Knee Pain Running: A Common Complaint

Knee Pain Running: A Common Complaint

Knee Pain Running Is The Most Common Running Injury

Runners knee, patellofemoral pain syndrome, chondromalacia patella whatever you wish to call it… The fact is knee pain running is an extremely common complaint. Knee pain from running is the most common running injury there is suggested to account for approximately 20% of all running injuries. Runners knee is so common, it makes up one of every four knee injuries. As a condition runners knee as its name would suggest occurs commonly, however not exclusively in the running population. It is an “injury” that can strike any athlete whose activity and training tends to involve a lot of knee bending under load. This can include sports such as walking, cycling, weightlifting, or anything involving regular leaping or jumping actions.

Where Do You Feel The Pain With Runners Knee?

The most common area I find in my Sydney and Randwick physio practices runners experience knee pain is centered around the patella (kneecap). This pain is often described to me as a dull ache around the kneecap, or as a more localized feeling of pain deep underneath, just above or on the medial side of the kneecap. Pain experienced with runners’ knee is usually described by  patients as being particularly noticeable when traveling up or downstairs, as well as being associated with squatting, kneeling, or running actions. Pain may even be experienced with some individuals associated with extended periods of sitting with their knees bent, which is why kneecap pain is also occasionally referred to as ‘movie-goers knee’ in literature, given the discomfort around the knee cap experienced with prolonged periods of sitting as may occur during watching a movie in the cinema.
With regard to running as a cause of kneecap pain, the onset of pain with running typically starts off mild at first becoming more pronounced over time if aggravating activities are continued. Meaning if the runner continues running without any adjustments to loading or other variables then the typical progression I see in my patients is that the pain experienced becomes both more frequent and more intense.

Other Causes Of Knee Pain Running

It is important to note here that runner’s knee is not the only cause of knee pain running. ITB syndrome is another common cause of knee pain running just as osteoarthritis, meniscal pathology, patella tendinopathy, fat pad syndrome the list goes on… Henceforth it is important that any injury or pain you have is assessed by your physio or other appropriately skilled professional to ensure accurate diagnosis and therefore meaning the correct management approach can be applied.

Condromalacia Patella A Cause Of Pain In The Knee When Running

One of the causes of knee pain running is due to the abnormal softening/degeneration (breakdown) of the cartilage of the underside of the kneecap as it slides over the lower end of the thigh bone (the femur). This is referred to as condromalacia patella one possible theory for the onset of pain associated with this condition postulated in physiotherapy circles is that when running the kneecap is ideally pulled over the end of the femur in a straight line like two perfectly fitted pieces of a puzzle sliding together. If rather than “tracking” smoothly in the groove there is “abnormal tracking” of the knee cap during running and the knee cap/femur “puzzle pieces” due to the different forces acting at the knee no longer line up perfectly then this situation sees the knee cap “rub” against the femur asymmetrically. This “abnormal tracking” when compared to a kneecap that is “tracking” smoothly in its groove as the knee bends back and forth may cause sensations which patients describe as pain, rubbing, grating, grinding… and this “rubbing” can be the trigger for areas of cartilage change on the kneecap or the associated groove it moves in.

Potential Reasons Behind “Patella Tracking” Issues

There are several potential factors hypothesized that influence the tracking of the patella that may leading to “mal-tracking” resulting in possibly experiencing knee pain running.

  • Tightness of the soft tissues of the lateral thigh, such as the ITB that can exert forces and may lead to the “pulling” of the kneecap laterally in the groove during movement.
  • Imbalance between the inner and outer thigh muscles specifically what are anatomically referred to as the vastus medialis obliquus and the vastus lateralis of your quadriceps. The commonly suggested pattern of relative weakness of the medial quad (vastus medialis) with regard to the “lateralis” muscle can lead to an imbalance medial to lateral pull again potentially causing “patella tracking” issues.
  • Weakness of pelvic stabiliser muscles. A common group of muscles I find in my Sydney physio practice that are weak with many runners,are are the “deep gluteal” muscles. Weakness in these muscles (or other trunk and pelvis stabilisers) may mean the runner fails to effectively control pelvic tipping or twisting when running, this can have the effect of altering femur angles and resulting muscle tension changes again may lead to “patella tracking” issues.
  • An imbalance between the strength of the front and back of the thigh musculature. Specifically an imbalance between quad and hamstring power.
  • Lower leg muscle extrinsic and intrinsic foot muscle weakness.
  • Poor footwear choices relative to specific foot qualities, training surfaces and load requirements.

