‘Runner’s Knee’

In this week’s article we will focus on the knee, which as the research suggests, is the number one site for running injuries with the patellofemoral pain syndrome (PFPS) being at the top of the list. Last week, we discussed in detail one of the most common causes of heel pain in runners – Plantar Fasciitis. If you missed it, you can access the article here.

Patellofemoral Pain Syndrome

  • Do you have pain in front of your knee and around the kneecap?
  • Is the pain present during activities where the knee is bend repeatedly, for example during running, squatting, climbing stairs, or jumping?
  • Do you notice any popping or crackling sounds in your knee when standing up after sitting for a prolonged time or climbing stairs?
  • Do you experience pain after sitting for a long time with your knees bent?

What is it?

The patellofemoral pain syndrome (PFPS), or simply ‘runner’s knee’ is the most common overuse injury among runners. It manifests as pain in front of the knee and mainly affects young women who show no structural damage in the knee joint itself. Women tend to have wider hips, resulting in a greater angling of the thigh bone to the knee. This puts the kneecap (patella) under more stress. PFPS occurs when a mistracking kneecap irritates femoral groove in which it rests on the thigh bone (femur).

Why it happens?

There are many factors which may lead to the development of PFPS and pinpointing a single cause is difficult. The problem could be biomechanical in nature. For example, the patella may sit too high in the femoral groove or it may dislocate easily. The alignment of your foot and ankle also plays a big role in PFPS, with studies showing that people with flat feet or knees that turn in or out excessively may be at a higher risk of having their patella pulled sideways. However, there are also muscular causes. Weak muscles around your hips, tightness in the quads, hamstrings or the iliotibial band can all cause the patella to track out of alignment.

‘The Fix’

In many cases the PFPS will improve with home treatments and surgery is not advised. At the first sign of pain, reduce your mileage and rest your knee as much as possible to let the healing begin. Avoid or modify activities which increase the pain, such as kneeling, squatting or climbing stairs.

RICE Method

As with most sports injuries, this method is also recommended for PFPS. RICE stands for Rest, Ice, Compression and Elevation.

  • Rest – You don’t have to stop running but decreasing your mileage for a few weeks will give the knee time to recover. Also switching things up will put less stress on the tissues. For example, if you are a road runner, switch to running on the grass. Low impact workouts such as cycling or swimming are a good choice to keep fit while letting your knee recover.
  • Icing Helps to reduce the pain. Apply ice wrapped in a towel to the heel twice a day for 20 min at a time. Never apply ice directly to the skin. You could also roll your foot over a plastic bottle filled with cold water. Try placing the bottle in the freezer for a few minutes to make it that bit colder.
  • Compression – Wrap the knee lightly in an elastic bandage, leaving a small opening for the kneecap. Make sure the bandage is not too tight causing additional discomfort but it fits snugly.
  • Elevation – Resting as often as you can with your knee elevated higer than your heart will speed up the healing process.

Additionally to the above method, it’s important to address the underlying cause of the PFPS whether is muscular or biomechanical in nature.

Taping and Patella Braces 

Will apply pressure to your kneecap to bring it back to a proper alignment. Both of these methods combined with a physical therapy show a great success in pain reduction.

Foot Orthoses

Poor foot alignment and flat feet can cause your thigh bone to rotate, placing an additional force on your knees. Your podiatrist may recommend you special shoe inserts to correct the malalignment. At South Dublin Podiatry, we provide the over the counter inserts, prescription insoles and custom made orthotics.

Physical Therapy

Specific exercises can strengthen the muscles that support your knees and control your limb alignment. Your podiatrist or physiotherapist will recommend you the best set of strengthening exercises combined with an appropriate stretching regimen.


Introducing a few small changes into your running routine may help you with preventing PFPS, such as running on softer surfaces. At South Dublin Podiatry, we recommend athletes to increase their mileage and hill work gradually, allowing their muscles to adapt and strengthen at a moderate pace to avoid any overuse injuries. Our podiatrist advises to consult a specialty running shop when choosing running footwear to make sure your shoes fit correctly and address your foot posture and gait. Also, working calf and hamstring stretches, and quadriceps strengthening exercises into your routine will improve the position of your kneecap and your overall lower limb alignment.

To recap, here is a short video summarising the main points…

Want to see me in person?

Just book a time online or call me on +353 (0) 83 8241454. I love to help runners recover. It is my passion!

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