Runner’s Knee

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Running is one of the most popular sports and hobbies in the whole world. In 2017, Strava the GPS tracking recorded over 240 million runs worldwide! That’s a lot of running, and that’s only the amount that has been recorded and tracked.

Running is an easy and affordable sport and exercise which almost anyone can take part in, which is one of the reasons for its popularity. It’s a great way to manage your physical and mental health and also a great way to burn calories.

However – running comes with its own injury – the dreaded runners knee.

Runners knee is an umbrella term for a collection of diagnoses which occur around the knee and kneecap which affect how we run.

Running is a dynamic and explosive activity which requires a lot of strength and control from the full body in order to complete the activity. Along the way we can develop minor imbalances and injuries which can contribute to runner’s knee.

This article will give you guidance on what runners knee is, what anatomy is involved within the knee and ways in which you can manage runner’s knee.

If you have had runners knee in the past, have it currently or simply want to avoid it, then this article will tell you all you need to know so that you can understand the problem better.

As a word of advice – if you are struggling with knee pain and are unsure of what the cause is, then get booked with a health professional like a physiotherapist who can expertly assess your issue and give a correct diagnosis.

Let’s take a look at the anatomy of the knee first.


Our anatomy is going to link in with all the different causes of runners knee.

The simple guide to the knee would be advising you of all of the main structures such as the thigh bone, shin bone and kneecap but we need to relate the specific structures to all of the potential conditions that cause runners knee for you to understand this issue more clearly.


  1. Anterior Knee Pain – this is a diagnosis which simply means pain at the front of the knee. It can involve the kneecap, patella tendon and also the main joint of the knee which is the tibiofemoral joint.


Having imbalances within the lower limb can lead to excess force going through the structures at the front of the knee which then causes the knee to be placed under too much load which then develops pain as a result.


  1. IT Band Syndrome – this is a common issue with runners where the strong band of fascia that runs down the side of the leg can become imbalanced, develop tightness and cause control issues at the knee when running.


The IT band also has a role to play with the kneecap helping it to stay within its groove on the femur. If you have IT band syndrome you can become sore at the outside of the knee but this can then leave the front of the knee sore from the imbalance – contributing to runners knee.


  1. Patellofemoral Malalignment – as discussed in the point above, IT band syndrome can contribute towards patella malalignment but other issues such as trauma, weak quads and also biomechanical issues can lead to the patella being misaligned.


This causes an issue because it is designed to stay within its groove and help smooth movement of the knee when flexing and extending. If the kneecap does not sit in the groove properly on the femur this can produce pain, swelling and clicking.


  1. Chondromalacia Patella – on the underside of the patella is cartilage that helps the patella run smoothly and pain free when it is moving backwards and forwards.


Overuse, trauma and individual specific reasons can contribute towards the cartilage on the underside of the kneecap becoming worn and damaged, thus causing irritation.

To summarise – the anatomy of the knee mostly affected by runners knee is the kneecap and the structures which help to control it. When we bend our knee and run with it, there is a lot of force going through the front of the knee and this is a reason why it needs to be working optimally and the lower limb requires balance as a whole to prevent pain developing.


The symptoms of runners can be commonly described as pain around the knee cap. It can be acute and sharp on running but mostly is described as a dull ache.

This presentation can vary from person to person and also depending on what is causing their issue. These are some of the symptom you may experience with runners knee:


  • Swelling
  • Popping
  • Grinding
  • Clicking


You may feel these symptoms when you are running but also during day to day activities such as:


  • climbing or descending stairs
  • squatting – with or without weight
  • running
  • sitting down or standing up
  • walking
  • kneeling
  • sitting for a long time with the knee bent


Depending on how intense your symptoms are you may experience these straight away or you be more tolerant with the symptoms coming on a long period after you perform the movements.

It is still possible to run with some runners knee issues and we will discuss later in the article how this is possible.

