Runner’s Knee

Runner’s knee is the common term given to a painful condition called patellofemoral pain syndrome. It’s estimated to affect up to 23% of adults annually, affecting almost twice as many women as men. Patellofemoral pain simply means pain present at the point where the patella (kneecap) meets the femur (thigh bone).



The coined term ‘runner’s knee’ comes from the fact that it has a high prevalence in runners. The painful symptoms at the knee develop when the kneecap mistracks, so that instead of gliding smoothly in a specific groove at the femur, it moves irregularly and rubs against the end of the femur repetitively as the knee bends and straightens. This friction causes bony damage, as well as damage to the articular cartilage that covers and protects the joints.


Causes & symptoms of patellofemoral pain syndrome (PFPS)


A number of factors are identified that can contribute to the development of runner’s knee. These include muscle imbalances which pull on the kneecap, alignment, posture and biomechanical problems affecting the feet or legs, training problems like increasing the intensity or duration of your workout without the right preparation, and exercising in unsupportive footwear.


When it comes to PFPS affecting more women than men, it may be related to the differences in hormones that affect ligament and muscle function, slight differences in the shape of the bones and generally having a wider-set pelvis, and differences in body composition like a predisposition for having less lean muscle mass.


You’ll likely feel pain behind your kneecap and around your knee, which may be accompanied by some swelling. The symptoms tend to come on gradually during activities that repetitive bend and straighten the knee or put significant force through the knee. Common examples include climbing stairs, squatting and running, as well as sports like basketball, skiing and netball. The pain can then persist while walking and as the damage worsens, can be felt when resting. 


Treating runner’s knee


Treating runner’s knee starts with alleviating the painful symptoms and understanding the cause of the problem. We then use treatments like 3D-scanned custom foot orthotics paired with the right footwear, shockwave treatment, strapping, bracing, gait retraining and physical therapy to help improve the knee function and prevent the mistracking. Ultimately, our goal is always to prevent your problem from recurring and continuing to cause you ongoing pain in the future.





I think I have runner’s knee but I don’t often run – is that possible?

Absolutely, runner’s knee affects those that don’t run or aren’t active too. Runner’s knee simply gets its name from having a high prevalence in those who run regularly due to the repeated bending and straightening movement of the knee during running. 


Can runner’s knee be prevented?

There are definitely things you can do to help reduce your likelihood of developing runner’s knee. These include addressing any muscle imbalances that may result in abnormal forces on and around the knee and kneecap, helping correct foot alignment and biomechanical issues using custom foot orthotics to help control the forces on the knee joint, gait retraining for proper running technique, implementing good training habits like not suddenly increasing the intensity or duration of your workout before your body can adequately support it, and wearing the right running shoes for your feet.


How do shoes affect runner’s knee pain?

Your knees are one of the largest joints in your body and are responsible for safely supporting your body weight, so having the right shoes to support your overall knee health is important and can lead to knee pain – or help prevent it. Given that physical activity and running is a cause of runner’s knee pain, wearing shoes that best support the knees during these activities is important. Opt for running-specific shoes that match your foot type and have adequate cushioning and shock absorption. Avoid unsupportive footwear or those that increase pressure on your forefoot like high heels or flat and rigid shoes.


I have a race or event coming up but am getting knee pain – can I run anyway and start my recovery afterwards?

We recommend coming in for an assessment before your event. This is because pain – and especially knee pain – never happens for no reason. Pain is our body’s natural warning sign that something is going wrong – or is about to. As such, it’s important to listen to our body, before something serious happens or an existing minor injury progresses. From our professional opinion, it is better to miss an event and treat a minor injury over a matter of weeks, then ignore it and potentially subject yourself to further pain, injury and mobility restrictions with months of recovery and the associated negative impact on your quality of life.


Will strapping my knee help my pain?

Knee strapping can be an effective way to help get some temporary relief from the symptoms of your runner’s knee. Our podiatrists will show you how to best strap your knee during your appointment so you can continue to replicate this at home as needed. In the meantime, here is an overview of one way you can strap your knee at home today.


How can I tell if the cause of my knee pain is runner’s knee or something else?

The only way to know for sure is by having an assessment with your podiatrist. Here at Masterton Foot Clinic, our podiatrists complete a comprehensive assessment of your knee and lower limbs, including range of motion and muscle strength testing, assessing the painful areas, completing a gait analysis, and making a diagnosis. If there is ever any uncertainty, or your symptoms match multiple potential injuries at the knee, we can refer you for medical imaging such as an x-ray or ultrasound to confirm your diagnosis. Having an assessment with a professional is the only definitive way to diagnose the cause of your knee pain.


Are different types of knee pain treated differently or similarly?

While all knee pain treatment does bear some similarities – such as the need to rehabilitate the damaged areas back to full strength and function to help get you back to pain-free movement, we always take a personalised approach to treatment based on exactly which area of the knee has been injured and how the injury occurred. This is important because different structures in your knee play different roles – some tendons help support knee movement and flexion, while some ligaments are responsible for keeping the knee joint stable and limiting excessive movement. Your treatment plan with us is uniquely tailored, including following evidence-based guidelines, to help you get the best outcomes.


Why does my knee pain keep coming back?

If you’ve been having recurring knee pain for months or years, it is likely because one of the causes of your knee pain has not been addressed. This may be as simple as something like your footwear, or as complicated as a dysfunctional movement pattern that has been hardwired into your brain after a period of walking ‘differently’ during your painful phase, where it was too painful to walk normally – leaving you walking in an abnormal way that your brain has remembered, even after the injury itself has healed. This may be putting strain on your knee, which may be leading to the recurrence of your knee pain – or pain elsewhere in the body.


Which movements should I avoid making with my knee?

Any movements that exacerbate your knee pain should be avoided in the initial stages of your recovery. Often this will involve going up and down stairs, squatting, running, lunging and repetitively moving from sitting to standing positions. You should notice that as your recovery progresses, these movements will begin to feel more comfortable and commonplace. Always listen to your body if it’s telling you to avoid a certain movement at a particular time.


Is runner’s knee treatment covered by health insurance?

Whether your runner’s knee pain treatment is covered by your insurance is dependent entirely on your health insurer, the policy you have taken out, and your level of cover. If your policy covers podiatry, then it is likely your insurer will be able to assist. Please contact your insurer directly to confirm.


Is runner’s knee treatment covered by ACC?

If your knee pain is a result of an accident, then you may be eligible for ACC. We can fill in a claim form for you and submit it to ACC, who will ultimately decide if your injury is covered.