Patellofemoral Pain (Runner’s Knee): Causes, Daily Triggers, and What the Evidence Supports
- Emma Glynn
- Nov 10
- 5 min read
By Emma Glynn - The Hip & Knee Physio
This article provides general information only. It is not personal medical advice
What Is Patellofemoral Pain?
Patellofemoral pain (PFP), sometimes called runner’s knee, refers to pain around or behind the kneecap. It’s often aggravated by activities that load the joint when the knee is bent, like going downstairs, squatting, running, or sitting with knees flexed for long periods.
While it can affect anyone, PFP is especially common in active adults, including women over 45, and often shows up gradually. It’s not caused by a single injury. Instead, it’s usually a result of the joint being asked to do more than it can currently tolerate, due to changes in training, joint mechanics, or tissue sensitivity.
Most people improve with the right mix of education, strength rehab, and activity adjustments over time [1].
Everyday Triggers (Stairs, Squats, Sitting, Hills) and Why They're A Problem
Patellofemoral pain is a mechanical overload problem - not a tear, fracture, or disease. The joint between your kneecap and femur gets stressed when load is applied in deep or repetitive knee flexion.
Common aggravators include:
Walking or running downhill
Going downstairs (especially fast or with long strides)
Deep or fast squats, especially with knees collapsing inwards
Prolonged sitting in cars, planes, or desks (sometimes called “movie-goer’s knee”)
Rapid training spikes or adding hill work too soon
These positions increase compressive load through the patellofemoral joint - especially when combined with muscle weakness or altered movement patterns like knees collapse in (valgus) [1,2].
Understanding these triggers doesn’t mean avoiding them forever. It means respecting your current tolerance and gradually rebuilding capacity with a plan.
What Helps...
Strong evidence supports conservative, non-surgical care as first-line treatment for PFP [1,2,3]. This includes:
✅ Education and Activity Modification
Helping people understand why their knee hurts and which daily movements are most provocative, improves pain and function in the short and long term [1].
Simple adjustments like:
Slowing down on stairs
Keeping knees aligned over toes when squatting
Breaking up long sitting periods can reduce symptoms without stopping activity altogether.
✅ Hip + Knee Strengthening
Combined hip and knee exercises outperform knee-only programs [3]. Strengthening the glutes, quads, and calves improves how force is distributed through the leg, reducing load on the kneecap.
While no single exercise works for everyone, the trend is clear: stronger hips and thighs = less patellofemoral pain [3].
✅ Movement Retraining
Strategies like:
Adjusting running cadence
Modifying step-down technique
Encouraging mid-foot strike or shorter stride have been shown to reduce joint stress and improve symptoms [1,4].
✅ Short-Term Adjuncts
Taping can help reduce pain short-term by improving patellar alignment or providing sensory feedback [5].
Soft knee sleeves may improve comfort or perceived stability in some people [6].
Foot orthoses may benefit selected people with excessive pronation but aren’t first-line for all [6].
Do You Need Imaging or Injections?
In most cases of patellofemoral pain, scans aren’t needed and often don’t change management.
If your symptoms are:
Gradual in onset
Localised around the kneecap
Related to movement or prolonged sitting then clinical assessment by a physio is typically enough.
Scans (MRI or X-ray) may be considered if:
Pain is worsening despite care
There’s suspicion of other pathology (e.g., fat pad irritation, tendon issues, chondral damage)
You're not responding as expected after several weeks of rehab
Injections are not routinely recommended for PFP. They may be considered for co-existing pathology, but should never replace active rehab [1].
When to Seek a Review
Most patellofemoral pain is self-limiting with the right care. But a review is warranted if you experience:
Night pain that’s worsening
Hot, red swelling with fever
Locking or true giving way after trauma
Numbness, tingling, or weakness in the leg
In these cases, your physiotherapist or GP may refer for imaging or surgical review.
If You’d Like a Personalised Plan
Most people with patellofemoral pain get better but the path isn’t one-size-fits-all. If your symptoms are impacting daily life or activity, a targeted assessment with a qualified physiotherapist can help.
If you're looking for a knee physiotherapist in Camberwell, we can help assess your movement, strength, and contributing factors.
You can book online or call the clinic to arrange a time on 9978 9833
👉 Take my Knee Quiz if you’re unsure whether your symptoms need attention.
FAQs
Do I need a scan?
Not usually. Clinical diagnosis is sufficient in most cases. Imaging may be used if your symptoms don’t follow a typical course [1].
How long does it last?
Many people improve significantly over 6–12 weeks with consistent rehab and load management [1,3].
Are deep squats always bad?
No. It depends on technique and tolerance. You may need to reduce depth or speed early on, then progress gradually [4].
Can taping or a brace help?
Yes - short-term. Taping can reduce pain and improve confidence. Sleeves may help some people. These are adjuncts, not primary treatments [5,6].
Can I keep running or cycling?
Often yes, with modifications. Reducing speed, distance, or gradient may help. A physiotherapist can guide you based on your movement patterns and goals [1,4].
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Disclaimer
The content provided on this website is for general information and educational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment.
While The Hip and Knee Physio strives to present accurate and up-to-date information, we do not guarantee results or outcomes based on the information provided. Any exercises, strategies, or recommendations featured on this site should not be considered a personalised treatment plan.
Always seek the advice of a qualified healthcare provider before starting any exercise program, particularly if you are experiencing pain, injury, or a pre-existing medical condition.
Use of this website does not create a physiotherapist–patient relationship. The Hip and Knee Physio accepts no responsibility for any injury or loss arising from reliance on or use of this information.
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References
Barton CJ, Lack S, Hemmings S, et al. Best Practice Guide to Conservative Management of Patellofemoral Pain. Br J Sports Med. 2015;49(14):844–852.
Crossley KM, van Middelkoop M, Callaghan MJ, et al. Patellofemoral pain consensus statement from the 4th International Patellofemoral Pain Research Retreat. Br J Sports Med. 2016;50(14):842–852.
van der Heijden RA, Lankhorst NE, van Linschoten R, et al. Exercise therapy for patellofemoral pain syndrome. Br J Sports Med. 2015;49(21):1450–1457.
Willy RW, Davis IS. The effect of a hip-strengthening program on mechanics during running and during a single-leg squat. J Orthop Sports Phys Ther. 2011;41(9):625–632.
Callaghan MJ, Selfe J. Patellar taping and bracing for the treatment of chronic knee pain: a systematic review. Arch Phys Med Rehabil. 2007;88(7):988–996.
Collins NJ, Crossley KM, et al. Foot orthoses in the management of patellofemoral pain: a systematic review and meta-analysis. Br J Sports Med. 2012;46(4):252–258.
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