Runner’s Knee (Patellofemoral Pain): who to see and what helps

Runner’s Knee (Patellofemoral Pain) · Kitchener, Waterloo & Cambridge

Runner’s knee, properly called patellofemoral pain, is pain around or behind the kneecap that comes on with squatting, stairs, running or sitting for a long time with the knees bent. The treatment with the evidence behind it is exercise for the hip and thigh muscles, with taping or shoe inserts as short-term extras. See a physiotherapist or a chiropractor first: both assess the knee and begin treatment at the first visit.

What runner’s knee is

Patellofemoral pain is pain around or behind the kneecap, made worse by activities that load the joint between the kneecap and the thigh bone while the knee is bent. Despite the name, it is not limited to runners: it is common in physically active people generally, and the highest rates are reported in adolescents.

It is an overuse problem. A torn ligament, and a meniscus tear in a younger person, usually start with an injury: a popping sound, then a knee that is unstable, gives way or cannot be straightened.

Symptoms of runner’s knee

• Pain around or behind the kneecap
• Pain when squatting or jumping
• Pain on stairs, especially going down
• Pain after sitting for a long time with the knees bent
• A catching, popping or grinding feeling when the knee moves
• Occasionally, the knee suddenly giving way

The sitting symptom catches people out, because nothing athletic is happening: a two-hour lecture at one of the universities or a long stretch at a desk can bring it on as surely as a run along the Iron Horse Trail.

What causes runner’s knee

• Doing more than the knee has adapted to. Overuse is a key proposed cause: the amount or frequency of activity going up faster than the tissues recover.
• Weaker thigh muscles. Lower strength in the muscles that straighten the knee predicts who develops it.
• Hip weakness, possibly. It is common in people with runner’s knee, but it may be a result of the pain more than a cause.
• Not the usual suspects. Knee alignment, height, body mass index and foot posture have inconsistent or no value in predicting who gets it.

How runner’s knee is diagnosed

From your history and an examination. The most strongly supported test is simple: a squat, or another task that loads the bent knee such as climbing stairs, that reproduces the pain. The rest of the examination is there to exclude other causes of pain at the front of the knee. If exercise has made no difference after 12 weeks, the diagnosis should be looked at again.

When knee pain is not runner’s knee

Runner’s knee is not an emergency. Get medical care the same day, from a physician, a nurse practitioner, an urgent care clinic or an emergency department, if the knee is badly swollen or has changed shape, you cannot move it or put any weight on it, it is very painful, it locks, gives way or clicks painfully, or you have a high temperature or feel hot, cold or shivery with redness or heat around the knee, which can mean an infection. Painless clicking is normal.

What the evidence says about treating runner’s knee

• What this draws on. A physiotherapy guideline, an international consensus statement and a Dutch guideline, under Sources. “Should” and “should not” are firm positions, and “may” is a weaker one.
• Exercise is the treatment. It should cover both the hip and the knee: the muscles at the back and side of the hip, and resisted squats or knee straightening for the thigh. Hip exercises may be favoured early on. At least 6 to 12 weeks is advised.
• Tape and shoe inserts are short-term extras. Taping the kneecap may be used with exercise for pain relief in the first four weeks or so. Off-the-shelf shoe inserts should be prescribed for people whose feet roll in more than normal, for up to six weeks and together with exercise. There is not enough evidence to recommend custom orthotics over off-the-shelf ones.
• Knee braces: the guidelines differ. The physiotherapy guideline says braces, sleeves and straps should not be prescribed. The Dutch guideline says a brace, tape or inserts should be considered when exercise has made no real difference after 6 to 12 weeks, with the person told that the evidence is lacking.
• Hands-on treatment, but not alone. Mobilization or manipulation of the kneecap, knee or lower back should not be used in isolation. Kneecap mobilization and leg stretching can be combined with exercise.
• Needles. Dry needling should not be used. Acupuncture may be used to reduce pain, with caution, because it is not known whether it works better than sham treatment.
• Machines. Ultrasound, electrical stimulation, laser and similar treatments should not be used, and shockwave is not among the treatments either guideline recommends.
• Runners can change how they run. Gait retraining over several sessions may be used: landing more on the forefoot for heel strikers, taking quicker steps, or reducing how far the thigh moves inward.

What a doctor may offer

Less than for most knee problems. The Dutch guideline says runner’s knee should not be treated with injections, urges caution with pain medication (acetaminophen first, then an anti-inflammatory gel, and only short term for severe pain), and recommends against arthroscopy. Open surgery is considered only after at least six months of non-surgical treatment, and only when imaging confirms an anatomical cause.

How each CARESPACE service treats runner’s knee

Physiotherapy

The assessment uses a squat, a step-down or a single-leg squat, then looks at hip and thigh strength, how the kneecap moves and how the foot sits. From that a physiotherapist can build the hip and thigh strengthening program, can tape the kneecap for pain relief in the early weeks, and can help you find what in your week has ramped up too fast.

See our physiotherapy team →

Chiropractic

A chiropractor can assess the knee, hip and foot and can set the same exercise program. The hands-on part is where the evidence draws a line: manipulation or mobilization should not be the whole treatment, though kneecap mobilization can be added to exercise.

See our chiropractic team →

Kinesiology

The strengthening runs over weeks and months, not a few visits. A kinesiologist can progress the hip and thigh program and can help plan a gradual return to full running or sport.

