Knee Pain When Running This Spring? Here Is What Runner's Knee Really Is
The mornings are lighter, the Bay Run and the Cooks River path are busy again, and you have signed up for a summer fun run. Then a dull ache starts around your kneecap. It nags on the stairs, it throbs after sitting through a movie, and it gets louder every time you add a few more kilometres. Runner's knee is one of the most common reasons runners come to see our physio team at PHYZFIT Bexley North and Marrickville. Here is what is going on and how we help you keep running.
Short Answer
Runner's knee is the everyday name for patellofemoral pain: a dull ache around or behind the kneecap that flares with running, stairs, squatting, hills and long periods of sitting. It is an overload problem, not a sign that your knee is wearing out. It usually shows up when training load rises faster than your knee and hip muscles can handle, which is exactly what happens every spring. The best current evidence supports a combination of hip and knee strengthening, smart load management and education. Most runners do not need to stop completely, and many keep training at a modified level while they rehab.
Below we explain what runner's knee actually is, why it flares this time of year, how to tell it apart from other knee problems, and how our team at PHYZFIT treats it.
What actually is runner's knee?
Your kneecap (patella) glides in a groove at the front of your thigh bone. Every time you bend your knee under load, the quadriceps press the kneecap into that groove. Patellofemoral pain is what happens when the tissues around this joint become sensitised because the load going through them has outpaced their capacity.
- Where you feel it. Around, behind or just under the kneecap. Often hard to point to with one finger, so people rub the whole front of the knee
- What makes it worse. Running (especially downhill), stairs, squatting, kneeling, jumping and sitting with your knees bent for a long time (the classic "movie goer's sign")
- What it is not. It is not usually a structural tear and it is not the same as arthritis. Scans often look normal, and that is expected
- Who gets it. Runners of every level, teenagers in growth spurts, people returning to the gym, and anyone who has suddenly added stairs, hills or squats to their week
The key message: runner's knee is a load problem with a load solution. Pain is real, but it does not mean you are damaging the joint every time you feel it.
Why does runner's knee flare up in spring?
We see a clear rise in knee pain every spring across our Bexley North and Marrickville clinics. These are the common drivers:
Training load spikes
Going from two easy runs a week over winter to four or five runs plus a long run on the weekend. The knee adapts to load, but it needs time to catch up.
Hills and stairs
Wolli Creek trails, the Bay Run hills and stadium stair sessions all increase the load on the front of the knee, especially on the way down.
Hip and quad strength
Lower strength in the quadriceps and the hip muscles (gluteus medius and maximus) is commonly found in people with patellofemoral pain and is one of the most reliable things to train.
Running technique
Overstriding with a low step rate means your foot lands well ahead of you, which tends to increase the load on the front of the knee with every step.
New shoes or surfaces
A big change in shoe type, a switch to trails or a jump onto a treadmill can shift load around the knee quickly.
Life load
Poor sleep, work stress and a busy end of year all reduce how well your tissues recover between sessions.
Is it runner's knee or something else?
Not every sore knee in a runner is patellofemoral pain. A proper assessment separates it from these common lookalikes:
Patellofemoral pain
Diffuse ache around the kneecap. Worse with stairs, squats, hills and long sitting. No major swelling and the knee does not lock.
Patellar tendinopathy
Pain pinpointed to the tendon just below the kneecap. Common with jumping and fast running. Often stiff to warm up, then eases, then worse the next day.
ITB related pain
Sharp pain on the outside of the knee that often kicks in at a predictable distance into a run, and is worse running downhill.
Meniscus irritation
Pain along the inner or outer joint line, sometimes with catching, swelling or a twisting injury at the start.
Knee osteoarthritis
More common past 50. Morning stiffness, joint line ache and swelling after activity. Running is not off the table, but the plan looks different.
Pain referred from the hip
In teenagers especially, a hip problem can show up as knee pain with a limp. This always needs a proper check rather than waiting it out.
Knee grumbling every time you run?
A proper physio assessment can pinpoint the cause and keep you training toward race day.
Can I keep running with runner's knee?
Usually yes, with some changes. Complete rest tends to settle the pain, but your knee also loses capacity, so the pain often comes straight back when you return. We prefer to keep you moving within limits your knee can tolerate.
- Use a pain guide. Pain during or after a run that stays at or below about 3 out of 10, and settles back to your usual level by the next morning, is generally acceptable while you rehab
- Cut volume before you cut runs. Shorter, easier runs on flat ground usually beat stopping completely
- Park the hills and stairs for a couple of weeks, especially downhill running and stair sessions
- Nudge your step rate up. A small increase in cadence (around 5 to 10 percent) shortens your stride and reduces the load at the front of the knee for many runners. Make the change gradually
- Space your sessions. Give the knee a day between harder runs so it can recover
- Build back gradually. Increase one thing at a time: distance, speed or hills, not all three at once
How does PHYZFIT treat runner's knee?
