Empowering Rehabilitation • Build Strength • Improve Balance • Live Well

Phone: 714-427-0803

Visit our Location
2790 Harbor Blvd. Suite 300
Give us a Call
Send us a Message
Hours of Operation
Runners Knee

Runners Knee Causes, Symptoms, Risk Factors and Treatment

Runner’s knee, medically known as patellofemoral pain syndrome (PFPS), is a common ailment that affects athletes and active individuals, particularly those engaged in running and high-impact activities. In this article, we will explain runners knee, explore runners knee causes, and the symptoms associated with it. Additionally, we’ll discuss the various factors that may influence a person’s susceptibility to developing runner’s knee, including age, weight, athletic ability, height, strength, and genetic predisposition.

Runners Knee Symptoms ~ Runners Knee Causes ~ Runners Knee Exercises ~ Runners Knee Risk Factors ~ Runners Knee Treatment

What is Runner’s Knee?

Runner’s knee, or patellofemoral pain syndrome, is a condition characterized by pain and discomfort around the front of the knee, specifically where the patella (kneecap) articulates with the thigh bone (femur). It often occurs due to abnormal tracking of the patella within the femoral groove during knee movement. The more recent and accepted theory has been that the femur is dysfunctional and moves under the patella. PFPS is also defined as excessive compressive and friction forces between the patella and the underlying trochlear groove of the femur. 

Runners Knee Symptoms

The primary symptom of runner’s knee is pain around or behind the kneecap. However, the pain may vary in intensity and may be accompanied by the following:

  • Pain During Activity: Pain often increases with activities that involve bending the knee, such as running, squatting, or climbing stairs.
  • Pain After Activity: Pain can persist after exercise, especially if the activity was prolonged or intense.
  • Swelling: Some individuals may experience swelling around the kneecap.
  • Popping or Grinding Sensation: Some people report sensations of popping, cracking, or grinding in the knee joint.
  • Stiffness: Stiffness in the knee joint, particularly after periods of inactivity, can be a common symptom.

Runners Knee Causes

These are five types of common runners knee causes.

  1. Overuse or Overtraining: One of the primary runners knee causes is overuse or excessive training. Repetitive high-impact activities, such as running, can strain the knee joint and lead to patellofemoral pain. It is important to implement the concept of cross-training and mix up your exercise routine to incorporate decreased high-impact training such as swimming or cycling.
  2. Muscle Imbalances: Weakness or imbalances in the muscles around the hip and knee, especially the gluteals, quadriceps and hamstrings, can alter the alignment of the patella, contributing to pain and instability.
  3. Incorrect Biomechanics: Poor running or movement mechanics, such as excessive foot pronation (the way your foot rolls inward) or excessive knee valgus (knee collapse toward the midline), trunk alignment, cadence, and stride length can put additional stress on the patellofemoral joint. It is important to realize that these mechanical faults tend to manifest later in your run when you are fatigued.  
  4. Improper Footwear: Wearing shoes that do not provide adequate support or cushioning can increase the risk of runner’s knee. There are many shoes on the market and it is important to consult with a professional to understand whether you need a stability or neutral shoe to best accommodate your foot posture and running style. 
  5. Sudden Changes in Training: Rapidly increasing the intensity, duration, or frequency of physical activity without proper strength and conditioning can irritate the knee joint.

We excel in gait analysis and can create a custom-fit orthotic that is personalized to accommodate your foot posture and ailments. CONTACT US TO LEARN MORE

Runners Knee Exercises:

If you’re dealing with runner’s knee, here are a few exercises that can activate your glutes and help alleviate the pain.

fire hydrant

Fire Hydrant
Place a band loop around your knees
Put your weight on the affected leg
On one leg, start abducting or moving the other leg out as you keep the other knee stable while in a slight squat position.

