Long-distance running has exploded in popularity over the last few years. Whether you're a casual runner looking to improve your fitness, training for your first running event (the Nike Melbourne Marathon is just around the corner!), or you've been running for years, chances are you've either experienced or heard of the dreaded runner's knee.
If you've experienced knee pain from running, you’ll know how frustrating it can be. Having to stop halfway through a run because your knees are aching, especially when you feel like you still have more in the tank, can be incredibly frustrating.
But does knee pain mean running is bad for your knees?
What is runner's knee?
Runner's knee is a common term for patellofemoral pain syndrome (PFPS). It describes pain or discomfort around the front of the knee, typically around or behind the kneecap (patella).
Runner's knee is relatively common among active people, although the exact prevalence varies between populations, ages and activity levels. Research suggests that females may also experience patellofemoral pain more frequently than males.
But how do you know whether your knee pain is runner's knee — or something else?
There isn't one single test that can diagnose runner's knee. Instead, physiotherapists consider your symptoms, injury history, training load and physical assessment to understand what may be contributing to your pain.
Common symptoms of runner's knee
Runner's knee can feel different from person to person, but common symptoms include:
A deep, dull ache around or behind the kneecap, which may feel sharper during certain movements
Increased discomfort when using stairs or running/walking up and down hills
Knee pain after sitting for prolonged periods
Pain during activities such as squatting, lunging, jumping or kneeling
Knee pain that develops gradually rather than following a specific injury or trauma
Symptoms that appear after a noticeable change in your training load, such as increasing your running distance, speed, frequency or intensity
What causes knee pain when running?
Patellofemoral pain doesn't necessarily come from a specific injury. Instead, it can occur when the knee is exposed to more load or stress than it is currently able to tolerate.
This can happen when there are sudden changes in your running or exercise routine, such as:
Increasing your running distance or duration
Running more frequently
Increasing your running speed or intensity
Introducing more hills or inclines
Returning to running after a break
Increasing other forms of exercise alongside your running
This doesn't mean running is damaging your knees. In many cases, it means your body needs time to adapt to the demands you're placing on it.
The good news? Your body is highly adaptable.
With appropriate training-load management and exercise therapy, many people with patellofemoral pain can improve their symptoms and return to the activities they enjoy.
How can you manage knee pain from running?
If you're experiencing knee pain while running, you don't necessarily need to stop all activity.
Instead, consider:
1. Try active rest
Rather than stopping exercise completely, consider modifying your activity to reduce the load on your knee while continuing to move.
This might mean temporarily reducing your running distance, speed or frequency, or choosing lower-impact activities that are more comfortable.
2. Think about recent changes to your training
Ask yourself: What changed before my knee pain started?
Did you suddenly increase your kilometres? Add more hills? Start running more frequently? Increase your speed or intensity?
Understanding changes in your training load can help identify what may be contributing to your symptoms.
3. Build strength
Strengthening the muscles around your hips and knees can be an important part of managing patellofemoral pain.
A physiotherapist can help identify areas that may benefit from strengthening and develop an exercise program that is appropriate for your current ability and goals.
4. Identify your aggravating factors
Pay attention to the activities that increase your symptoms.
You may not need to eliminate them completely. Instead, modifying the intensity, duration or frequency can help keep your symptoms manageable while your capacity improves.
5. Seek professional advice
If you're unsure what's causing your knee pain, or your symptoms aren't improving, a physiotherapist can assess your knee and help develop an individualised plan to get you moving confidently again.
When should you see a physiotherapist for knee pain?
While some mild knee pain may settle with appropriate activity modification, it's worth seeking professional advice if:
Your knee starts to give way or buckle
Your symptoms continue to worsen despite reducing your training load
Your pain becomes increasingly sharp or severe
You develop pain outside of exercise or activity
Your symptoms consistently worsen during activity
Your knee pain is affecting your daily life, work, sleep or ability to exercise
You're unsure what is causing your knee pain
A physiotherapist can help determine whether your symptoms are consistent with runner's knee or whether another condition may be contributing to your pain.
What can physiotherapy do for runner's knee?
Physiotherapy for runner's knee is focused on understanding why your symptoms are occurring and helping you gradually build your capacity again.
Depending on your individual needs, treatment may include:
Physical and biomechanical assessment to identify factors contributing to your symptoms
Individualised exercise programs targeting strength, mobility and movement capacity
Running and exercise-load management to help you safely progress your training
Education and advice about your symptoms, training and recovery
Manual therapy, where appropriate, to help manage pain and movement
Your treatment should be tailored to you, your body and your goals — whether that's getting back to running around the neighbourhood or preparing for your next big running event.
So, is running bad for your knees?
In short, no.
Running places high and repetitive loads through your knee joints, but this doesn't automatically mean that running is damaging your knees.
The human body is designed to adapt and respond to physical load. Problems can occur when the demands placed on your body increase faster than your current capacity to handle them.
The key is finding the right balance between training, recovery and your body's current capacity.
Mindlessly pushing through increasing pain can make your symptoms more irritable and interfere with your ability to run. On the other hand, understanding your symptoms, adjusting your training load and progressively building strength and capacity can help you get back to running with confidence.
So, if you're experiencing knee pain from running, you don't necessarily have to give up running altogether. The goal is to understand what's contributing to your pain, manage your current load and gradually build your body's capacity to handle the demands of running.
Your knees aren't necessarily telling you to stop running. They might just be telling you it's time to adjust the load.