Runner’s Knee, medically referred to as Patellofemoral Pain Syndrome (PFPS), is a common overuse injury in runners.

Various athletes are also susceptible to this condition, as well as people who spend long hours working at a desk.

Runner’s Knee (PFPS) is the most common of all knee injuries in runners. Symptoms can range from mild to severely painful. While most people can relieve the pain with rest, for others it isn’t as simple. It is characterised as pain circulating around or below the knee cap (patella).

This pain is most frequently located where the knee connects to the lower end of the thigh bone (femur).

Despite running being the main cause of the injury, any activity that adds repeated stress on the knee joint can cause the disorder.

Other activities that can apply this stress include:

Jumping
Walking
Skiing
Hiking
Cycling
Field Sports

IT Band Syndrome and Runner’s Knee

How do you differentiate the injuries?

If you Google the words “Runner’s Knee”, you’ll likely find a range of results that refer to both IT Band Syndrome (ITBS) and Patellofemoral Pain Syndrome (PFPS). If you’re still confused, I can confirm that Runner’s Knee only refers to PFPS.

Although these conditions share very similar symptoms, it is important to identify one from the other.

The treatment plan for IT Band Syndrome and Runner’s Knee is different. Getting it wrong could prolong your recovery and keep your fitness goals sidelined for longer than expected.

Let’s take a look at the key symptoms that help identify and differentiate these two injuries:

Iliotibial Band Syndrome (ITBS) — The pain is usually located on the lateral side of the knee. The IT band is a huge tendon-like structure on the side of the thigh and knee. Either the tendon itself can feel painful or irritated, running down the side of your leg from the hip to the knee, or the patella feels very unstable, like its about to “give way” with pain only located on the lateral side. Pain is usually onset by repeated flexion and extension at the knee joint.
Patellofemoral Pain Syndrome (PFPS) — In this instance, the pain is usually located on the front of the knee or around and under the kneecap. PFPS is more common than ITBS and even more so in non-runners. Pain located behind the knee is also a common sign of Runner’s Knee.

Other Symptoms Of Runner’s Knee

Popping or clicking sounds when standing up from a seated position or climbing stairs.
Pain when sitting for long periods of time (especially in a right angle position - 90 degrees).
Pain during weight bearing exercises such as squats and lunges.
Pain when increasing intensity in aerobic activity ex. running > sprinting.
Tender to touch knee cap when feeling painful onset.
Grinding or rubbing noises when straightening the leg from bent position and vice versa.
Pain when changing playing surface for physical activity.

What causes Runner's Knee?

Runner’s knee can be caused by several factors, including one or a combination of the following:

Training errors. These errors include training agonist muscles and neglecting antagonist muscles. In other words, self-caused imbalanced muscles. When performing a strength and conditioning program, you need to train opposite muscle groups so no biomechanical issues arise. For instance, if you train your quadriceps, you must train your hamstrings. Otherwise these muscles become frail and weak and cause an issue like patellofemoral pain syndrome. Also, a sudden increase in load or intensity in your program can overwhelm the knee joint and its supporting muscles. Lastly, inadequate rest time can also lead it to further injury on the joint.
Tight muscles. Tight muscles, especially in the hips and hamstrings, can cause complications with correct running form. This causes repetitive stress on the knee joint. This can typically lead to Runner’s Knee.
Overtraining. Training for long durations without taking any time to recover. Participating in physical activity without taking breaks can weaken the knee joint and cause injury due to overuse. This is even common in well conditioned athletes. Marathon runners who run for long spells in a single session can be susceptible to PFPS if not taking days off.
Footwear. Incorrect footwear affects how your foot impacts the ground. If the soles of your shoes offer no support or suspension while working out, then the impact from each step you take can apply stress on the knee and all its assisting mechanisms. Having flat or overpronated feet can also lead to complications when running. If this is the case, have a specialist recommend the right shoes or orthotics.
Weak thigh muscles. Weak thigh muscles can cause the patellofemoral joint to bear more load or weight during exercise. If this issue stays consistent, it can eventually develop runner’s knee.
Being overweight. Carrying excess weight adds to more pressure on the knees. The supporting muscles that manage the movements of the joint are also made to work harder and made weaker.
Hard Playing Surfaces. As mentioned, increasing the load or training volume suddenly can affect the knee joint. Playing on a harder surface without any gradual increase can do exactly that.
Inflexible Muscles. Poor flexibility in the supporting muscles causes stiffness and tightness. Tight muscles, particularly in the quadriceps, hamstrings, hips, and iliotibial band, cause the patella to become unstable and shift out of position.
Gender. Women tend to have wider hips and different knee alignment from men, making women more prone to Runner’s Knee.
Excessive Hill Walking. Participating in too much hiking counts as an overuse injury, adding receptive stress on the patellofemoral joint.

