What causes runner's knee, and how do you get back to running?

Runner's knee, properly called patellofemoral pain, is pain around the front of the knee or the kneecap, typically brought on by running, squatting, stairs or prolonged sitting. The knee joint itself is rarely damaged: it is usually an overload and control problem, and the most effective treatment is strengthening, particularly of the hip and thigh muscles, alongside sensible load management. Despite the name, it affects non-runners too. Surgery is rarely needed. A well-designed strengthening and loading programme is usually what lets you return to running without the pain returning.

What causes it

Patellofemoral pain arises when the load through the front of the knee, and the way the kneecap tracks and is controlled, exceeds what the joint is comfortably tolerating. Contributing factors often include weakness or poor control at the hip and thigh, a rapid increase in training, and running mechanics that load the knee heavily. The knee is usually not damaged or "worn out," which is reassuring and shapes the treatment: build capacity and control rather than protect and rest.

Why hip and thigh strength is the fix

It surprises many people that knee pain is often best treated by strengthening above and around the knee, especially the hip and thigh muscles. Strong, well-controlled hips and quadriceps improve how the knee and kneecap are loaded and controlled during running and daily activity, reducing the strain on the front of the knee. Combined with sensible load management, gradually adjusting running volume instead of stopping entirely, this addresses the root of the problem. The evidence strongly supports exercise, and hip-focused strengthening in particular, for patellofemoral pain. A systematic review and meta-analysis of 12 studies (604 patients) found hip muscle strengthening produced a large, statistically significant reduction in patellofemoral pain compared with no hip strengthening.

How movement and gait assessment helps

Because running mechanics and movement control play a role, looking at how you actually move adds real value. Assessing your strength, control and running gait can reveal the specific factors loading your knee, so the programme, and any running-technique tweaks, target your particular pattern instead of following a generic template. This tends to work better and get you back to running faster.

Why Hanbury Health is different

Runner's knee is exactly where our sports and testing capability shows its value. As a team with deep experience in running and sport, we look at the whole chain, including the hip, thigh and running mechanics, and use objective testing and movement and gait analysis to pinpoint what is driving your pain. Strengthening is then progressed properly in the rehab gym, and your return to running is guided by how you are actually loading and controlling the knee. It is runner's knee treated by people who understand runners. See how our physiotherapy service works, or read our companion pieces on movement and gait analysis and recovery for runners . For treatment in Milton Keynes, see our knee pain physiotherapy page.