Conditions We Treat
Runner's Knee
At a glance
Runner's knee, known clinically as patellofemoral pain, is an ache around or behind the kneecap that flares with running, squatting, stairs and long periods of sitting. It is one of the most common causes of knee pain in active people, and despite the name it is not limited to runners. Exercise therapy and education form the core of treatment, with manual therapy and running changes added where they suit you, all built into a structured rehabilitation programme.
The first few kilometres feel fine. Somewhere around the fifth, a dull ache settles in around your kneecap, and by the time you walk down the stairs at home it has turned sharp. Sitting through a long meeting or a drive with your knee bent makes it throb, and you catch yourself straightening the leg under the desk to ease it.
Runner's knee is pain coming from the joint between the kneecap and the thigh bone, the patellofemoral joint, and the tissues around it. It usually builds gradually rather than starting with a single injury, and it is provoked by activities that load the front of the knee while it is bent: squatting, stairs, jumping, running and prolonged sitting (Willy et al., 2019). Despite the name, it is not only a runner's problem. A systematic review put the annual prevalence at 22.7% in the general population and 28.9% in adolescents, with women affected more often than men (Smith et al., 2018). We see it in teenagers, gym-goers, hikers and cyclists as well as runners.
There is rarely one cause. When we take a history there is often a recent change: a jump in weekly distance, a new hilly route, a block of hill repeats or a return to running after time off. We also look at strength in the thigh and hip, how the knee moves as you land and step down and how much load it carries day to day. Current best practice is to start by understanding these individual factors, your main symptoms and what you want to get back to, because that is what shapes the treatment plan (Neal et al., 2024).
That same 2024 best practice guide, built from 65 high-quality randomised trials involving 3,796 participants alongside interviews with patients and clinical experts, recommends exercise therapy underpinned by education as the primary treatment for patellofemoral pain (Neal et al., 2024). Knee-focused exercise, with or without hip-focused work, sits at the centre. Supporting treatments, including manual therapy, taping and running retraining, are then chosen to suit the person in front of us.
Hands-on care has a clear place in that plan. A 2024 meta-analysis of 10 randomised trials with 346 participants found that lumbopelvic manipulation significantly reduced pain in people with patellofemoral pain. The benefit was more pronounced when manipulation was combined with other physical therapies such as quadriceps strengthening, and no adverse events were reported (Lin et al., 2024). That matches how we use it: as part of a programme, not instead of one.
At our Sandton practice, treatment starts with a thorough assessment of the knee, hip, ankle and lower back, along with how you squat, step down and, if you run, how you run. From there we combine joint mobilisation and adjustments where appropriate, soft tissue work and a graded rehabilitation programme that builds strength in the quadriceps and hip. We also go through your training so you know how much running to keep and how to build it back. If you are training for a race, our page on sports chiropractic for athletes explains how we plan care around an event.
You do not need a referral to see us. Most runner's knee is diagnosed from your history and examination, and X-rays are generally kept for knee pain lasting more than six weeks or for injuries that meet specific criteria. Some knee pain does need a closer look. After an injury, severe pain, swelling, a knee that feels unstable or one that will not take your weight should be seen promptly, as should a swollen, red knee with a fever or loss of movement (Bunt et al., 2018). As primary contact practitioners, we can refer you directly for X-rays, ultrasound or to a specialist when the picture calls for it. For other common causes of knee pain, see our knee pain page.
In pain now? Same-day appointments available at our Sandton rooms.
Book OnlineCommon symptoms of runner's knee
- A dull ache around or behind the kneecap
- Pain going up or down stairs
- Pain when squatting or lunging
- Aching after sitting for a long time with the knee bent
- Pain that builds during a run and lingers afterwards
- Pain with jumping or landing
- Pain getting up from a low chair after sitting
- Gradual onset with no single injury you can point to
- Needing to straighten the leg to ease the ache
If the front of your knee aches with stairs, squats or runs, getting assessed early helps you start the right rehabilitation sooner, often while you are still training.
Located on Rivonia Road in Morningside, we treat patients from Sandton, Bryanston, Rivonia, Fourways and across Johannesburg.
Book an appointment at our Sandton practice and let us help you get back to running comfortably.
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Same-day appointments available at our Sandton rooms.
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Frequently Asked Questions
Yes. Runner's knee responds to a combination of exercise therapy, education and hands-on care. We assess the knee, hip, ankle and lower back, then combine joint mobilisation, soft tissue work and a graded strengthening programme. A 2024 meta-analysis found that lumbopelvic manipulation reduced pain in patellofemoral pain, particularly when it was combined with other treatments such as quadriceps strengthening.
A dull ache around or behind the kneecap that builds gradually rather than starting with one injury. It typically flares with squatting, going up and down stairs, jumping, running and sitting for long periods with the knee bent.
Not necessarily. In most cases we look to adjust your running rather than stop it completely, keeping the distance and terrain at a level your knee tolerates while strength builds. Your assessment helps decide how much running to keep and how quickly to build it back.
Exercise therapy is the main treatment. A 2024 best practice guide based on 65 high-quality randomised trials recommends knee-focused exercise, with or without hip-focused exercise, underpinned by education. In practice that means progressive strengthening of the quadriceps and hip muscles, chosen and progressed to suit how irritable your knee is.
Very common, and not just in runners. A systematic review found an annual prevalence of 22.7% in the general population and 28.9% in adolescents, and it is more common in women than men. We see it in teenagers, gym-goers, hikers and cyclists as well as runners.
Usually not. We diagnose runner's knee from your history and a hands-on examination, and guidance on knee pain evaluation reserves X-rays for pain lasting more than six weeks or for injuries that meet specific criteria. If something does not fit the pattern, for example swelling or instability after an injury, we can refer you directly for an X-ray, ultrasound or specialist opinion.
References
- Willy RW, Hoglund LT, Barton CJ, et al. Patellofemoral pain. Journal of Orthopaedic and Sports Physical Therapy. 2019;49(9):CPG1-CPG95.
- Smith BE, Selfe J, Thacker D, et al. Incidence and prevalence of patellofemoral pain: a systematic review and meta-analysis. PLoS One. 2018;13(1):e0190892.
- Neal BS, Lack SD, Bartholomew C, Morrissey D. Best practice guide for patellofemoral pain based on synthesis of a systematic review, the patient voice and expert clinical reasoning. British Journal of Sports Medicine. 2024;58(24):1486-1495.
- Lin LH, Lin TY, Chang KV, Wu WT, Özçakar L. The effect of lumbopelvic manipulation for pain reduction in patellofemoral pain syndrome: a systematic review and meta-analysis of randomized controlled trials. Life (Basel). 2024;14(7):831.
- Bunt CW, Jonas CE, Chang JG. Knee pain in adults and adolescents: the initial evaluation. American Family Physician. 2018;98(9):576-585.