Understanding Patellofemoral Pain Syndrome and How to Overcome Runner's Knee

Runner's knee, medically known as patellofemoral pain syndrome (PFPS), affects about one in four runners, making it the most common injury in the sport. This condition causes pain around or behind the kneecap, especially during activities like running, squatting, climbing stairs, or sitting for long periods. If you are a runner struggling with knee pain, understanding PFPS and how to manage it can help you get back on track safely.

What Causes Patellofemoral Pain Syndrome?

PFPS results from increased stress on the patellofemoral joint, where the kneecap (patella) meets the thigh bone (femur). This stress leads to irritation and pain around the kneecap. Several factors contribute to this increased load:

• Weakness in hip muscles, especially the abductors and external rotators

• Poor running mechanics causing the knee to collapse inward (medial knee collapse)

• Excessive foot pronation (rolling inward)

• Overuse from repetitive running or sudden increases in training intensity

  
  

Weak hip muscles fail to control the position of the thigh and knee during running, which increases pressure on the patellofemoral joint. This explains why strengthening the hips is a key part of treatment.

How Physiotherapy Helps with PFPS

Physiotherapy is the primary treatment recommended by health guidelines and supported by research. A Cochrane review found that exercise therapy reduces pain and improves knee function in people with PFPS. Hip strengthening exercises show particularly strong benefits.

Key Physiotherapy Approaches

• Hip strengthening exercises: Target muscles like the gluteus medius to prevent the knee from collapsing inward.

• Patella taping: The McConnell taping technique can provide immediate pain relief and help patients start rehabilitation exercises sooner.

• Gait retraining: Adjusting running form, such as increasing step rate by 5-10%, reduces joint stress by up to 20%. Correcting pelvic drop on the opposite side also helps.

• Manual therapy: Techniques applied to the patellofemoral joint and soft tissues around the knee can ease pain and improve mobility.

  
  

These treatments work best when combined. For example, taping can reduce pain enough to allow more effective exercise sessions.

The Role of Running Biomechanics

Running mechanics play a crucial role in PFPS. A biomechanical assessment can identify faulty movement patterns that increase knee stress. Common issues include:

• Overstriding

• Excessive hip adduction (thigh moving inward)

• Contralateral pelvic drop (pelvis tilting down on the opposite side)

  
  

By addressing these, runners can reduce the load on their knees and lower the risk of ongoing pain.

Foot Orthoses and Their Use

Foot orthoses, or custom shoe inserts, can help runners with excessive pronation. Moderate evidence supports their use as an adjunct to exercise therapy. However, orthoses alone are not enough and should be part of a broader rehabilitation plan.

Practical Tips for Managing Runner's Knee

• Start hip strengthening exercises early: Focus on side-lying leg lifts, clamshells, and resisted hip abduction.

• Use patella taping if recommended: This can reduce pain during activity.

• Modify running technique: Work with a physiotherapist or running coach to increase cadence and correct pelvic alignment.

• Avoid sudden increases in running volume or intensity: Gradual progression helps prevent overload.

• Consider a biomechanical assessment: This identifies specific issues to target in rehab.

• Use foot orthoses if you have flat feet or overpronation: Consult a specialist for proper fitting.

  
  

When to Seek Professional Help

If knee pain persists despite rest and self-care, seeing a physiotherapist is essential. They can provide a tailored rehabilitation program and use techniques like taping and manual therapy to speed recovery.

For runners in South Kensington, Ali Momeni Pour at Physiome Kensington, Ethos Sports Centre, Imperial College London, offers expert assessment and physiotherapy for runner's knee.