Patellofemoral Pain Syndrome (Runner’s Knee)

Patellofemoral Pain Syndrome (PFPS) is a very common knee injury. It is often referred to as Runner’s Knee because of its prevalence among runners. It can however affect participants in any sport. The main characteristic of PFPS is pain across the front of the knee. This pain can affect athletes to the point where they can’t train and compete. Finding, and dealing with, the cause of the problem is key to tackling this frustrating injury.

I recently wrote an overview of the most common knee injuries. If you wish to read more generally about knee injuries then click here.


Read on to learn more about this injury. Learn how to deal with it and get back to doing what you love.

Female runner clutching knee with pain after running

A note on “Runner’s Knee” – This is a catch-all term that is used interchangeably to describe a number of different knee injuries. While it is most commonly applied to Patellofemoral Pain Syndrome, other knee complaints are often blanketed with the same term. Using a term like this can lead to confusion so I tend to avoid it. I will however point out the conditions that are often referred to as “Runner’s Knee”. Admittedly, it can be useful for people who have no interest in the technicalities of their injury – but that’s a whole other debate! Because PFPS is the most common injury referred to as Runner’s Knee, I will continue to use the term in this article.

Symptoms of PFPS

If you have any of these symptoms, you could be suffering from PFPS or Runner’s Knee:

          Pain felt around the front of the knee or around the edges of the kneecap.

          General, non-specific, dull pain around the area of the kneecap.

          Pain after sitting for long periods with the knee bent.

          Clicking or popping under the kneecap.

          Pain is increased when running up/downhill or climbing/descending stairs.

          Pain around the outside of the knee is more likely to be caused by IT Band Syndrome.


Runner's knee injury

What Causes the Pain of Runner's Knee?

PFPS is actually an umbrella term for a number of different causes of pain. The most common of these is an irritation of the joint surfaces between the patella (kneecap) and the femur (thigh-bone) – hence the word “Patellofemoral”.

As you walk, the patella slides back and forth in a groove. Sometimes the muscles pulling on the kneecap are slightly out of line. Alternatively the joint may be unstable due to poor biomechanics or a lack of movement skill (ie running technique).


If you are suffering from PFPS, an assessment from a qualified sports therapist can help to diagnose the most likely causes of your pain. 

For more information about preventing this injury before it happens, check out my article on Staying Injury Free.

Why Do We Get PFPS?

Runner’s Knee can have a number of underlying causes. It is an injury that usually arises from a combination of contributing causes rather than one specific cause. Like other issues at the knee, problems up and downstream of the knee are often to blame. Triggers for PFPS are largely the same as for other common knee injuries….

          Weak hip/glute muscles, quadriceps, lower back or core.

          Lack of control and co-ordination at the hip, knee and/or ankle.

          Sudden increases or changes in training.

          Lack of hip mobility and tightness in the hamstrings.

          Muscular tension in the hip, lower back or thigh.

Man running on road
People in rehab session with kettlebells

How Do We Treat PFPS?

Most PFPS injuries can be resolved in a matter of weeks with an appropriate rehab plan.

When a client comes to me with pain on the front of their knee,  we start with a full assessment. This helps to discover the various contributing factors. Of these factors, tackling the most clear deficiencies will be the most effective way of treating the injury.

A rehabilitation plan is then developed around the findings from this assessment and tailored to the individual. However aspects of all of the following are usually taken into account when forming the rehab plan…

–  An honest assessment of training routines. Usually volume will be lowered and cross-training will be advised for a period.

– Exercises to increase hip mobility – especially rotation which is commonly lacking in many athletes.

– Strength training for the glutes and hip muscles. Extra attention is paid to the quads. (To read more about the importance of the glutes and for advice on glute training, see my article The Vital Glutes)

– Sports massage to relieve muscular tension in the quads and around the knee and to reduce levels of pain.

– Assessment of running technique.

– Exercises to improve proprioception, agility and balance.

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