Treatment For Runner’s Knee

Step 1 is to stop all activity if you are experiencing knee pain.

Step 2 is to have it diagnosed by a physiotherapist are scanned from an MRI exam for further confirmation. There is an array of knee injuries with similar symptoms - IT Band Syndrome, Anterior Knee Syndrome, Chondromalacia Patella, Meniscal Cyst, etc. Even a specialist might suggest an x-ray for clarification.

For most people, runner's knee will heal by itself with rest, while avoiding activities that aggregate the joint and its assisting muscles. Getting better on its own with time. To help speed up the recovery, here is a list of things you can do:

Rest. There is many ways to rest your knee. Apart from working out, there are other forms of physical activity that can prolong recovery. Avoid activities that put strain and impact on the joint - including hiking, running, cycling, weight bearing exercises, or anything that involves constant flexion, extension or pivoting of the knee.
Icing. If you are dealing with knee pain from running, your first line of defence is ice it immediately. Use an ice pack or cold bag of peas to stop the swelling. Apply the bag for 20 minute periods 3-5 times a day. Do this daily until the pain subsides.
Ibuprofen. Your second call to stop the swelling would be to take Ibuprofen or other forms of painkillers. Make sure to consult your local doctor or pharmacist for more advice.
Bandage your knee. Use an elastic bandage that isn’t too tight but offers enough compression to stop the swelling. patellar straps, or sleeves to give it extra support.
Elevation Your Leg. Elevating your leg on a pillow or arm rest helps to take the weight off the injury. It also increases circulation and sends blood back efficiently to the affected area for healing.
Weight Loss. As mentioned before, carrying excess weight puts strain and pressure on the knee joints. Participate in a strength and cardio program to shed the extra pounds. To make this program effective, you’ll also need to have a healthy and balanced diet. If you are looking for guidance on how to start eating healthy, please refer to our guide to start eating well. Lastly, sleep quality is essential for losing weight. Make sure to always get to bed at a reasonable time.
Footwear. Make sure to have the right shoes for participating in running or have the right footwear for any sport specific activity. If you suffer from having arched or flat feet, have a specialist fit your needs with insoles or another alternative.
Collagen and Magensium. Studies have shown that collagen and magnesium can improve joint health and reduce swelling and pain. Get more advice from your local nutrition store on supplements or food products that are suitable.
Massage. Light massage on the affected area for 10-15 minutes daily can help to eliminate the build up of excess fluid in the affected area. Reducing the amount of this fluid allows blood flow to reach the injured location more effectively.
Stretch and Foam Roll. To make our muscles flexible and avoid injury, we need to stretch. Perform holding stretches on the quadriceps, hamstrings, glutes and calves for 15-30 seconds daily. Also you will need to foam roll your IT Band, TFL and Hips to reduce risk of injury.
Strength Training. Make sure to incorporate strength training exercises to develop all muscles from your core to the lower extremities of your body - Hips, Glutes, IT Band, Quadriceps, Hamstrings, Calves. Weight bearing exercises such as squats should be done with safe methods. Exercises that are not weight bearing, such as done on a mat, are key factor for recovery through exercise. Check out our options for personal training or book a consultation if interested in learning more.

Tips To Takeaway about Runner’s Knee

More than often Runner’s Knee will start as a dull pain on top of the knee cap, leading to secondary pain around and behind the knee if the condition persists.
The most common cause is running form, if not hereditary from a structural defect. If that’s the case, have a running specialist perform a gait analysis when experiencing the first signs of pain.
Check for sounds at the knee joint when walking up and down stairs, running up or down hills.
Make sure to adopt the RICE method immediately if seeing any signs of swelling. Follow this step by getting prescribed painkillers. Catching this condition early is the best road to recovery.
Please re-read the paragraph above about “IT Band Syndrome and Runner’s Knee” and check out our article about ITBS. Both conditions share similar symptoms and its important to closely identify which issue you are facing.