Knee Pain When Running: Why It Happens and How to Fix It Properly

If you’re a runner and feel pain around or behind your kneecap - especially during or after runs, stairs, squats, or downhill walking, you may have what’s commonly known as runner’s knee.
Clinically, this is called patellofemoral pain syndrome (PFPS). It’s one of the most common running-related injuries and affects runners of all levels - from beginners to seasoned marathoners.
The good news?
Runner’s knee is very treatable, and in most cases, you don’t need to stop running long-term - you just need the right strategy!

What is Runner’s Knee (Patellofemoral Pain)?

Runner’s knee refers to pain originating from the patellofemoral joint, the joint under where the kneecap (patella) sits.
Importantly, runner’s knee:

• is not usually caused by structural damage to the knee
• doesn’t mean your knee is “worn out”
• often develops gradually rather than from one single injury

Research shows patellofemoral pain is best understood as a load management and movement control issue. 

Common Symptoms of Runner’s Knee
​Runner’s knee pain is typically:

• Felt around or behind the kneecap
• Worse during or after running
• Triggered by stairs, hills, squatting, lunging, or sitting for long periods with the knee bent
• Can feel achy, sharp, or tight
  
• Some runners describe it as a “pressure” or “burning” sensation rather than sharp injury pain.

Why Does Runner’s Knee Happen?

Runner’s knee rarely has one single cause. Instead, it usually develops when the knee is exposed to more load than it can tolerate, often combined with poor control through the hip, knee, or ankle.

Common contributing factors include:

• Sudden changes in training
  Increasing distance, speed, hills, or intensity too quickly
• Poor load tolerance
  The knee simply isn’t strong enough yet for the demands placed on it
• Quadricep and gluteal weakness
  Reduced strength and control upon landing can increase stress at the kneecap
• Poor running mechanics
  Excessive knee collapse (valgus), over-striding, or inefficient cadence
• Reduced ankle or foot control
  This can change how force travels up the leg, poor footwear choices 
• Inadequate recovery
  Not enough rest between sessions or poor sleep and stress management

Why Rest Alone Doesn’t Fix Runner’s Knee
​A common mistake runners make is stopping all running until pain disappears, then attempting to return to training exactly the same way.
This often leads to:

• temporary relief
• loss of strength and fitness
• loss of running tolerance 
• repeated flare-ups once running resumes

Current evidence strongly supports active rehabilitation rather than prolonged rest.

​How Physiotherapy Helps Runner’s Knee 

At House of Physiotherapy in Petersham, runner’s knee rehab isn’t about generic exercises or advice like "just don't run anymore”.
​
Your assessment focuses on:

• how your hips, knees, ankles, and feet work together
• your running load and training structure
• strength, control, and timing combined
• identifying why the knee is being overloaded

Treatment typically includes:

• targeted strength training (especially hips, quads, calves depending what you need)
• control and stability work including single leg exercises and landing dynamics 
• gradual, structured return-to-run planning
• gait and technique guidance when needed
• education so you understand what your knee needs

​
The goal isn’t just pain relief - it’s resilient knees that tolerate running long-term.

Should You Keep Running With Runner’s Knee?
In many cases, yes - with modifications.
Pain-guided running, adjusted volume, and smarter loading are often part of recovery alongside strength training/rehab. Complete rest is rarely necessary unless pain is severe or worsening and in that case it may need a short period of de-loading first.

We can help you:

• reduce aggravating factors
• relieve symptoms 
• maintain fitness 
• restructure your running program
• rebuild tolerance safely
• avoid the stop-start injury cycle
• avoid it happening again in the future 

When to Seek Help
​You should book an assessment if:

• knee pain lasts longer than 1–2 weeks
• pain keeps returning every time you run or is worsening 
• stairs, walking or daily activities are painful
• you’re unsure how to modify training or progress safely and you're feeling stuck

Early intervention leads to faster recovery and fewer flare-ups.

House of Physiotherapy offers:

• 1:1 tailored sessions
• evidence-based rehab
• runner-specific strength and load planning
• running programs and structured plans
• clear explanations 

👉 Book your assessment today and get back to running with confidence.

Book here