Off Step
Standing on the outside of a step or a curb with your affected knee
Keep hips level, then hinge forward and bend your affected knee to tap the opposite heel down on the ground and then come straight back up. Make sure your knee stays in line with your third toe as you come down, and then stand straight at the top.

off step
side plank

Side Plank
Lay on the affected side, pick up your hips, drive your knee into the mat, and bring yourself up and forward.
Your body should be in a nice straight line.
Hold in place for 10 seconds, make sure that your bottom glute is activated.

While runner’s knee is commonly associated with running, it can also be triggered by a variety of sporting activities and exercises that involve repetitive knee movements and high-impact forces.


Schedule a Visit

Risk Factors:

Sports Activities ~ Demographics ~ Biomechanical

Several risk factors can contribute to the development of runner’s knee, also known as patellofemoral pain syndrome (PFPS). These factors can be categorized into various categories, including sports activities, demographics, and biomechanical factors. In terms of sports activities, high-impact and repetitive activities such as running, basketball, volleyball, and soccer can increase the risk of developing runner’s knee due to the repetitive stress placed on the knee joint. Demographic factors such as age and gender also play a role, with adolescents and young adults, particularly females, being more prone to PFPS. Additionally, biomechanical factors such as muscle imbalances, poor running or movement mechanics, foot pronation abnormalities, and inadequate footwear can contribute to the onset of runner’s knee. Other potential risk factors include previous knee injuries, overweight or obesity, and participation in activities that involve frequent changes in direction or sudden stops. Identifying and addressing these risk factors through appropriate training, biomechanical correction, and injury prevention strategies can help reduce the likelihood of developing runner’s knee.

Sports Activity Risk Factors:

Several sporting activities can potentially lead to runner’s knee and other injuries. This list below highlights some of the sports activities that could lead to runners knee.

  • Cycling 🚴: Cyclists, especially those who engage in long-distance rides or use improper bike setup, may experience patellofemoral pain due to the repetitive knee flexion and extension involved in pedaling.
  • Hiking🏔️ : Hiking, particularly on uneven terrain or with a heavy backpack, can stress the knee joint and increase the risk of developing runner’s knee.
  • Jumping Sports🏀🏐 : Sports such as basketball, volleyball, and high-intensity interval training (HIIT) often involve frequent jumping, which places significant strain on the knee joint.
  • Soccer⚽: Soccer players frequently change direction, pivot, and engage in quick acceleration and deceleration, all of which can contribute to patellofemoral pain.
  • Skiing ⛷️: Skiing, especially downhill skiing, can place excessive pressure on the knees due to the bent-knee position required during descents.
  • Tennis 🎾: Tennis players frequently pivot on their knees, making sudden starts and stops, which can lead to knee strain and potential development of runner’s knee.
  • Aerobics 🏃‍♀️: High-impact aerobics classes that involve repetitive knee movements, such as lunges and squats, can increase the risk of developing patellofemoral pain.
  • Gymnastics🤸 : Gymnasts perform a wide range of dynamic movements that require strong knee stability, which, if not well-maintained, can lead to knee pain.
  • Weightlifting🏋️‍♂️: Exercises like squats and leg presses, when performed with improper form or excessive weight, can strain the knee joint and potentially cause patellofemoral pain.
  • Triathlon Training🏃‍♂️🚲🏊 : Triathletes who engage in swimming, cycling, and running may experience runner’s knee due to the cumulative impact of these activities on the knee joint.
  • Rowing 🚣‍♀️: The repetitive motion of bending and extending the knees while rowing can potentially contribute to knee pain if not executed with proper technique and form.
  • CrossFit💪: CrossFit workouts often involve high-intensity, multi-joint movements, some of which can put significant stress on the knees, especially if executed incorrectly.

It’s essential to note that while these activities may increase the risk of developing runner’s knee, they can also be modified to reduce the strain on the knees. Proper technique, strength training, stretching, and wearing appropriate footwear can help minimize the risk of patellofemoral pain while participating in these sports. Additionally, athletes should pay attention to early signs of knee discomfort and seek timely medical advice to prevent the progression of runner’s knee and ensure optimal knee health.

