What to do if you have ‘runner’s knee’

Jo Perkins is a sports medicine physiotherapist with a special interest in women’s health and female exercise, and one of the experts in the Run Mummy Run Community Run Club in association with ASICS. Jo will be providing essential content around common running problems and injuries, and how to overcome them. These blogs are exclusive to RMR CRC members for a few months before being made public, so if you do want to get expert advice on your running, as well as a training sessions, expert Q&As, access to exclusive kit and much more, join the club today! In this post, Jo talks about one of the most common issues you might face as a runner: knee pain. 

Knee pain isn’t uncommon in women runners, and it can be really frustrating when trying to progress your training plans. You’ve most likely heard of terms like runner’s knee, patellofemoral pain syndrome or ITB syndrome, but what are they and what can we do about them? This blog gives a little more insight into runner’s knee, what causes it and, of course, how we can manage it!

What is runner’s knee?

Runner’s knee is typically characterised by pain around the edges of and under the knee cap. Research has shown that, as women, we tend to suffer with it more than our male counterparts. While we don’t fully understand the reasons for this, contributing factors can be that we typically have a wider pelvis, resulting in a greater ‘Q’ angle (the angle between the top of the hips and centre of the knee cap), which can potentially result in the patella being pulled differently. This can result in the patellofemoral joint (the joint between the patella and femur-thigh bone) becoming irritated and overworked. The joint can become really sensitive and doesn’t necessarily mean harm. There can be a lot of scaremongering out there, such as being told your knee is out of ‘alignment’ and causing ‘serious damage’, but be reassured that it very rarely has serious underlying pathology so it’s important not to fear the worst.

What causes runner’s knee?

A variety of issues can result in knee pain. Typically these include:

  • Changes in training load: increased volume/speed and type (different surfaces; more downhill running is typically aggravating)
  • Lack of muscular support or muscular imbalances surrounding the knee and hip, resulting in the knee being loaded ineffectively
  • Running technique
  • Trainers
  • Foot type

How to manage runner’s knee

The important thing to remember is not to panic and be reassured that runner’s knee is really responsive to treatment approaches. Try these options to see how things settle.

1. LOAD MANAGEMENT: This doesn’t mean don’t run (hooray!), but look at your training week. Has your running volume suddenly gone sky high? Have you introduced more hills, speed or different strength work? Find out what affects your pain. If it’s over 10km, drop back to 8km while we’re settling it down. If it’s hill running that is the issue, leave the hills for a few weeks, then start with running uphill and walking down. As a rough guide, allow the pain to be around 3/10 during running, but settles within 24 hours. If it’s more severe, have a few days of complete rest and ice the knee, then build the distance back up slowly. It may be useful to cross train in-between runs while we’re settling it down to minimise the load going through your knees ,such as swimming or cycling. Also consider different terrains to help manage the stress on your knees, such as grass running.

2. STRENGTH WORK: It’s not just about having strong quads! We need a variety of muscles working together to help support your knee and other joints as well. These include the calf, gluteal muscles and hamstrings. Look at your squat technique too, double leg then single leg. Does your knee fall inwards? Can you see your toes when you do it, or does your shin bone more further over your toes? Both of these overload that knee joint. Do you do this down the stairs too? I have attached some generic rehab exercises to work through (these are not intended to substitute the advice of your specific healthcare provider).


3. RUNNING TECHNIQUE: Your running technique can influence the loads that go through your knees. Evidence has shown that braking with the heel down in front of you, upright postures, long strides and pulling back with the leg, can increase the forces going through your knee by 6-8 times. This is often related to a backward tilt of your pelvis (butt tucked under), weaker glute muscles and a stiff running posture, which is often seen in women post-partum. Think about leaning forward and rotating through your trunk (not just your arms) so your body isn’t held stiff or gripping with your abdominals. Try and think about the weight going through your mid foot (opposed to toes or heel), and push through the foot propelling you forwards with a lean rather than pulling back with larger strides. This can be really helpful for those of you who leak while running too. Other options are to shorten stride length too.

4. TRAINERS: Making sure you have the correct supportive footwear can also assist in managing the loads though your knees. It can be worth investing in an assessment to look at your foot type and the right trainer for you.

5. TAPE OPTIONS: There are various taping options available that can help your knee, such as the option shown here using Kinesio tape.

6. PHYSIO ASSESSMENT: If things don’t settle with the above, it’s worth seeking an assessment. We talk you through all of this, as well as pelvic floor dysfunction, diastasis healing, training as a woman and more in my online female fitness and rehabilitation programme (see more below).


About  Jo

Jo Perkins (BSc MSc Sport Med) is sports medicine physiotherapist with a special interest in women’s health and female exercise. She graduated from Cardiff Uni, then went on to complete an MSC in Sport and Exercise in Medicine. She has worked in professional Rugby Union since 2008, but developed a passion for women’s health following the birth of her daughter, Sienna. She has her own physiotherapy company and has extensively trained in supporting women through pregnancy, post partum and the menopause, as well as through menstrual cycles. She went on to have her son Rory in 2018, and has since been involved in research for women’s exercise.

For more information on Jo’s online female fitness and rehabilitation programme The Glow Method At Home visit www.theglowmethodathome.com. Use code GLOW7 for a free 7-day trial.


*Featured image by Angelo Esslinger from Pixabay


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