See our kinesiology team →

Acupuncture

Acupuncture may be used to reduce pain, but it is not known whether it works better than sham acupuncture for runner’s knee. If you want to try it, use it as an add-on to exercise.

See our acupuncture practitioners →

Other services people ask about

The evidence for massage therapy is thin: the consensus panel rated soft-tissue techniques as uncertain.

Where most people start

With a physiotherapist or a chiropractor. Whichever you choose, expect the plan to centre on hip and thigh exercise.

How your team works together

The plan is one exercise program, whoever sets it. Kinesiology can be added when the goal is a race or a season. Acupuncture is an optional extra and does not replace the exercises.

Browse by service: physiotherapists, chiropractors, kinesiologists and acupuncture practitioners.

What to expect at your first visit

1. The pattern. Where exactly it hurts, what brings it on (stairs, squatting, sitting, running) and what has changed lately in your training or routine.
2. The tests. A squat and similar movements to bring on the pain, then hip and thigh strength, kneecap movement and foot posture.
3. Whether it fits. Runner’s knee is confirmed partly by excluding other causes, so the examination also looks for signs that point elsewhere.
4. Your first exercises, and a plan to take home.

What you can do at home

• Work out which activities bring the pain on and scale them back, but stay active: modify, do not stop.
• Build up gradually. Increase how much and how often you train slowly enough for the knee to recover.
• Strengthen the hip and thigh muscles, and stretch the ones that are tight.
• Pain relief can help you keep moving. Ask a pharmacist what suits you.
• You do not need to be free of symptoms before you go back to work.

If the knee has not improved within six weeks, or is getting worse, have it assessed.

How long runner’s knee lasts

Often longer than people expect. It does not reliably clear up by itself: in one follow-up of trial participants, 57% reported an unfavourable outcome five to eight years later. Even so, exercise therapy is recommended to reduce pain in the short, medium and long term. People who have had symptoms for longer, or who start with more pain and poorer function, tend to do less well.

Runner’s knee treatment in Kitchener, Waterloo and Cambridge

Kitchener. Physiotherapy in Kitchener, Chiropractic in Kitchener, Kinesiology in Kitchener and Acupuncture in Kitchener. Locations: Victoria North, Fischer-Hallman, Westmount East and Deer Ridge.

Waterloo. Physiotherapy in Waterloo, Chiropractic in Waterloo, Kinesiology in Waterloo and Acupuncture in Waterloo. Locations: Weber North, Uptown Waterloo and Waterloo GoodLife.

Cambridge. Physiotherapy in Cambridge and Acupuncture in Cambridge. Location: Hespeler Road.

The city pages linked above show the locations and practitioners for each service, with their next availability.

Common questions

Can I keep running with runner’s knee?

Usually some, yes. The advice is to modify the activities that aggravate the knee and stay active, not to stop everything. There is no exact rule for how much pain is acceptable on a run, so how far to cut back is worked out at your assessment.

How long does runner’s knee take to get better?

Plan on at least 6 to 12 weeks of regular exercise, with progress checked at 6 and 12 weeks.

Is runner’s knee the same as jumper’s knee?

No. Runner’s knee is pain around or behind the kneecap, set off by stairs, squatting and sitting. Jumper’s knee is pain at the lower tip of the kneecap, in the tendon, set off by high loads such as jumping and sprinting. The exercise programs are different, so it matters which one you have. See Jumper’s Knee (Patellar Tendinopathy).

Will runner’s knee give me arthritis?

That is not known. A link between the two has been proposed, but there is insufficient evidence that runner’s knee causes arthritis later.

Where can I get runner’s knee treated in Waterloo?

At CARESPACE locations in Waterloo, where Physiotherapy, Chiropractic, Kinesiology and Acupuncture are all offered. Each practitioner’s profile shows which location they work at.

Do I need a referral?

No. Book online or call 519-208-2273. You pay at each visit and receive a receipt for your extended health plan. More on fees and insurance →

Sources

• Willy RW, Hoglund LT, Barton CJ, et al. Patellofemoral Pain: Clinical Practice Guidelines (Academy of Orthopaedic Physical Therapy). Journal of Orthopaedic & Sports Physical Therapy, 2019. Summary of recommendations. Due to be considered for review in 2024.
• Collins NJ, Barton CJ, van Middelkoop M, et al. 2018 Consensus statement on exercise therapy and physical interventions (orthoses, taping and manual therapy) to treat patellofemoral pain. British Journal of Sports Medicine, 2018.
• Ophey M, Koëter S, van Ooijen L, et al. Dutch multidisciplinary guideline on anterior knee pain: Patellofemoral pain and patellar tendinopathy. Knee Surgery, Sports Traumatology, Arthroscopy, 2025 (published online 2024). Full text.
• NHS inform. Patellofemoral pain syndrome. Updated 2023.
• HealthLink BC. Patellofemoral pain syndrome. Current as of 2022.
• NHS. Knee pain. Reviewed 2023.

Related conditions

Jumper’s Knee (Patellar Tendinopathy)

Meniscus Tears

Ready to book?

Book online with a physiotherapist or chiropractor, or call 519-208-2273 and our Central Reception Team will match you with the right person and the closest location.

Online booking