Demographic Risk Factors:

Several demographic factors can influence an individual’s susceptibility to patellofemoral pain syndrome (PFPS), commonly known as runner’s knee. Adolescents and young adults, particularly females, are more prone to PFPS due to various anatomical, hormonal, and biomechanical factors. Females tend to have wider pelvises and greater angles between the hip and knee joints, leading to increased stress on the patellofemoral joint during activities like running and jumping. Additionally, hormonal fluctuations, such as those associated with puberty, menstruation, and pregnancy, can affect ligament laxity and joint stability, contributing to PFPS risk. However, PFPS can affect individuals of all ages and genders, especially those who engage in high-impact activities or have underlying biomechanical issues. Identifying and addressing these demographic risk factors, along with appropriate management strategies, is essential for effectively preventing and managing PFPS.

  • Age: While runner’s knee can affect individuals of all ages, it is more common among adolescents and young adults, possibly due to growth-related changes in muscle strength and biomechanics.
  • Weight: Excess body weight can increase the load placed on the knee joint, making it more susceptible to stress and strain. Overweight individuals may be at higher risk for developing runner’s knee.
  • Athletic Ability: People with varying levels of athletic ability can develop runner’s knee. However, those who engage in high-impact activities like long-distance running or competitive sports may be at a greater risk.
  • Height: Height alone does not directly influence the likelihood of runner’s knee. However, taller individuals may have longer limbs, which can affect biomechanics and potentially increase the risk if they do not pay attention to proper form and strength training.
  • Strength and Muscle Imbalances: Weakness or imbalances in the quadriceps, hamstrings, and hip muscles (gluteals) can affect the alignment of the femur and contribute to runner’s knee. Strengthening these muscles through targeted exercises can help reduce the risk.
  • Genetic Predisposition: Some individuals may have a genetic predisposition to musculoskeletal conditions, including runner’s knee. This may involve factors like joint structure and collagen composition, which can impact joint stability.

Biomechanical Risk Factors:

Biomechanical risk factors play a significant role in the development of runner’s knee (patellofemoral pain syndrome, or PFPS) by influencing the alignment, stability, and function of the knee joint. Here are some key biomechanical risk factors associated with PFPS:

  1. Muscle Weakness or Imbalances: Weakness or imbalances in the muscles surrounding the knee, particularly the quadriceps, hamstrings, and hip abductors, can alter the biomechanics of the knee joint. For example, weak quadriceps may fail to adequately support the patella (kneecap), leading to improper tracking and increased stress on the patellofemoral joint.
  2. Poor Patellar Alignment: Abnormal patellar alignment, such as lateral patellar tilt or lateral patellar tracking, can contribute to PFPS. Factors like muscle imbalances, tightness in the soft tissues around the knee, or structural abnormalities may lead to malalignment of the patella within the femoral groove, resulting in excessive pressure and irritation on the joint surfaces.
  3. Excessive Foot Pronation: Overpronation, or excessive inward rolling of the foot during walking or running, can affect the alignment of the lower extremity and increase the risk of PFPS. Pronation abnormalities can alter the biomechanics of the knee joint, leading to increased stress on the patellofemoral joint and surrounding structures.
  4. Knee Valgus (Knock Knees): Knee valgus refers to the inward collapse or rotation of the knee towards the midline of the body. This biomechanical deviation can result from muscle weakness, ligament laxity, or structural factors. Knee valgus places excessive stress on the lateral aspect of the patellofemoral joint, potentially contributing to PFPS.
  5. Hip Weakness or Dysfunction: Weakness or dysfunction in the muscles around the hip, such as the gluteus medius and gluteus maximus, can impact lower limb alignment and stability. Hip weakness may lead to altered biomechanics during dynamic movements, increasing the risk of PFPS.
  6. Tightness in Soft Tissues: Tightness in the muscles, tendons, ligaments, or fascia around the knee joint can affect joint mobility and biomechanics. Restricted flexibility in these structures may alter movement patterns and increase stress on the patellofemoral joint, predisposing individuals to PFPS.
  7. Inadequate Footwear: Wearing shoes that do not provide adequate support, stability, or cushioning can contribute to biomechanical issues and increase the risk of PFPS. Improper footwear may alter foot mechanics, affect lower limb alignment, and exacerbate patellofemoral joint dysfunction during physical activities.

