Why Does My Knee Hurt When I Run? Understanding Runner's Knee

By Maria Josefina Cánepa Bustos

MSc Senior Musculoskeletal Physiotherapist · physiotherapist

AHPRA registered · PHY0002918524

Paediatric Musculoskeletal Sports Rehabilitation · Overuse Sport Injuries Rehabilitation · Dry needling · Therapeutic exercise

Maria Josefina Cánepa Bustos is a Senior Musculoskeletal Physiotherapist with a focus on sports and paediatric musculoskeletal rehabilitation, with eight years of clinical experience across private practice, sports clubs, and academic settings. Holds a Master of Science in Advanced Professional Practice in Paediatric Musculoskeletal Health, alongside postgraduate qualifications in therapeutic exercise and university teaching, with a focus on young athletes, injury prevention, and performance-based rehabilitation in sport settings.

Last reviewed: 10 November 2026

Runner's knee, usually called patellofemoral pain, is pain around or behind the kneecap that commonly worsens with running, stairs, squatting or prolonged sitting. It is managed primarily with an individualised exercise program addressing knee and hip strength, movement capacity and training load.

Key Takeaways

• Pain behind or around the kneecap that worsens with running, stairs or sitting is typical of patellofemoral pain

• Exercise targeting the hip and knee muscles is the main treatment

• Complete rest is usually unnecessary; activity modification helps you stay active while symptoms settle

• Scans are not routinely needed for typical presentations

What patellofemoral pain is and how it feels

Patellofemoral pain is discomfort arising from the area where the kneecap moves against the thigh bone. You might describe an ache behind or around the kneecap, sometimes with clicking or creaking. The pain often builds during a run, worsens going downstairs or downhill, flares after squatting or lunging, and can be sharp after sitting with your knee bent for a long time.

In my practice, I see amateur runners, active women and adolescents who have usually lived with this discomfort for months before it stops them doing what they want. Often they have been modifying how they run, avoiding hills or cutting sessions short, but they come in when the pain starts to prevent them from training or playing sport altogether.

The diagnosis is clinical, meaning a physiotherapist considers your pain pattern, what makes it worse, your strength and movement, your training history and how the knee is affecting your daily life. A typical patellofemoral pain presentation does not require a scan to confirm it.

Why it develops and what drives it

Symptoms often occur when your knee is exposed to more load than it can currently tolerate. This may follow a sudden increase in running distance, speed, hills, the number of sessions per week, sport participation or gym training. Reduced capacity in the thigh, hip and trunk muscles, changes in how you run or move, limited recovery and previous knee pain may all contribute.

One of the most common things I hear is, "Why did this happen? I haven't done anything different." Overuse injuries are usually the result of several factors building up over time, such as training load, recovery, strength gaps, movement patterns, or even stress and sleep. My job is to identify which factors are contributing in your case and help you address them so you can recover and reduce the risk of it happening again.

A common pattern I see is that people do not combine their running or sport with regular strength training, and the muscles around the knee, hip and trunk are not prepared for the demands being placed on them.

Imaging is not routinely required when the presentation is typical. If your symptoms follow a major injury, the knee locks or gives way, there is substantial swelling, fever, inability to bear weight or night pain, seek assessment promptly.

How the whole lower body matters, not just the knee

Patellofemoral pain is related to muscle imbalance and movement patterns that increase the stress between the kneecap and the thigh bone. It is not only about the knee, but about the entire lower body and trunk: it can be affected by lower back, hip, knee, ankle and foot mechanics and strength.

As part of my assessment, I always do a thorough evaluation of the hip, lower back, knee, ankle and foot. A common question I get is, "Why are you assessing and treating my hip or my ankle when I only have pain in my knee?" The answer is that the way your hip controls your leg, or the way your ankle and foot absorb load, directly influences how your kneecap tracks and how much stress it experiences. If you want to stay active and continue doing your activity, you need to address the root cause of the issue, not just treat the stiffness or pain in the knee.

What treatment depends on and how we approach it

Management is tailored to you. Exercise targeting both the hip and knee is the main treatment, with gradual progression towards running and sport. Temporary modification of aggravating activities can help, but complete inactivity is usually unnecessary.

The 2019 clinical practice guideline from the Academy of Orthopaedic Physical Therapy recommends combined hip and knee targeted exercise as the primary intervention, with education and load management, while selected taping, orthoses and manual therapy may be used as adjuncts. Hip targeted exercise should focus on the muscles at the back and side of the hip, and may be prioritised early. Knee targeted exercise may use weight bearing exercises, such as resisted squats done slowly and with control, or non weight bearing exercises, such as resisted knee straightening.

