How To Prevent Runner’s Knee, Plus Causes, Symptoms And Treatments

“Runner’s knee is actually a bit of a made-up term,” says McDermott, “and it’s certainly not an actual proper medical diagnosis.

“Experts use the phrase ‘patellofemoral pain syndrome’, which means the same thing: pain at the front of the knee or knees linked to running. It’s an extremely common problem.”

If you have such pain, and it’s severe, the most important thing might actually be a proper diagnosis beyond runner's knee.

“Pain at the front of your knee – anterior knee pain – is just a symptom,” says McDermott. “If your symptoms are more than just a niggle then you should really seek a proper diagnosis. So the right question to ask is, ‘what’s actually causing my knee pain?’”

The clearest symptom of runner’s knee is pain, usually in the form of an intense ache at the front of the knee around the kneecap.

“This pain tends to come on not immediately as you start running but part way through a run,” says McDermott, “and it generally gets worse the longer you continue. The knee often particularly hurts after a run.”

The pain can also be aggravated by exercises like lunges, squats and leg presses because they load the joint at the front of the knee, where it straightens and bends.

Another big symptom is swelling, as McDermott explains.

“If the articular cartilage layer covering the surface of the bones in the joint becomes badly damaged from wear and tear due to excessive loading, this tends to cause intermittent swelling in the knee.

“Swelling in the joint can make the knee feel tight and stiff, and the most obvious place where you might see the swelling is directly above the kneecap – the suprapatellar pouch.

“It’s not the swelling itself that’s the actual problem: the swelling is simply a sign that there’s an underlying issue with possible damage in the joint itself, which is why just aspirating the joint [sucking out the fluid with a needle and syringe] is rarely ever the answer to the problem.”

There are several underlying factors that can combine to cause runner’s knee.

“Pressure overload and eventually damage to the cartilage in the patellofemoral compartment at the front of a knee tends to be a multifactorial thing,” says McDermott. He lists the possible factors:

You’ve read a lot of bad news up to here, but don’t despair. If you suspect you have dodgy knees and have already signed up for a marathon, there are ways to avoid the pain.

“The best advice that I can give is to take your knees seriously,” says McDermott.

“If you have any concerns about symptoms linked to running, start by ensuring that you’ve got the best and most appropriate running shoes. This means seeing someone with specific expertise in assessing foot posture and providing proper supportive footwear that suits your particular needs.

“Going hand in hand with this is getting a full and detailed biomechanical assessment with gait analysis, from a senior experienced qualified physiotherapist or biomechanist.”

Once you’ve got the right running shoes it’s time to focus on your training. You need to give yourself as much time as possible.

“If you’re training for an event then you should give yourself plenty of preparation time,” says McDermott, “so that you can slowly and gradually ramp up your distances without unduly overloading your knees with too much too fast.”

If you’ve already succumbed to what you fear might be runner’s knee, the first thing to do is get a proper diagnosis of the problem, says McDermott.

“You can’t really talk about treatment until you’ve got a clear and specific diagnosis. If you’re getting any significant symptoms in your knees, go and have a proper assessment from either a physio or a knee specialist.”

Drastic cases might require surgery, but for most people a physiotherapist will be able to help with the problems.

One thing to remember – do not do lower-body exercises that put pressure on the knees.

“Unfortunately too many people with runner’s knee end up being told to do loads of squats and lunges,” says McDermott.

“This seems a bit crazy, given that this increases patellofemoral loading and all too often simply aggravates the person’s symptoms.”

Resting up is key and the muscles you do need to focus on are your glutes, McDermott says.

“What’s often required is a period of relative rest combined with specific exercises to strengthen up your glutes, to stretch out your ITB and to build up the inner part of your quads [your VMO], combined with ensuring that your alignment, posture and running style is fully optimised.”

As you'd expect, this depends on the severity of your problems. It could be case of reducing your running a bit, but you might need to stop altogether to avoid future problems.

“For some people, all they might require is to cut down their mileage a bit,” says McDermott. “Mix in some cycling and the cross-trainer, and then slowly ramp things back up.

“For others, there could be significant damage inside the knee joint, in which case it might be a really bad idea to continue running – you might simply be storing up severe problems for the future.

“This is why it’s very important to pay attention to your knees, to take any symptoms seriously and, if your knees don’t feel right, to get them checked out. A bit of time and effort up front could save you years of pain in the future.”