Runner's Knee (Patellofemoral Pain)

What it is

Patellofemoral pain is pain around or behind the kneecap that's aggravated by activities loading the knee while bent — squatting, stairs (especially down), prolonged sitting, and running, particularly downhill¹. It usually comes on gradually rather than from a single injury, and it's typically an overuse/load problem rather than structural damage.

Why runners get it

It's generally a mismatch between load and what the knee is currently prepared for — a jump in mileage, hills, or speed; or contributing factors like hip and quad weakness and movement patterns that change how the kneecap tracks. There's no single cause, and importantly, knee pain in runners is rarely "wear and tear" — patellofemoral pain is not the same as arthritis¹.

How it's generally managed

Most cases improve with conservative care, and the best-supported cornerstone is exercise — particularly hip- and knee-focused strengthening — alongside load management¹. In broad terms that means:

• Reduce, don't necessarily stop: dial back the volume/hills/speed that provoke it; stay active within a comfortable range.
• Strengthen: hip and quad strengthening is the most evidence-backed element of rehab — best guided by a professional.
• Reintroduce load gradually once symptoms settle, rather than jumping back to where you were.
• Get a professional assessment: a physical therapist can identify your specific contributors and build the right progression — that individualization is why guidance helps.

When to see a professional

See a sports-medicine professional if the pain persists despite a week or two of reduced load, limits daily activities, or you're unsure what's going on. Seek prompt care for knee swelling, locking or giving way, pain from a specific traumatic incident, or sharp/pinpoint bone pain — those suggest something other than ordinary patellofemoral pain.