
As a physical therapist, I see a lot of runners come into the clinic with knee pain, specifically patellofemoral pain syndrome (PFPS). Up to 25% of all injuries in runners are related to patellofemoral problems. If you're a runner experiencing vague knee pain around or under the kneecap that worsens with activities like running, squatting, or going up and down stairs, patellofemoral pain could be the culprit.
What is Patellofemoral Pain? The patellofemoral joint is the intersection where the kneecap (patella) meets the thighbone (femur). With PFPS, the patella does not track properly in the groove of the femur, leading to increased stress and irritation of the surrounding soft tissues.
Common Causes in Runners For runners, patellofemoral pain often stems from overuse, rapid increases in mileage or hill training, weakness or imbalance of the quadriceps and hip muscles, excessive foot pronation, or even just the high-impact, repetitive nature of running itself. Improper running form or footwear can also be a contributing factor.

How Physical Therapy Can Help If you are suffering from patellofemoral knee pain with running, seeing a physical therapist can get you on the road to recovery and back out on the roads or trails. Here are some of the ways physical therapy addresses patellofemoral pain:
Biomechanical Assessment Your PT will evaluate your gait, strength, flexibility, and any muscle imbalances or faulty movement patterns that could be causing abnormal patella tracking.
Manual Techniques Hands-on treatments like mobilization, soft tissue massage, and muscle stretching can help improve patella mobility and decrease pain/inflammation.
Therapeutic Exercises You'll be given specific exercises to strengthen weak muscles (especially the quadriceps and hip abductors/external rotators), improve flexibility and promote proper patellar tracking.
Gait/Running Retraining If needed, your PT can assess your running form and footwear to provide feedback on any adjustments to make for improved running mechanics.
Modalities Treatments like electrical stimulation, and kinesiology taping may also be used adjunctively to relieve pain and facilitate healing.
Return to Running Program as your patellofemoral pain improves, your PT will safely guide your progression to gradually and fully return to running at your prior level.
Don't Push Through the Pain Many runners try to "push through the pain" of PFPS, but this can actually delay healing and lead to further injury down the road. If you are experiencing patellofemoral knee pain with running, cross-training with low-impact activities and seeing a physical therapist can get you back on track. With the right treatment plan, you can overcome this common injury and continue pursuing your running goals.
-Lilly Koh, PT, DPT, OCS, CSCS
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