Runner’s knee is an aching pain around or behind your kneecap, worse on stairs, squatting, kneeling or after sitting with your knees bent. Its proper name is patellofemoral pain. Most people get better with the RIGHT exercises, not rest alone and not surgery.
- Treatment: strengthen the thigh and hip muscles and cut back, for a while, on whatever flares it
- Recovery time: most people notice a difference within about 6 to 12 weeks of steady exercise
- The catch: it often comes BACK if you stop the exercises or ramp up too fast
It is very common. In any given year, about 1 in 5 people and nearly 3 in 10 teenagers have it. You don’t need to be a runner to get it.
Runner’s knee vs chondromalacia patella
These two terms get mixed up all the time, including in clinic letters.
- Patellofemoral pain (runner’s knee): a description of WHERE it hurts, the front of the knee around the kneecap. It doesn’t mean anything is damaged
- Chondromalacia patella: softening and wearing of the cartilage (the smooth lining) on the back of the kneecap. It is something seen on a scan or during surgery
- They often don’t match: many people with front-of-knee pain have normal cartilage, and many people with softened cartilage have no pain. Cartilage itself has no nerves
- Chondromalacia is not the same as arthritis, although later in life the two can overlap. See knee arthritis
So if your report says chondromalacia, the plan is usually the same: load the knee well, and it settles.
Symptoms
- A dull ache around or behind the kneecap, sometimes in both knees
- Worse on stairs, especially going down, and with squatting, kneeling, running downhill and jumping
- The “movie-goer’s sign”: pain after sitting for a long time with bent knees
- Grinding or crackling under the kneecap. This is common in knees without pain too, and on its own isn’t a sign of damage
Why it happens
- Too much, too soon: a jump in running distance, hills, stairs or squats is the most common trigger
- Weak thigh and hip muscles: the knee takes more load when the quadriceps and the muscles on the side of the hip can’t share it
- How the kneecap tracks: the shape of the groove and the pull of the muscles play a part in some people
Pain on the OUTSIDE of the knee during runs is a different problem. See IT band syndrome.
Exercises that help
Exercise is the main treatment, and working the hip as well as the knee tends to work better than the knee alone. Aim for 2 to 3 sessions a week. Mild discomfort during exercise is fine if it settles by the next day.
- Side-lying leg raises and clamshells: build the muscles on the side of the hip that keep the knee from dropping inward
- Bridges: strengthen the buttocks without bending the knee deeply
- Wall sits or mini squats: start in a shallow, comfortable range and go deeper over the weeks
- Step-ups and sit-to-stands: everyday strength for stairs and chairs
- Straight leg raises or leg press: build the quadriceps (the big muscle on the front of the thigh)
Runner’s knee is a load problem. Rest calms it down, but strength is what keeps it away.
What else helps
- Adjust, don’t stop: keep moving, but cut back on hills, stairs and deep squats while it settles. Cycling and swimming are often comfortable
- Kneecap taping, a knee sleeve or shoe inserts: can ease pain in the short term for some people. They work best alongside exercise, not instead of it
- Running changes: slightly shorter, quicker steps can take some load off the kneecap
- Pain relief: ice or simple pain relief can help you stay active through a flare
- Injections and scans: usually not needed. Surgery is very rarely needed and only after a long trial of good rehab
How long does runner’s knee last?
- Weeks 1 to 6: pain eases as you reduce the aggravating activities and start strengthening
- Weeks 6 to 12: most people are clearly better and building back toward running or sport
- Longer term: it has a habit of lingering or returning. About 4 in 10 people still have some symptoms a year after treatment. Keeping up a short strength routine and increasing training gradually are the best protection
For a clear overview of causes and treatment, see OrthoInfo’s guide to patellofemoral pain.
Get it checked soon if
- The kneecap slipped out of place, or the knee swelled up quickly after a twist. See kneecap dislocation
- The knee locks and won’t fully straighten
- You can’t put weight on the leg
- The knee is hot, red and swollen, especially with a fever
See your doctor or physio if
- Pain hasn’t improved after 6 to 8 weeks of regular exercise
- The knee keeps giving way
- Pain wakes you at night or is there even at rest
- A teenager has pain in the hip or thigh as well as the knee, or starts limping
Rest settles runner’s knee. Strength stops it coming back.