Marx Running Guide to Common Running Injuries: Patellofemoral Pain Syndrome/Runners Knee

Marx Running is writing a series of blog posts on the most common running-related injuries. We recently published our first blog post in this series, which covered plantar fasciitis. Today we will cover patellofermoral pain syndrome, commonly known as “runner’s knee”. Upcoming posts will tackle shin splints, Achilles tendonitis, and IT band syndrome (the other “runner’s knee”). The goal of these blog posts are to gather existing and accepted information on the definition, characteristics, and treatment of these injuries and present it to you in a way that you can benefit from. We also have the advantage of working with runners everyday, so we also rely on our personal experiences working “in the field” to shape our recommendations.

Patellofemoral pain syndrome is characterized by dull pain on the front of the knee, typically behind or on the edges of the knee cap. In most cases, it isn’t too severe and will go away with rest. 80-90% of people affected by this form of runner’s knee make full recoveries. But for those unlucky 10-20%, it can become chronic. Those that suffer from patellofemoral pain syndrome commonly report hearing snapping, popping, or grinding in the knee (not fun!). This happens when the patella rubs rather than slides over the femur. It is exacerbated by running/walking downstairs or downhill or after sitting for long periods of time. As a whole, this type of runner’s knee is typically referred to as a “tracking problem”, “mechanical failure”, or “grinding cartilage”. However, consensus on what these terms exactly mean and how they physiological cause patellofemoral pain syndrome has not been reached. In fact, despite studying this area for decades, the medical community is still mostly unclear on what exactly constitutes runner’s knee and how to fix it. Fear not, though! Having dealt with plenty of runners with this form of knee pain, we can make some general but effective treatment recommendations.

So what causes patellofemoral pain syndrome? Like most running injuries, overuse tends to be the primary culprit. Sharp increases in mileage and the commencement of speed work can cause a flair up in knee pain. It can also be caused by chronically running on uneven surfaces such as a banked track or a road that’s sloped one way or the other. Excessive over-pronation can also cause imbalances in the lower leg and potentially lead to runner’s knee. Folks with wider hips have been rumored to be more susceptible to patellofemoral pain because of the angle in which they put pressure on the knee, but this claim doesn’t seem to be grounded in any real science.

As mentioned before, there is no real proven treatment for patellofemoral pain syndrome. The most common prescription and subsequent remedy is rest and to start PT sessions which aim to strengthen the quad. This approach actually works for most people and is attributed to the PT sessions. However (!), those PT sessions haven’t been proven to make a real difference in runner’s knee, and the healing is typically simply due to the rest rather than the strengthening sessions. This is why rest is our #1 recommendation. Bottom line: when you rest your body heals, and this seems to be the key for most people suffering from patellofemoral pain to become pain-free again. Simple but effective.


Other things that will facilitate recovery are as follows: Ice after working out helps with reducing inflammation. Knee sleeves or patella wraps can make a small difference as they will increase blood flow to the area. Some simply like the feeling of warmth and compression on an ailing area. 110% Play Harder makes a special knee sleeve that not only is compression but is designed with a special compartment for an ice-pack (see above photo), which is included. This kills one bird with two stones and allows you to ice and compress at the same time and still be mobile. For those that have excessive over-pronation, a shoe with the right support will make a positive difference. Some advocate kineseo tape over the knee to keep it tracking correctly, but we can’t testify to the efficacy of this approach. Rest is the main treatment. Beyond that the other treatments we mentioned in this paragraph are supporting activities that will make incremental improvements. At any rate, stay on top of knee pain. When it becomes chronic it means you can’t run for a long time! So when you start to feel pain similar to what we’ve described, take a few days to rest it and pick a few of the mentioned treatments to get a head start on combating it. Based on the research and what we’ve seen, this appears to be the best strategy.

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