Patellofemoral Pain Syndrome (PFPS), commonly known as Runner’s Knee, is one of the most frequent causes of knee pain in athletes and active individuals. Despite its name, PFPS doesn’t only affect runners - it impacts anyone whose activities place repeated stress on the knee joint, including hikers, weightlifters, dancers, and office workers who sit for long periods.
If you’ve noticed aching around the kneecap, discomfort when squatting or going down stairs, or stiffness after sitting, you may be experiencing PFPS. The good news: with the right physical therapy approach, this condition is highly treatable.
Below, we break down what causes Runner’s Knee and the most effective PT strategies for long-term relief.
What Is Patellofemoral Pain Syndrome?
PFPS occurs when the patella (kneecap) doesn’t track smoothly within the femoral groove during movement. This can create irritation, inflammation, and pain around or behind the kneecap. Unlike ligament tears or fractures, PFPS is often a biomechanical problem - meaning it stems from how the knee, hip, and foot move together during activity.
Common Causes of PFPS
Patellofemoral Pain Syndrome can develop gradually or suddenly, depending on stress placed on the knee. Common contributors include:
1. Muscle Imbalances
Weak hip abductors, glutes, or quadriceps can change kneecap alignment and increase stress on the patellofemoral joint.
2. Overuse or Sudden Training Increases
Jumping into high mileage, heavy squats, or high-intensity training without proper progression can overload the knee.
3. Poor Movement Mechanics
Knee valgus (knees collapsing inward), excessive foot pronation, or limited hip mobility can alter patellar tracking.
4. Tight Tissues
Tight quadriceps, hamstrings, IT band, or calf muscles can increase pressure on the kneecap.
5. Prolonged Sitting
Sitting with the knees bent can compress the patellofemoral joint, leading to stiffness or aches.
6. Footwear or Running Surface Changes
Unsupportive shoes or sudden transitions to hills or hard surfaces can increase knee strain.
Symptoms of Patellofemoral Pain Syndrome
PFPS typically presents with:
- Pain around or behind the kneecap
- Discomfort during running, squatting, kneeling, or jumping
- Pain when walking downstairs more than upstairs
- A feeling of grinding or clicking in the knee
- Stiffness after sitting (“movie-theater sign”)
- Tenderness around the front of the knee
Symptoms often worsen with activities that require deep knee bending or repetitive loading.
How Physical Therapy Helps Runner’s Knee
Physical therapy is the gold standard for treating PFPS because it addresses the underlying biomechanical issues that cause kneecap irritation. At Core Performance Physical Therapy, treatment focuses on reducing pain, improving alignment, and restoring proper movement patterns.
Here are the strategies proven to work:
1. Strengthening the Hip and Glutes
Research shows that strengthening the hip abductors and external rotators is one of the most effective ways to reduce PFPS pain. Stronger hips improve knee alignment and reduce inward collapse during movements like running and squatting.
Exercises often include:
- Glute bridges
- Lateral band walks
- Clamshells
- Single-leg stability exercises
2. Quadriceps Strengthening
A strong quadriceps - especially the vastus medialis oblique (VMO) - helps guide the kneecap properly during movement. PTs use progressive strengthening such as:
- Straight-leg raises
- Step-downs
- Wall sits
- Controlled squats
3. Improving Mobility
Tight quads, calves, hamstrings, or restricted ankle mobility can all increase patellofemoral pressure. Manual therapy and targeted mobility work help restore balance and reduce joint stress.
4. Manual Therapy
Hands-on techniques may include:
- Patellar mobilizations to improve tracking
- Soft-tissue mobilization for the quads or IT band
- Joint mobilizations to improve knee and hip mechanics
These techniques help reduce pain, improve movement, and prepare tissues for strengthening.
5. Neuromuscular Re-Education
Movement retraining is essential for lasting improvement. PTs teach you how to:
- Squat with proper knee alignment
- Land softly from jumps
- Run with improved cadence and mechanics
This rewires the body to move more efficiently and reduces stress on the knee.
6. Activity Modification and Load Management
You don’t need to stop being active - just adjust loading while symptoms calm down. PTs help determine:
- How much running or training is appropriate
- Whether you need to change shoes or running surfaces
- How to gradually progress safely
This keeps you moving while preventing flare-ups.
7. Strengthening the Foot and Ankle
Weak intrinsic foot muscles or limited ankle mobility can alter the entire kinetic chain. PT addresses these deficits to improve stability and reduce knee stress during dynamic activity.
When to See a Physical Therapist
Seek PT if you experience:
- Persistent pain around the kneecap
- Pain that worsens with stairs, squatting, or running
- Clicking, grinding, or instability in the knee
- Stiffness after sitting
- Recurring flare-ups during training cycles
Early treatment is key to preventing chronic symptoms and maintaining athletic performance.
Get Relief From Runner’s Knee at Core Performance Physical Therapy
Patellofemoral Pain Syndrome is highly treatable with the right combination of strengthening, mobility work, manual therapy, and movement retraining. At Core Performance Physical Therapy, our evidence-based approach helps restore proper knee mechanics, reduce pain, and get you back to the activities you love.
If you’re experiencing knee pain, schedule an evaluation today and take the first step toward long-term relief.
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