Runner’s knee – what is it and how can I avoid it?

May 12, 2025

Runner’s knee is an umbrella term used to describe a few common knee injuries, often related to overtraining, running mechanics, and muscle imbalances.

The most common conditions we see that affect the knee are ‘patellofemoral pain’ (PFPS), patella tendinopathy, and iliotibial band syndrome (ITBS).

Each condition would benefit from an assessment by a physiotherapist to be able to diagnose the problem, and understand what factors may be contributing to it.

Patellofemoral pain (PFPS):

PFPS refers to pain located around the knee cap (patella). There is usually nothing structurally affecting the patella, but things like muscle imbalances, anatomy and biomechanics can have an impact on the forces places on the patella and how well the patella moves with the knee joint. If muscle imbalance are at play, it is often due to a weakness in the quads and hip muscles, which help to support and control the knee. This can lead to a build up of pain due to increased demand on the patella. It is usually aggravated by going downhill or downstairs. Running mechanics and form can affect it, as more force and stress can go through the knee joint and patella if running with an overstride and striking the ground with your heel. This in addition to overtraining, or an increase in mileage or intensity too quickly, can exacerbate the problem.

Patella tendinopathy:

Another form of runner’s knee, Patella tendinopathy refers to pain on the patella tendon, which is an extension of the quadriceps muscle and helps with transferring load. It is particularly prevalent in jumping sports, however runners can also experience it due to the repetitive nature and impact involved. An increase in mileage is often a contributing factor, as the tendon becomes overloaded especially if this is done too quickly without appropriate programming or strength training. Muscle imbalances can also affect this problem, as a weakness in supporting muscles can affect the load the tendon has to cope with.

Iliotibial band syndrome (ITBS):

ITBS is a condition affecting the outer aspect of the knee, again usually due to an overload secondary to muscle imbalance and running technique. With this condition, it is often related to a tightness or over activity of the hip flexor muscles, and weaker gluteal/hip muscles in relation to this. This over activity and tightness in the hip flexors affects the ITB, which is a thick band of fascia inserting into the outer knee, and can cause inflammation and pain in this area. It can also be brought on and aggravated by overstriding when running and landing with a heavy heel strike, as this increases the forces going through the knee and how much stress is placed on these structures.

Key tips for preventing runner’s knee:

• Increase running milage and intensity gradually, only changing one thing at a time. Use a guided running programme to help with this
• Increase your running cadence (steps per minute) to around 170, which can help to reduce any overstriding, improve running form and efficiency
• Include at least 2 strength training sessions into your training programme. This should include some functional movements such as squats, deadlifts, lunges, as well as single leg strength and control exercises such as single leg deadlifts, single leg balance, and plyometric exercises (jumping/hopping)
• Include mobility exercises such as hip stretches at least 2 times per week, and after running
• Consider a gait analysis through Physiotherapy Matters for expert advice on your running technique

If you think you may have any of the above conditions, or if you would just like some advice on prevention, you may benefit from a physiotherapy assessment. Our physiotherapists can help you understand what is contributing to the pain and help devise a plan as to how to manage and improve it. Our physiotherapist Emma has a specialist interest in running related injuries and is also trained in gait analysis. For more information on this, contact reception to book in a free triage call with Emma to discuss your assessment and treatment options.

Visit the gait analysis page for more detail on this – https://www.physiotherapymatters.co.uk/private-clinics/services/running-gait-analysis/

Contact us on info@physiotherapymatters.co.uk, or call 0191 285 8701 for more information or if you would like to book an appointment.