In my practice, I combine movement assessment, hands on treatment and an individualised exercise program. From the moment you come into the room, I start assessing your body mechanics: how you move, whether you are compensating, and how you are using the affected limb. I also pay attention to your body language, listening to what you say and what you do not say, the discomfort in certain positions, or the postures you adopt to avoid pain.

My approach is always movement first. Symptoms are informative, but not the main problem. From the movement assessment, I get a sense of your control and quality of movement, which helps me narrow down what may be driving those patterns. Once I have a clearer understanding, I combine hands on treatment, such as soft tissue release, joint mobilisation, dry needling and taping, with active rehabilitation. The goal is to reduce your symptoms efficiently during the session so your body can move more freely, and then to give you a specific, tailored exercise program to build the strength and control you need for the long term.

What the research shows

A 2015 Cochrane review found that exercise improves pain and function in people with patellofemoral pain. A 2012 systematic review published in Sports Health reported that exercise was associated with reductions in pain and improvements in function. A 2022 systematic review found that at three months, several interventions are supported, including knee targeted exercise, combined interventions, foot orthoses for global improvement and lower body manual therapy for function.

The table below, drawn from the 2019 clinical practice guideline, summarises the main recommendations:

What the research shows

Combined hip and knee targeted exercise: Recommended to reduce pain and improve outcomes and function in the short, medium and long term

Hip targeted exercise: Should target the muscles at the back and side of the hip and may be prioritised early

Knee targeted exercise: May use weight bearing exercises, such as resisted squats, or non weight bearing exercises, such as resisted knee straightening

Foot orthoses: May be useful for selected patients, particularly as part of combined care

Manual therapy: Should not generally be used as the sole treatment; it may complement exercise

What you can do while waiting for an appointment

Reduce, rather than completely stop, the activities that clearly aggravate your symptoms. Temporarily shorten your runs, reduce hills or avoid repeated deep squats, then rebuild gradually as pain settles. Begin a strengthening program for the thigh, hip and trunk muscles; these help your knee tolerate running, stairs and sport.

Track your pain during and after activity. I use a traffic light system for pain with my patients: pain between 0 and 3 out of 10 is the green zone, mild discomfort that does not prevent you from continuing. Pain between 3 and 5 out of 10 is the yellow zone; you can continue with caution, but you need to pay attention to how long it takes to settle and whether it worsens after activity. If it lingers or gets worse, the load needs to be reduced. Pain above 5 or 6 out of 10 is the red zone, where your body is signalling that it is not tolerating the load at that time and you should stop.

Avoid relying on passive treatments alone. Taping, manual therapy or orthoses may help symptoms, but exercise and progressive return to activity remain central.

"In most cases, with the right exercise programme and modification of activity, you should be able to continue being active without aggravating your symptoms," says Maria Josefina Canepa Bustos, Senior Musculoskeletal Physiotherapist.

Seek assessment if symptoms follow a major injury, the knee locks or gives way, there is substantial swelling, fever, inability to bear weight, night pain or no meaningful improvement after several weeks of sensible self management.

Common Questions

Is runner's knee the same as patellofemoral pain syndrome?

Yes. Runner's knee is the everyday name for patellofemoral pain syndrome, which is pain around or behind the kneecap. The terms describe the same condition, and you do not need to be a runner to have it; it affects anyone whose knee is exposed to more load than it can currently tolerate.

Do I need an MRI or X ray?

Usually not. A physiotherapist can diagnose patellofemoral pain from your history, symptoms and movement assessment. Scans are reserved for cases where the presentation is unclear or there is concern about another structure such as a ligament, meniscus or bone. A typical patellofemoral pain presentation does not require imaging to confirm it or to guide treatment.

How do I manage my training load?

Complete rest is usually unnecessary. The key is load management: reducing intensity, frequency or duration so your knee can tolerate the activity without aggravating symptoms. In my practice, I help you adjust your training while maintaining appropriate activity, and we focus on strengthening so that when you do progress, your body is able to tolerate that load safely.

Why does it hurt going downstairs or after sitting?

Patellofemoral pain often worsens with activities that increase the contact force between the kneecap and the thigh bone. Going downstairs loads the knee in a bent position, and sitting with the knee bent for a long time compresses the joint. Both can provoke the ache or sharp pain typical of this condition. Strengthening the muscles that control the knee and hip usually helps reduce these symptoms over time.

Book an assessment at Physio K

If knee pain is affecting your running, sport or daily activities, book an appointment online for a thorough assessment and an individualised treatment plan.

Reviewed by Kenny Merlevede. Kenny Merlevede is a Senior Physiotherapist with 18 years of experience in private practice, with a focus on complex cervical presentations and persistent musculoskeletal conditions. Registered with the Australian Health Practitioner Regulation Agency (PHY0002060505)

This article is for general information only and is not a substitute for personal medical advice. If you have concerns about your health, please consult a qualified clinician or your GP.