Runner’s Knee or Patellofemoral pain syndrome (PFPS) is characterized by a dull pain that is “behind” or “around” the top of the kneecap. It is the most common of all running ailments, accounting for 16.5% of injuries according to one recent study.

You will likely have pain when resisting leg extension, and possibly tenderness if you push against the kneecap itself – aggravating movements include squatting, running (especially downhill), descending stairs and prolonged sitting.

Research on PFPS focused on factors that affected the motion of the kneecap, particularly how the quadriceps control how the patella “tracks” in the femoral groove.

It has shown that people with poor quadriceps and calf flexibility, poor vertical jumping ability (which is highly dependent on your quads), and weak quadriceps are all risk factors for PFPS.

Recent research has shown that hip mechanics also contributes to runners’ knee injuries. Although the kneecap “tracks” towards the outside of your leg during squatting and running motions, it’s actually the femur rotating underneath the kneecap.

This explains why many runners (particularly women) with patellofemoral pain syndrome have weak hip abductors and external rotators. This seems to contribute to altered biomechanics when they run. Because of their muscular weaknesses, their knee “collapses” towards the center of their body when they run.

Research has shown very good results from hip strengthening exercises and techniques. Specifically, the literature demonstrates that a successful program should definitely incorporate hip abductor, external rotator, and quadriceps strength.

Many programs that have produced good results also include hip flexor/extensor strength, closed-chain “functional” exercises like squats, and balance training.

For most runners, a dedicated strength training program will be what ultimately provides relief from patellofemoral pain.

An experienced physical therapist like Institute of Sport Physio can prescribe a treatment plan for you and advise you how long it will take you to return to running. It is better to let it heal. You may only need a few days off if you catch it early, but if you’ve been running on PFPS for a while, you may need a lot longer.

The treatment plan from Institute of Sport Physio includes:

1. Spinal assessment to correct any spinal dysfunction
2. Exercises to strengthen hip and quadriceps, esp. vastus medialis:
• Abductors—lying side leg lift or band abduction
• External rotators—lying “clam” or band external rotation
• Quadriceps—straight leg lift
A good starting place is 15 of each, once per day. As your strength improves, you can move to two or even three sets of 15 each. All exercises must be done SLOWLY!
3. Stretching exercises for the vastus lateralis
4. General lower leg strengthening and balance
• Balance, possibly on unstable surface (foam pad, bosu ball)—start with
30sec or 1min
• Mini-squats on a step, starting around 15 repeats and working to two or
three sets
• Glute bridge—start with 10-12 10-second holds, build toward 2min
5. Patellar taping, either with traditional athletic tape or flexible
kinesiology tape
6. Electrotherapy and acupuncture for the knee pain
7. X-Ray the knee if long term.

Call Institute of Sport Physio now for an assessment if you have Runner’s Knee symptoms.