Runners knee


Anterior knee pain? Patella femoral pain? Runners knee? What is going on with my knee?

Looking at your knee from a front on view you have the femur on top and the tibia below creating the knee joint. There is a groove in the front of the femur called the trochlear groove, this is where the patella sits. The patella floats there attached by the quadriceps tendon and the patella ligament. When the knee bends and straightens (when you are walking), the patella glides up and down the groove.

Unity Studios Blog Runners Knee Diagram
Anterior view of the right knee
Fun fact—babies are born without patella’s. Their knee caps are made of soft cartilage and don’t show up on x-ray until the age of 3-5 years.
So what is runners knee?

The pain in runner’s knee can present quite similar, but often their can be different causes from person to person.

Symptoms of Runners knee include a vague ache, or discomfort at the front of the knee. ‘Crepitus’ (a clicking or grinding sensation that can be heard on certain movements). Pain while running tends to be worse during the start of the run, eases as you get going but then can return with increasing distance. Walking downstairs, and hills are often worse, as well as sitting for prolonged periods with a bent knee.


There can be many causes for runner’s knee so that’s why it’s important to be assessed by your physiotherapist. Causes include over load, poor form, poor muscle coordination, tightness, and irregular training.

Over load or irregular training load is a common cause of runner’s knee pain. Running takes time and consistency to build up running endurance, but runners being runners, most just want to run. Doing too much too quick and/or not giving your muscles gradual time to build up strength for running can lead to load and irritation through the knee.

It is important to have good strength and muscle coordination to power you forward and guide your knees in the correct direction. Poor strength in lateral hip muscles, decrease single leg control, and poor calf strength are all common problems for anterior knee loading. It’s essential that if you enjoy running, you must incorporate some strength and stability training into your exercise regime.

Due to fatigue and overload tightness in the quadriceps, iliotibial band (ITB), and hamstrings can contribute to making knee symptoms worse. The increase pressure from stiffness around the joint can be associated with the achy feeling in the knee. Having a regular stretching routine helps reduce some of that tightness.

So how can your physiotherapist help?

Physiotherapists can assess your strength, review your running technique and guide you with a rehabilitation program and a gradual return to running plan. Having a review and working on muscle and running imbalances can reduce the risk of repeated running injuries in the future. The quicker you have your knee assessed, the quicker you can return back to running, only stronger and better for it!

Book in with one of our Physiotherapists —

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