Our physio team (Julian De Rosa, Ari Moushis and Sam Nunan) treats runners with knee pain every week. A first appointment includes a full knee, hip and foot assessment, strength testing, a look at your running load and, where useful, a review of your running technique. You leave with a clear diagnosis and a written plan.
Many runners notice meaningful improvement within 6 to 8 weeks of consistent rehab, with a full return to their usual training often in 8 to 12 weeks. Everyone is different, and a knee that has been sore for a long time can take longer.
Typical treatment approach
- Weeks 1 to 2 (settle): education about what is driving the pain, load modification, hands on treatment for short term relief, patellar taping or a temporary foot orthosis if it helps you stay active, isometric quad and hip holds
- Weeks 2 to 6 (restore): progressive hip and knee strengthening (the combination has the strongest evidence), step downs, split squats, glute work and calf strength, with a modified running plan
- Weeks 6 to 12 (build): heavier single leg strength, hill and speed work reintroduced, running technique changes where needed, and a graded build toward your goal event
- Weeks 12 and beyond (resilience): a simple twice weekly strength routine and smart training load habits to reduce the risk of the pain coming back
What should I NOT do with runner's knee?
- Push through sharp or worsening pain on every run because race day is coming up
- Stop all exercise and wait. Rest alone rarely fixes it and the pain often returns once you start again
- Rely only on foam rolling or stretching. They may feel nice, but on their own they do not build the strength your knee needs
- Add distance, speed and hills in the same week
- Go straight to a scan. Patellofemoral pain is diagnosed clinically, and scans often show changes that are common in people with no pain at all
- Buy an expensive brace or new shoes as the whole plan. These can help in the short term but they are not a replacement for strengthening
⚠ See a physio or GP promptly if you have
- Knee pain after a fall, a twist or a big impact, especially with a pop, rapid swelling or difficulty weight bearing
- A knee that locks, catches or gives way
- A hot, red, swollen knee, particularly with fever or feeling unwell. Go to an emergency department the same day
- Calf swelling, warmth or tenderness, especially after a long flight or surgery. Seek urgent medical care
- A child or teenager with knee pain and a limp, or pain that is not settling
- Night pain that is severe and unrelenting, or unexplained weight loss
How long does runner's knee take to settle?
- Recent flare from a training spike: often 4 to 8 weeks with load changes and strengthening
- Pain for several months: commonly 8 to 12 weeks or more of structured rehab
- Long standing or recurring pain: a longer, steadier build, with a focus on strength, confidence and training habits
- Patellar tendinopathy: typically 12 weeks or more of progressive tendon loading
- ITB related knee pain: often 4 to 8 weeks
We support patients across Bexley, Kingsgrove, Beverly Hills, Bardwell Park, Earlwood, Rockdale, Kogarah and Hurstville from Bexley North, and Marrickville, Newtown, Enmore, Dulwich Hill and Petersham from Marrickville.
Frequently asked questions about runner's knee
Usually not. Patellofemoral pain is diagnosed from your history and a physical examination. A scan is considered if there was a significant injury, the knee is locking or very swollen, or symptoms are not improving after a good period of quality rehab.
Patellar taping and some braces can reduce pain in the short term and help you stay active. They work best as a bridge while you build strength, not as the whole plan. Your physio can show you how to tape it properly.
Shoes can change how load is spread through your leg, and a short term foot orthosis can help some people early on. On their own, though, shoes rarely fix runner's knee. Strength and load management do the heavy lifting.
Often yes, depending on how far away it is and how irritable your knee is. We will look at your timeline and build a plan that gives you the best chance of getting to the start line, while being honest if the goal needs adjusting.
Patellofemoral pain is not the same as arthritis, and having it does not mean your knee is wearing out. Research into any long term link is still evolving, which is one more reason to manage it properly now with strength work and sensible training.
Yes. Medicare can cover up to 5 sessions per calendar year under a GP Chronic Condition Management Plan if you are eligible. Private health Extras rebates are processed through HICAPS on the day. Workers Compensation, CTP and NDIS (plan managed and self managed only) are all accepted.
Ready for Us to Help You With Your Pain?
If knee pain is getting in the way of your spring running, book a physiotherapy assessment at PHYZFIT Bexley North or Marrickville with Ari Moushis, Sam Nunan or Julian De Rosa. Same day appointments are usually available and we will get you a clear plan on day one.
📍 20 Shaw Street, Bexley North 2207
📍 4 Carrington Road, Marrickville 2204 (inside World Gym)
✉ admin@phyzfit.com.au
PHYZFIT Health and Rehab | Bexley North and Marrickville, Sydney | Helping you rebuild trust in your body and live a life without limits.