Patellofemoral Pain Syndrome – Runners Knee

Patellofemoral pain syndrome (PFPS) is also known as ‘Runners knee’ and is one of the most common causes of knee pain with an estimated prevalence of 23% in the general population. Broken down, the name means ‘kneecap pain’ which isn’t too helpful at describing what’s actually happening at the knee or what causes it. It tends to present as a diffuse ache in the front of the knee.


Partly, this is because there are a number of factors which can increase the risk of developing PFPS. It is often diagnosed partly through a process of elimination – looking at the other structures which could cause pain in this area, such as the patellar tendon, fat pad and bursae. I often see it happen in people who have suddenly increased their training volume or intensity, or if they have been running downhill more than usual. The specific factors that can cause it can vary individual to individual. 


Some common factors are: 

  • Training error
  • Insufficient glute or quadriceps strength (not strong enough to tolerate the load that is being applied)
  • Foot position/footwear
  • Muscle tension e.g. in quadriceps 
  • Biomechanics/structural alignment (for example the way you move or your individual anatomy) 


Some common features are: 

  • A diffuse ache around the kneecap
  • Worse after sitting for prolonged periods 
  • Painful walking or running on hills and stairs (tends to be downhill/downstairs) 


So what can be done about it?


First and foremost, a physiotherapy assessment can lead to a diagnosis and rule out other injuries which may need to be managed differently. It can also help to talk through your training patterns in the months leading up to the onset of symptoms as well as looking at your knees structure and the way you move to ascertain which of the risk factors are likely contributing in this case. 


  • Exercise, particularly gluteal and quadriceps strengthening and movement retraining if/where needed
  • Activity modification, this means working around the injury to maintain your fitness and strength whilst not exacerbating the problem. We use this to help people avoid complete rest from exercise where possible as too much can be counterproductive. 
  • Taping can reduce pain and facilitate doing the exercises and can help you get back to running 
  • Knee support/brace for pain relief again to manage the pain well enough to strengthen it
  • Insoles can help to redistribute the forces in the lower limb and correct foot position which has also shown to reduce pain 


Looking at the breadth of factors that can contribute to knee pain you can see why you might have several different runners who fall under the bracket of ‘PFPS’ but who might be managed completely differently. A comprehensive assessment and personalised rehabilitation which addresses not only your particular risk factors but also your particular goals is key. 


Bolgia, A.L., Boling, M.C., Mace, K.L., DiStefano, M.J., Fithian, D.C. and Powers, C.M. 2018. National Athletic Trainers’ Association Position Statement: Management of Individuals with Patellofemoral Pain. J Ath Train 53 (9) pp. 820-836.


Smith, B.E., Selfe, J., Thacker, D., Hendrick, P., Bateman, M., Moffat, F., Rathleff, M.S., Smith, T. O. and Logan, P. Incidence and prevalence of patellofemoral pain: A systematic review and analysis. 2018. PLoS ONE 13(1): e0190892. https://doi.org/10.1371/journal. pone.0190892 


Rebekah Knight Physiotherapist at Agile TherapyWritten by Rebekah Knight, Physiotherapist.
Rebekah graduated from Cardiff University with a BSc Physiotherapy in 2013.

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