Quick Summary
Patellofemoral pain syndrome — commonly known as runner's knee — is one of the most frequent causes of pain at the front of the knee, producing a dull ache around or behind your kneecap that worsens with stairs, squatting, running and prolonged sitting. Research suggests it affects roughly one in five active people, and evidence shows the most effective treatment is a progressive, individualised exercise programme targeting the hip and knee, supported by hands-on therapy and load management. At J&J Therapy, most patients follow a typical course of around 6–12 sessions over 6–12 weeks.
What Is Patellofemoral Pain Syndrome?
Patellofemoral pain syndrome is pain around or behind the patella (kneecap) that is aggravated by activities loading the joint in a bent position — squatting, climbing stairs, running, jumping and sitting for long periods (Crossley et al., BJSM, 2016). It is diagnosed clinically, once other causes of anterior knee pain such as patellar tendinopathy, meniscal injury and osteoarthritis have been ruled out.
It is common: a systematic review reported a pooled annual prevalence of 22.7% in the general population and 28.9% in adolescents, with incidence particularly high in amateur runners and military recruits (Smith et al., PLoS One, 2018). Women are affected roughly twice as often as men.
It is not simply a cartilage problem. The older term "chondromalacia patellae" (softening of the kneecap cartilage) was once used almost interchangeably with this condition, but it is now understood as a separate, overlapping entity — many people with patellofemoral pain have entirely normal cartilage, and many with cartilage changes have no pain at all.
Current models describe it as a load-related overuse condition: pain develops when the cumulative stress across the patellofemoral joint exceeds the tissue's capacity to adapt, often after a rise in training or activity. Several factors interact — altered tracking of the kneecap within its groove, weakness of the hip abductors and external rotators allowing the thigh to collapse inwards, and reduced quadriceps strength or control (Willy et al., JOSPT, 2019).
Because local factors at the knee and non-local factors at the hip and foot combine differently in each person, our physiotherapists assess your individual pattern before designing your programme.
Do You Experience These Symptoms?
✓ A dull, aching pain around or behind your kneecap that is often hard to pinpoint to one spot
✓ Pain that worsens when going up or down stairs or hills
✓ Discomfort with squatting, kneeling or deep knee bends
✓ Aching after sitting for long periods with your knee bent — sometimes called the theatre sign
✓ Pain during or after running, jumping or cycling
✓ A grinding, clicking or creaking sensation when you bend your knee
✓ A feeling that your knee might give way, usually caused by pain or muscle inhibition rather than true instability
These symptoms can be treated.
The sooner you begin, the better your chances of a smoother recovery.
What Causes Patellofemoral Pain Syndrome?
• A sudden increase in training load
Patellofemoral pain often appears after a rise in running distance, hill work or a new sport.
The joint is loaded faster than it can adapt, so pain develops without any single injury.
• Hip and gluteal weakness
Weakness of the hip abductors and external rotators allows the thigh to collapse inwards during running and squatting.
This shifts load across the kneecap and is one of the most consistently reported factors in the research (Willy et al., JOSPT, 2019).
• Quadriceps weakness or imbalance
The quadriceps guide your kneecap through its groove as the knee bends and straightens.
When they are weak or poorly coordinated, patellar tracking and joint loading are altered, contributing to pain.
• Biomechanical and footwear factors
Excessive foot pronation, reduced flexibility in the calves, hamstrings or iliotibial band, and worn or unsuitable footwear all change how force travels through the knee.
Our physiotherapists assess these factors and address the ones relevant to you.
• Age, sex and activity profile
The condition is especially common in adolescents, runners and physically active women.
Research suggests women are around twice as likely to be affected as men, which may reflect differences in lower-limb mechanics.
How We Treat Patellofemoral Pain Syndrome at J&J Therapy
Hands-On Manual Therapy
Hands-on soft-tissue work to the quadriceps, iliotibial band and lateral structures, together with patellar mobilisation, to help reduce pain and improve comfort — used alongside your exercise programme, never in isolation.
Shockwave Therapy*
Swiss Storz Medical MASTERPULS
is not a first-line treatment for patellofemoral pain — targeted exercise is. Following assessment, our physiotherapists may consider radial shockwave as a second-line adjunct in selected cases, such as when your pain also involves the patellar tendon or tender trigger points in the quadriceps.
Not used over the growing bones of children and adolescents.
Targeted Exercise Programme
The core of your treatment: progressive hip-targeted strengthening for the gluteal and external rotator muscles combined with knee-targeted quadriceps work, plus load management, movement retraining and education — the combination supported by the strongest evidence (Willy et al., JOSPT, 2019).
When to Seek Urgent Medical Help
While most symptoms are not serious, urgent medical attention is required if you experience any of the following:
True locking or a mechanical block, where your knee catches and cannot be fully straightened or bent
Significant swelling, especially if it develops rapidly or follows an injury
Inability to bear weight or to lift your straight leg, or severe pain after a fall or impact
A hot, red, swollen knee with fever or feeling generally unwell (possible infection)
FAQs About Patellofemoral Pain Syndrome
Is runner's knee serious, and will it go away on its own?
Patellofemoral pain is not dangerous, but it should not be dismissed as trivial. It was traditionally viewed as self-limiting, yet research shows a large proportion of people still report symptoms years later — one study found 57% had an unfavourable outcome 5–8 years after diagnosis (Lankhorst et al., BJSM, 2016). Starting appropriate physiotherapy early gives you the best chance of a full recovery.
Can I keep running or exercising?
Often yes, but usually with modification. The aim is to keep loading your knee within a tolerable range rather than resting completely, since prolonged rest tends not to help. Our physiotherapists will help you adjust your volume and intensity so the joint can adapt while you stay active.
How long does recovery take?
Many people notice meaningful improvement within 6–12 weeks of consistent, progressive exercise, though this varies between individuals. A longer duration of symptoms before treatment begins is associated with slower recovery, which is another reason to seek help early.
Do I need a scan or an X-ray?
Usually not. Patellofemoral pain is diagnosed clinically from your history and a physical examination. Imaging is generally reserved for cases where another problem is suspected or where symptoms do not respond as expected to treatment.
Do you use shockwave therapy for runner's knee?
Not as a first-line or routine treatment. For patellofemoral pain the strongest evidence supports targeted exercise, so that comes first. After assessment, we may offer radial shockwave using our Swiss Storz Medical MASTERPULS device as a second-line adjunct in selected cases — for example, where your pain also involves the patellar tendon or quadriceps trigger points. The direct evidence for shockwave in patellofemoral pain itself is limited, and we do not apply it over the growth plates of children or adolescents. We will always explain whether it is suitable for you.
This page is for general information only and does not replace professional medical advice.
Reviewed by Lavya Arigalayan, MSc, HCPC Registered Physiotherapist.
Last reviewed:
2026년 8월 20일