It is important to understand that not all pain you experience is bad pain equating to damage. Mostly, the symptoms you experience is raised sensitivity which is giving you feedback to tell you that a certain area is sensitive currently.

The next step is you doing something about it.


So what actually causes runners knee?

Well, running……..but there are a few other factors which need to be considered in why it develops.

The soft tissues and smaller structures around the front of the knee are easily aggravated and here are some of the main reasons why this happens.


Kneecap Injury


Any blunt trauma to the knee such as a collision with another person, a fall or even excessive kneeling can cause injury to the kneecap. The kneecap is only a small bone but it also has ligaments which hold it in place and also bursa and a fat pad which sit underneath to cushion it. Any excess pressure to the kneecap can really cause it to become aggravated and uncomfortable which can then turn in to runners knee if not properly addressed.


Lower Limb Imbalance


If you have had previous injury or are weak on one side compared to the other, this can lead to excess load and force being placed through the front of the knee. When we run, the whole lower limb works together to control the force being placed through it. If there is a weak part of the chain, what will happen will be the kneecap and front region of the knee will not be able to tolerate the forces placed through it – which then results in pain developing.


Poor Load Management


Sudden increases in running distances and speeds which the body cannot keep up with usually lead to tissue breakdown and potential injury. Runners knee is common when people who don’t typically run much will train for an event and try to cram a lot of training in to a short period of time to be ready for their event. It is also common in the January months when people embark on new year’s resolutions. The best way to avoid this is to plan a gradual increase in your running over a sensible timeframe.




Overuse and age can cause a breakdown in cartilage which is the tissue which helps to cushion our joints. As described in the anatomy section, the kneecap has a covering of cartilage on the back side which helps it to glide smoothly. If there is arthritis present this may not be as smooth as it once was and this in turn can sometimes cause pain.


So – how do we get rid of and manage runners knee. Here are a few sensible ways for you to manage the problem.




If you don’t have any previous experience or are unsure about the diagnosis, go and see the people who know what they’re doing. A physio can assess your problem, diagnose and then provide a combined approach of education, movement retraining, strength work and treatments to help the problem reduce down. They will also give you a plan for returning to exercise and tell you what you can and can’t do at various stages. This leads us in to our next point.


Load Management


Proper planning of your exercise can totally help prevent runners knee altogether. Plan your training in blocks and increase your amount or intensity over sensible periods. Allow yourself enough recovery between sessions for the tissues to settle down and recover.




If you have runners knee or any pain around the front of the knee the standard approach to acute sport in juries applies here. Any swelling should be managed with compression and elevation. Gentle movement and appropriate rest are also advised for the knee as a whole. Self-treatments such as patella mobilisation can help, especially if this area has become sensitive. These can be simply performed by sitting with your legs out, quad relaxed and moving and gliding your kneecap in to all different positions. This helps the kneecap to stay mobile and reduce any irritation.




Exercises for runners can vary. It also depends on your symptom level and how it affects you. Keeping good quad engagement and strength in the lower limb is vital. If you are able to run this is great, keep it slow, on a soft surface and perform shorter amounts. Changing the type of exercise for something like swimming or cycling would be a great way to move the knee without impact. Consider strength training of the knee with quadriceps and hamstring exercises to improve lower limb control.




There are specific straps and knee supports which are designed for runners knee. There are different types which can be placed under the knee and over the knee focusing on providing support to different parts of the knee. There are knee sleeves which have holes in them to reduce pressure on the patella and also straps which sits underneath the kneecap to provide support to the patella tendon. A good support can help to manage mild pain and ensure you keep moving. If you have swelling on your knee – a knee sleeve can be a good way of supporting the knee but also compressing it to help reduce the amount of swelling which is on the knee.


That’s concludes our guide to runners knee and we hope that it has been helpful. If you find this article will benefit someone you know then please share it with them. Take a look at some of our other articles which give you a further look at knee sleeves but also exercises which can help to strengthen the lower limb. Thanks for reading.

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