Patellofemoral Pain Syndrome, or Runner’s Knee

Patellofemoral pain syndrome (PFPS), also known as runner’s knee, is a common complaint among runners and other athletes. In fact, it is one of the most prevalent orthopedic injuries among both amateur and professional runners alike.


The pain that characterizes PFPS originates at the point where the patella (kneecap) connects to the femur (thighbone). Runner’s knee presents a diagnostic challenge because its symptoms are similar to other conditions, including iliotibial band syndrome.

Although anyone can develop PFPS, this condition is most commonly seen in younger, physically active female patients who run recreationally.

Causes of Runner’s Knee

Running (and other activities that place stress on the kneecap) can sometimes cause irritation or misalignment at the spot where the patella interacts with the femur. In some patients, PFPS develops as the result of tightness in the soft tissues or poor neuromuscular control of the gluteal and quadriceps muscles. For others, PFPS is the result of improper biomechanical technique when running.

The unique stress and repetitive motion that walking, jogging and running place on the patella can result in the pain and discomfort that characterizes PFPS. However, runners aren’t the only athletes who suffer from this condition.

Weight lifters, basketball players and fitness enthusiasts may also experience this condition. In fact, anyone who regularly climbs stairs, hikes, squats or otherwise places pressure on the knee can suffer from PFPS. In addition to repeated stress, a sudden change in type or intensity of physical activity can result in runner’s knee pain.

Symptoms and Diagnosis of Runner’s Knee

Runner’s knee is characterized by dull pain located primarily at the front of the kneecap; however, you may feel pain that seems to come from under or around the patella. It can affect one or both knees.

The pain of PFPS typically worsens when climbing stairs or hills, although you may feel it upon descending as well, once the condition progresses. Squats and deep knee bends cause pain, as can sitting for long periods with the knees bent. Runner’s knee can result in inconsistent symptoms and changes in the location or intensity of pain.

To diagnose patellofemoral pain syndrome, the sports medicine doctor will take a detailed medical history followed by a manual examination of the knee to identify the location and nature of the pain. You may also be asked to perform basic movements so that the doctor can assess your gait, core and leg strength, stability, alignment and flexibility.

Although PFPS can often be confirmed with a medical examination, the doctor may also request X-rays to verify the diagnosis.

Runner’s Knee Treatment

The goal of treatment for runner’s knee is to relieve the pain and restore mobility and functionality. For most patients, a conservative treatment approach is sufficient to achieve these goals.

In addition to the RICE treatment (rest, ice, compression and elevation), the doctor may recommend nonsteroidal anti-inflammatory drugs (NSAIDs). Physical therapy may be used to assist with improved neuromuscular control, strength and flexibility. Dr. Engelen or another sports medicine physician may perform a running gait analysis to help correct any underlying biomechanical running errors.

Rarely, surgery may be necessary to relieve PFPS. Both arthroscopic and open surgical techniques are used, depending on the severity of the patient’s condition.

Sports medicine physicians recommend that runners adopt a preventive regimen to guard against PFPS. This includes wearing appropriate footwear, maintaining a healthy body weight and incorporating strength training, stretching and flexibility exercises into your regular routine. Strength training should include a special emphasis on gluteal muscle activation and stregthening exercises.

If you experience runner’s knee symptoms, limit those activities that cause pain, and seek the advice of an orthopedic or sports medicine physician.