Runner's Knee

Runner's knee, or patellofemoral pain syndrome, is an umbrella term for pain around or behind the kneecap that tends to worsen with running, squatting, or sitting for long periods with bent knees. It's one of the most common complaints among distance runners, and in most cases it responds well to sensible load management rather than requiring anything dramatic.

What runner's knee actually is

The pain usually sits at the front of the knee, around or slightly beneath the kneecap, and often builds gradually rather than appearing after a single incident. It's generally linked to how the kneecap tracks in its groove as the knee bends and straightens, which can be influenced by muscle strength and running mechanics rather than any single structural problem.

Common causes

• A rapid increase in running volume, hill work, or downhill running
• Weakness in the hip and outer thigh muscles that help stabilize the knee
• Worn or unsuitable shoes that change how load travels up the leg
• Consistently running on cambered or uneven surfaces
• Limited flexibility in the surrounding leg muscles

General management approaches

Reducing the volume or intensity that triggered the pain, particularly hills and downhill sections, is usually the first practical step. Many runners find some relief by temporarily swapping a portion of running for lower-impact cross-training like cycling or swimming while symptoms settle.

Strengthening the hips and thighs is one of the more consistently recommended approaches for managing runner's knee over the medium term, since stronger surrounding muscles tend to improve how the kneecap tracks. Pairing this with a sensible warm-up routine, see stretching before and after running, and appropriate footwear, see how to choose running shoes for your first race, supports the same goal.

Returning to running

Once symptoms ease, building mileage back up gradually matters more than the specific pace you return at. Many runners find flatter routes and softer surfaces easier to tolerate early on, saving hills and speed work for later in the return.

When to see a doctor or physiotherapist

Pain that persists despite reduced training, swelling around the joint, a knee that catches, locks, or gives way, or pain that wakes you at night are all reasons to see a doctor or physiotherapist rather than continuing to self-manage. A proper assessment can also rule out other causes of front-of-knee pain that need a different approach. For a wider view of overuse injuries in runners, see common running injuries.