Runner's knee (patellofemoral pain): causes and how to fix it

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, 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. It is usually an overload and control problem rather than structural damage, which is why the answer is rarely rest alone and rarely surgery, and is usually a well-designed strengthening and loading programme that 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. Crucially, it is usually not a sign of the knee being 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 the 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 rather than stopping entirely, this addresses the root of the problem. The evidence strongly supports exercise, and hip-focused strengthening in particular, for patellofemoral pain.

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, can be targeted rather than generic. This is where objective assessment turns "do some leg exercises" into a plan aimed at your particular pattern, which 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, hip, thigh and running mechanics, not just the sore knee, and we can 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, rather than by guesswork. 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 .