Runner’s knee is one of the most common complaints we see at Balance Physio, particularly in the lead-up to events like the Gold Coast Marathon. It sounds straightforward, but it’s worth understanding properly because the right treatment depends on what’s actually driving it.
What is runner's knee?
Runner’s knee is the common term for patellofemoral pain syndrome (PFPS): pain at the front of the knee, around or under the kneecap. As the name suggests, running is a frequent cause, but it also affects triathletes, hikers, cyclists, and anyone whose training involves repeated knee loading.
The pain is typically dull and achy rather than sharp, and tends to flare during running, walking, going up or down stairs, squatting, kneeling, or sitting for extended periods with the knee bent.
What causes it?
PFPS develops when the kneecap doesn’t track smoothly in its groove on the thigh bone. This creates irritation in the soft tissues and cartilage underneath the kneecap, leading to inflammation and pain with movement.
In runners, this is most commonly linked to a spike in training load, a change in running surface, or biomechanical factors like weakness in the hip or glute muscles, or issues with stride length and cadence. It’s often described as an overuse injury, which is accurate, but that framing can make it sound simpler than it is. Two runners with the same symptoms may need quite different management depending on what’s driving their pattern.
Is it the same as IT band syndrome?
Not quite, and this distinction really matters.
Iliotibial band syndrome (ITBS) is another common knee injury in runners, but the pain sits on the outside of the knee rather than at the front. It’s caused by overactive hip flexors and weakness in a runner’s quads and hip abductors, which comes from the hip. The theory is that when running, the gluteus maximus and Tensor Fasciae Latae (TFL) normally help control and slow the leg as it comes down. But, if these muscles are not working well together, it can change the way force is transferred through the leg. This may increase stress on the outside of the knee (known as ITB syndrome) or increase pressure behind the kneecap (which may cause patellofemoral pain).
While both conditions can develop from similar training errors, the rehabilitation approach differs. Running speed and training intensity may influence the development of ITBS more than PFPS, which is one reason getting the right diagnosis early matters. Targeted treatment from the start is always more effective than working through a process of trial and error.
What does physio treatment involve?
Treatment for runner’s knee at Balance Physio typically involves a thorough assessment of your knee, hip strength, and running mechanics to identify what’s contributing to your symptoms. From there, your physio will put together a management plan that might include hands-on treatment to address pain and stiffness, a targeted exercise programme to build the strength and control your knee needs, load management advice to keep you training where possible, and running retraining if biomechanical factors are playing a role. Additional treatments, such as taping, bracing and foot orthoses can also be considered.
The goal is to get on top of the pain quickly, because the longer PFPS is left unmanaged, the more stubborn it tends to become. Chronic PFPS is common and much harder to treat than the early presentation, so earlier is always better.
Can you keep running with runner's knee?
Often, yes, with the right guidance. Prolonged or absolute rest is rarely the answer and can be ineffective for long term recovery as it reduces the loading stimulus the tissue needs to heal.
As relative rest and activity modification are critical for pain relief, de-loading may be recommended by your physiotherapist to support your body’s structures. Your physio will advise on what level of activity is appropriate for your presentation and how to modify your training to stay moving without aggravating things further.
If you’re preparing for the Gold Coast Marathon and your knee has been giving you trouble, read our post on physio for runners on the Gold Coast for more on what a pre-race assessment involves.
When to see a physio for runner’s knee
If you’ve had knee pain for more than a week or two, or it’s affecting your training, it’s worth getting it assessed. The primary sensation of runner’s knee is a dull, aching pain felt behind or around the kneecap. You may find that your symptoms are aggravated by running, walking down steps or downhill.
A physio can confirm the diagnosis, rule out other conditions, and get you started on the right management plan.
Knee pain won't sort itself out
Book an appointment at Balance Physio and get a clear diagnosis and a plan to keep you running.
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Frequently asked questions
How long does runner's knee take to heal?
Recovery time varies depending on how long the symptoms have been present, what’s driving them, and how well load is managed during treatment. Mild cases that are caught early often respond well within a few weeks. More established or chronic presentations can take longer. Your physio will give you a clearer timeframe once they’ve assessed your specific situation.
Can I keep running with runner's knee?
In many cases, yes. Most runners can continue running with reduced loading to the joint, when pain is being managed well. Complete rest is rarely necessary and can sometimes slow recovery.
However, the key is understanding how much load your knee can tolerate at a given point in your rehab, and adjusting your training accordingly. This is where it is vital that you seek input from your physio, who can advise on what’s appropriate for your presentation and help you modify your running, rather than stop it altogether.
Do I need a scan or X-ray to diagnose runner's knee?
Not usually. PFPS is typically diagnosed through a clinical assessment, which looks at your symptoms, movement patterns, and strength. Imaging may be recommended in some cases to rule out other conditions, but it isn’t a routine requirement for most presentations.
What's the difference between runner's knee and IT band syndrome?
Both are common knee injuries in runners, but they affect different parts of the knee. Runner’s knee causes increased stress and pressure at the patellofemoral joint, whereas ITB irritation is often due to increased compression and poor control of hip and leg movement during running. The causes and rehab approaches differ between the two, which is why an accurate diagnosis matters before starting treatment.
About the Author
Sakshi’s sports rehabilitation experience includes working as a Sports Trainer and Physio Assistant for the Eagles Rugby Union Club, managing acute injuries and return-to-play programs. Preeti has also worked at Independent Living Specialists (ILS), prescribing mobility aids and assistive technology to help clients maintain independence in daily life.
