Runners Knee: What It Actually Is and How to Fix It

If you’ve ever felt a dull ache behind or around your kneecap during a run, a squat, or even just sitting for too long, you’ve likely experienced what most people call runners knee. The clinical term is patellofemoral pain syndrome, and it’s one of the most common conditions we treat at Basham Chiropractic.

Despite the name, runners knee doesn’t just affect runners. We see it in people who squat, lunge, cycle, play team sports, and sometimes in people who simply sit at a desk all day and then try to get active on the weekend.

What is patellofemoral pain syndrome?

Your kneecap (patella) sits in a groove at the front of your thigh bone (femur). Every time you bend and straighten your knee, the kneecap slides up and down within that groove. When everything is tracking well, there’s no issue. But when the kneecap doesn’t track properly, the repetitive movement creates friction and irritation where the two surfaces meet.

That’s patellofemoral pain syndrome. The pain can feel sharp or dull, it can come and go, and it typically gets worse with activities that load the knee in a bent position.

What causes runners knee?

There’s rarely a single cause. In most cases, it’s a combination of factors working together. The most common ones we identify in our clinic include:

Poor balance between the inner and outer quadriceps muscles. Your quad has four heads, and if the outer portion is doing more work than the inner, it pulls the kneecap off centre. This is one of the biggest contributors we see.

Tightness through the structures around the kneecap. The ITB, quads, and lateral retinaculum can all create tension that affects how the kneecap moves.

Foot and ankle issues. Overpronation (flat feet rolling inward) changes the angle of force going through the knee. Poor ankle mobility does the same thing from the other direction.

Training errors. Increasing your running volume too quickly, changing your shoes, switching from a soft surface to concrete, or adding heavy squats without building up to them.

Hip and pelvis issues. Weak glutes and poor hip control change how your entire lower limb loads, and the knee often cops the consequences.

How we treat patellofemoral pain syndrome

A thorough assessment is the starting point. We look at how you move, how you walk, and where the problem is actually coming from. That includes gait analysis, orthopaedic and neurological testing, and a detailed look at your training history.

From there, treatment depends on what we find. It often includes a combination of joint mobilisation or manipulation, dry needling to release tight muscle groups, taping to improve kneecap tracking, and soft tissue work through the quads, ITB, and hip.

But the real key to long-term improvement is rehabilitation. Specifically, strengthening the inner quadriceps (VMO), improving hip and glute control, and correcting any biomechanical issues further up or down the chain. We prescribe exercises that are specific to you and progress them as your knee allows.

Training load management is also critical during recovery. We’ll work with you to keep you as active as possible while the knee settles, and then build back up with a structured return to your sport or activity.

When should you get it looked at?

If knee pain is changing the way you train, making you avoid stairs, or nagging you every time you sit for more than 20 minutes, it’s worth getting assessed. Patellofemoral pain syndrome responds well to treatment, especially when you catch it before compensation patterns set in.

Book an appointment with our team and we’ll get to the bottom of what’s driving your knee pain.