Knee Pain in Runners - Understanding Patellofemoral Joint Pain

Do you experience pain at the front of your knee?

Are you a runner?

There are multiple causes of knee pain, but one of the most common causes is patellofemoral joint pain.

Our Physiotherapist and Clinical Pilates Instructor Kara was lucky enough to attend the 2019 Sports Medicine Australia’s “Run Like You Stole It” Symposium and learn from world renowned physiotherapist and researcher Natalie Collins regarding the current evidence for assessing and treating patellofemoral joint pain. Read on to find out more…

So firstly, what is patellofemoral joint pain?

The patellofemoral joint is the joint between your knee cap (patella) and thigh bone (femur). Patellofemoral joint pain occurs when there is excessive load through this joint often because of poor patella alignment and/or poor biomechanics.

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How is patellofemoral joint pain diagnosed?

To be diagnosed with patellofemoral joint pain, patients must have:

1.       Pain around or behind your patella, and

2.       Pain with at least one of the following activities that loads the patellofemoral joint:

a.       Squat

b.      Stairs

c.       Jump

d.      Hop

e.      Run

Patients may also report a small amount of swelling around the patella and crepitus when bending and straightening their knee. Often there is pain with prolonged sitting, knee straightening and when getting out of a chair.

How is patellofemoral pain treated?


Education is paramount to any injury and patellofemoral joint pain is no different. Education regarding load management is crucial. We understand that runners hate being told they can’t run so we will make every effort to keep our runners running. One way of approaching this is by running for shorter durations but more frequently. For example, instead of doing 2x1hour runs per week, you may run 4x30minute runs or whatever it is you can tolerate. Our basic rule is that you are not to run on consecutive days, your pain should remain tolerable during the run and settle to 2/10 pain or less within one hour after the run. If it does, then we would gradually progress the duration of each of your runs. However if it doesn’t, then you have run too far, should wait till symptoms settle and then decrease the duration of your next run, before your start gradually progressing again.

It is also important to discuss the prognosis of patellofemoral joint pain. It has been proven that 50% of patients with patellofemoral joint pain will have persistent pain for 5-8years and 60% are likely to have patellofemoral joint osteoarthritis. Given these statistics, seeking treatment for your knee pain earlier, rather than later, is advised.

Lastly, crepitus does not equal damage. We only worry about crepitus if it is causing pain, so don’t be concerned by all the weird noises your knees are making if they are not painful!


The best treatment for patellofemoral joint pain is a combination of hip and knee strengthening exercises. Your physiotherapist will be able to create you an individualised exercise program in the gym or home setting, depending on your preference, which can be gradually progressed as your strength improves.

Other treatments

If required, your physiotherapist may utilise additional treatments such as taping, massage, dry needling, foot orthotics and gait retraining, depending on your needs.


Lastly, due to the debilitating nature of patellofemoral joint pain, it is important to not only address the body, but also the mind. Many patients become fearful of moving or certain activities because of their pain and therefore reassurance and education here is vital. Your physiotherapist may choose to involve a sports psychologist if they believe your psychological state is a barrier to your pain.

Lastly, remember prevention is always better than cure! Even if you don’t have knee pain, all runners should ensure they are fitted in the right footwear, complete strength training at least 2x/week , maintain a healthy weight and gradually progress your running load. If you need advice about preparing for that next run event or would like to improve your run technique, we’d love to help.

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Kara graduated from La Trobe University with a Bachelor of Health Sciences and Master of Physiotherapy Practice. Kara has a keen interest in sports physiotherapy having worked with University Blues Football Club, Victorian Indoor Hockey and Boroondara Netball Club. Due to her personal running background, she enjoys working closely with runners ensuring they stay injury free and doing what they love - running!

Kara is a qualified DMA Clinical Pilates Instructor, has completed further training in Dry Needling and is currently studying her Graduate Certificate of Sports Physiotherapy.

Kara is a keen athlete enjoying running, netball, tennis, AFL and water sports. She has also been fortunate to have traveled overseas extensively, most notably coordinating physiotherapy volunteer programs in Nepal and Cambodia.

To book with Kara, call one of our friendly reception team on 03 9885 8961.