proactive approach to joint health and movement mechanics. Key strategies include:
- Strength and Conditioning: Regular exercises to strengthen the quadriceps, hamstrings, glutes, and core muscles help maintain knee stability.
- Proper Footwear: Invest in supportive, activity-appropriate shoes and replace them regularly to ensure adequate cushioning and stability.
- Technique Correction: Work with a physiotherapist or coach to refine sport-specific techniques, such as running form or jumping mechanics, to reduce knee stress.
- Weight Management: Maintaining a healthy weight reduces mechanical stress on the knee joint.
- Gait and Posture Assessment: Periodic evaluations of walking or running patterns can identify and correct issues before they lead to pain.
Key Takeaways
- Patellofemoral pain syndrome, or runner’s knee, is a common cause of knee pain, particularly in active individuals.
- Symptoms typically worsen with activities involving knee bending, jarring, or weight-bearing.
- Manual Therapy is a proven, non-invasive treatment that accelerates healing and prevents recurrence.
- Long-term management may involve biomechanical corrections, such as orthotics, and ongoing strength training to support joint health.
By addressing patellofemoral pain syndrome early and adopting preventive measures, individuals can return to their activities pain-free and with greater confidence in their knee health.
Want to know more or take advantage of our complimentary initial chat ? Contact us here 🙂