What is “Runner’s Knee”?

“Runner’s knee” refers to a usually dull, but not always, diffuse pain on the front or outer surface of the knee. It describes a broad group of pathological conditions involving the patellofemoral joint or the iliotibial band.

It mainly affects runners but also any athlete involved in intense activities that require frequent knee bending, such as CrossFit, cycling, jumping, soccer, skiing, and basketball.

What are the symptoms of runner’s knee?

The most common symptoms of runner’s knee are:

• Pain usually located at the front part of the knee, though it can also appear at the back or outside, during running or immediately afterward
• Pain worsens when bending the knee, such as walking, running, kneeling, sitting, or descending stairs
• Weakness or a feeling of instability when standing up after sitting for a long time
• Hearing “clicks” or grinding noises in the knee when bending or straightening it

What are the predisposing factors?

The most common predisposing factors are:

Weak or unbalanced muscles of the thigh, hip, and shin

• The quadriceps muscles stabilize the knee during bending or straightening. If they are weak or tight, the kneecap may not stay in the correct track during movement, causing increased pressure on the cartilage.
• Weak gluteal muscles may predispose to increased internal rotation of the femur and increased pressure of the kneecap on the femoral groove (the “groove” on the front surface of the femur), while tight gluteal muscles may cause friction of the iliotibial band on the femur.
• Tight hamstring muscles.
• Tight Achilles tendon.

Overuse due to excessive training, usually involving repeated exercises with deep knee bending, like deep squats.

Anatomical reasons

• A kneecap that is anatomically positioned too high on the knee joint can cause increased pressure between it and the femoral groove
• Foot problems (flat feet—overpronation, high arches) can alter the loads on the knee and cause pain
• Poor alignment from the hip to the foot may result in excessive pressure on certain points of the knee
• A knee injury
• Patellar chondropathy (wear under the kneecap as a result of acute injury or multiple microtraumas)

How is runner’s knee diagnosed?

The doctor diagnoses based on the patient’s medical history and clinical knee examination. Imaging tests such as X-rays or MRI may be needed for better assessment.

Can runner’s knee be prevented?

Prevention includes:

• Proper warm-up and stretching exercises before starting physical activity
• Mild stretching and cool-down after exercise
• Strengthening weak muscle groups and restoring muscular balance

Additionally, the following are recommended:

• Gradually increase training intensity and duration
• Wear appropriate sports shoes that absorb shock well and support the foot
• Replace shoes when they lose their shape (usually every 700-800 km)
• In cases of anatomical foot problems, use proper orthotic insoles after examination with a pedobarograph
• Avoid running on hard surfaces such as asphalt and concrete

How is runner’s knee treated?

• Mild cases are treated with ice application (10-15 minutes, 3-4 times a day), rest, and simple wrapping with an elastic bandage.
• When acute symptoms subside or during recovery, avoid activities that strain the knee and worsen pain, such as running and deep squats, but also avoid long periods of immobility. Choose alternative exercises that do not irritate the knee, like swimming.
• If symptoms persist, it is advisable to see a specialized orthopedic surgeon or sports medicine doctor to confirm the diagnosis, rule out other knee conditions, and identify the cause.
• If necessary, follow a physiotherapy program with muscle strengthening exercises.
• For persistent cases, modern biological treatments like Platelet-Rich Plasma (PRP) therapy may be considered. This therapy uses the body’s own cells containing growth factors to promote self-healing.
• If pain continues or significant damage is present, arthroscopy—a minimally invasive surgical technique—might be needed. During arthroscopy, the inside of the knee joint is examined with a small camera through a tiny incision, and any damage is repaired. The specialist surgeon can remove damaged cartilage from the kneecap or femur and correct the position of the kneecap, reducing excessive pressure on cartilage and supporting structures around the front of the knee.

When will my knee feel better?

Recovery time depends on your body and the severity of the injury. During recovery, you don’t need to stop exercising completely; try alternatives like swimming or cycling if they don’t cause discomfort.
Whatever you do, don’t rush. Returning to training before the knee fully heals may lead to a relapse.

When can I return to running?

A key factor in returning to running is the gradual increase in distance and intensity (no more than 10% increase per week), while maintaining good warm-up, stretching, and strengthening exercises.