Addressing these biomechanical risk factors through targeted interventions, such as strengthening exercises, flexibility training, gait analysis, orthotic interventions, and footwear modifications, is crucial for preventing and managing PFPS. Physical therapists play a vital role in assessing and addressing these factors to optimize biomechanical alignment, improve joint function, and reduce the risk of runner’s knee.

Runners Knee Treatment: Physical Therapy

Physical therapy offers numerous benefits for individuals dealing with runner’s knee, also known as patellofemoral pain syndrome (PFPS). Here are some of the key advantages of physical therapy for managing runner’s knee:

  1. Pain Reduction: Physical therapists employ various techniques, such as manual therapy, modalities (e.g., ice or heat therapy), and therapeutic exercises, to alleviate pain associated with runner’s knee. By targeting the underlying causes of pain, physical therapy can provide significant relief.
  2. Improved Strength: Weakness in the muscles surrounding the knee, particularly the quadriceps, hamstrings, and hip abductors, can contribute to runner’s knee. Physical therapy includes specific exercises to strengthen these muscles, improving joint stability and reducing the risk of further injury.
  3. Enhanced Flexibility and Range of Motion: Tightness in the muscles and soft tissues around the knee can exacerbate runner’s knee symptoms. Physical therapists incorporate stretching and flexibility exercises to improve range of motion and promote proper biomechanics, reducing stress on the knee joint.
  4. Correction of Biomechanical Issues: Improper movement patterns or biomechanical abnormalities, such as excessive foot pronation or knee valgus, can contribute to runner’s knee. Physical therapists assess movement mechanics and implement corrective strategies through targeted exercises and gait analysis to address these issues.
  5. Education and Self-Management Strategies: Physical therapists educate patients about proper running mechanics, footwear selection, and training techniques to prevent future occurrences of runner’s knee. They also provide guidance on activity modification and self-management strategies to empower individuals to take control of their condition.
  6. Individualized Treatment Plans: Every individual with runner’s knee may have unique contributing factors and underlying issues. Physical therapists develop personalized treatment plans tailored to each patient’s specific needs, addressing their unique biomechanical, strength, and flexibility deficits.
  7. Functional Rehabilitation: Physical therapy focuses on restoring functional abilities, such as walking, running, jumping, and squatting, that may be impaired due to runner’s knee. Therapists utilize functional exercises and movement patterns to simulate real-life activities and facilitate a safe return to sport or recreational activities.
  8. Prevention of Recurrence: By addressing muscular imbalances, biomechanical issues, and training errors, physical therapy helps reduce the risk of future episodes of runner’s knee. Patients learn strategies to maintain proper form, prevent overuse injuries, and gradually progress their activity levels safely.
  9. Avoidance of Invasive Treatments: In many cases, physical therapy can effectively manage runner’s knee without the need for invasive interventions such as surgery or corticosteroid injections. By addressing the root cause of the condition and promoting natural healing mechanisms, physical therapy offers a conservative and non-invasive approach to treatment.

Overall, physical therapy plays a crucial role in the comprehensive management of runner’s knee by addressing pain, improving strength and flexibility, correcting biomechanical issues, and empowering individuals to take an active role in their recovery and injury prevention. If you’re experiencing symptoms of runner’s knee, consulting with a physical therapist can help you embark on a personalized treatment plan to address your needs and get you back on track to pain-free movement.

Understanding Runners Knee causes and symptoms is crucial for early detection and effective management. By addressing muscle imbalances, improving biomechanics, using appropriate footwear, and gradually increasing training intensity, individuals can reduce their risk of developing runner’s knee and continue enjoying an active lifestyle. If you experience persistent knee pain or suspect you have runner’s knee, consult a healthcare professional for a proper evaluation and personalized treatment plan.

You may also be interested in these articles:


Schedule a Visit

Skip to content