A physiotherapist and/or sports podiatrist should be well versed in recognizing which factor/s may be playing a role in your individual situation and equally they should be skilled in helping set up a plan of attack to address any identified factors. As well as this assist in setting up a plan to manage training loads whilst working on any of the other identified variables.

Who Is Most At Risk Of Developing Knee Pain Running?

A number of main etiological factors associated with developing a running injury include:

  • Previous injury
  • Lack of running experience
  • Competitive running and excessive weekly running mileage.

Such factors suggest that the prevention and if necessary, treatment of running injuries should always include a component of behavior change through education. Education, focusing on the importance of complete rehabilitation following injury, early recognition of symptoms of overuse, and the provision of training load guidelines for the individual new to running, as well as the experienced competitive runner.

Is There A Cure For Runners’ Knee?

Management of patellofemoral pain syndrome and the frustration of knee pain running in some situations can be quite simple to manage, yet at other times it can be considerably more involved and multi-factoral. As suggested above “load management” often takes a lions share in the roll of managing knee pain running. If you have steeply ramped up your running mileage recently then the first plan of attack could be considering scaling things back a bit. Likewise, backing off on any new/extra hill, or speed work included in your training assessing variable of change in your routine without appropriate time for tissues to adapt and getting to the bottom of what this may be is often key to unloading the knee whilst still maintaining some level of training.

Other factors regarding training changes may include:

  • Trying to avoid running on banked surfaces, or curved tracks which can effectively give you the equivalent of one short leg whilst running. Where possible try to run on a more level surface and even consider running on soft sand as it reduces the impact forces as well as typically reduces the number of steps taken to reach fatigue. However this is a dramatic change in the type of loading and a swap to soft sand running to reduce knee pain running should only be done under professional advice.


  • Having your footwear and running technique assessed. Both variables can play a massive role in helping manage knee pain running. If you have knee pain from running that is not responding to your initial efforts to subdue it then it seems foolish not to consider running technique and/or poor footwear choices as factors to consider.

Prescription of:

  • Appropriately targeted strengthening, stretching exercises are frequently important for a full recovery allowing the increase of training loads whilst reducing the likelihood of recurrence of symptoms. Foam rolling techniques and more recently the use of massage guns are commonly prescribed treatment approaches by Sydney physiotherapists. Such soft tissue release techniques can enhance the effectiveness of other prescribed stretching exercises or soft tissue techniques employed.
  • The use of taping techniques to facilitate desired muscle activation, or with the intention of assisting correct “tracking” are fairly standard approaches used by physios over the years and are often used to good effect whilst efforts are made to actively through rehabilitation exercises to make changes to muscles lengths and tensions ultimately negating any need for ongoing taping.
  • Taping techniques can be used to assist diagnostically, to relieve acute pain, or to help enable continued training whilst the effects of any prescribed exercises are still taking effect. Occasionally when taping techniques are effective in helping manage the pain then knee bracing may also be beneficial. However, in my experience the benefits of knee braces are typically underwhelming as finding the perfect fitting brace can be a challenge given variations in thigh, knee and calf sizes often means getting a perfect fit is difficult.
    With any episode of knee pain running when resuming running, a gradual and graded increase to activity using a return to running program is almost always important to help avoid any relapse.

If you have any questions regarding knee pain running then a great starting point is booking and appointment with your physio and bringing in your running shoes and a rough diary of your recent training loads.

Disclaimer: This information is provided as an educational service and is not intended to serve as a substitute for personalized medical advice. Sydney Physio Clinic does not endorse any treatments, procedures, products mentioned in this post. Anyone seeking specific advice, or assistance regarding “knee pain running” should consult his, or her physiotherapist, orthopaedic surgeon, general practitioner, sports medicine specialist, or otherwise appropriately skilled medical practitioner.