Knee issues, Runner's Knee

by Aaron Adragna

There are a handful of injuries that just seem to plague us runners. Most of them are in the lower half, knees, calves, shins and feet/ankles. "Runner's Knee" is certainly in this category. The medical term for this is commonly "chondromalacia" although it at times can be called otherwise, or diagnosed differently. Now that we're getting into some good, decent running, this injury is becoming a bit more prevalent.

What is Runner’s Knee

Runner’s knee is technically called Chondromalacia or Patella Femoral Pain Syndrome (PFPS) and the dull, achy pain on the lower/center portion of the knee cap.  Some will feel it right underneath the center of the knee, others will feel it in the lower portion.  Do not get it confused with ITBS (more below) or other injuries that occur on the OUTSIDE of the knee, adjacent to the knee cap. It usually hurts after running, and especially going down stairs.  Some will experience swelling, and some even a "grinding" sensation.


It's what I call a "shock" and "overuse" injury, and is quite frustrating because it affects even young and otherwise healthy active people.


  • "Shock" because it’s a response to the initial shocks of running.
  • "Overuse" cuz along with "shock" it takes its toll quickly as we humans quickly introduce a lot of running to our daily lives.

In other words, it is commonly triggered by doing too much too fast as it's just shocking to your body and joints, especially the knees! It's also more common with women - and that's said to be from anatomical and structural difference.


Here is a great article on PFPS -  http://www.sdri.net/2014/02/iliotibial-band-syndrome-itbs-vs-chondromalacia-patella-femoral-pain-syndrome-pfps/


With that said, I personally had it really bad in both knees post college and had a lateral release surgery done when I was 27 yrs old. Strangely, I wasn't running a lot at the time, but very active in the gym and still doing field events with track. The Doctor basically said it was an "overuse" injury over lots of time and wear and tear. I personally worked on my form over years and even at 200+ lbs and in the first half of my 40s, I haven’t had knee issues since.

Caution! It May Be ITBS

One other “knee injury” that runners commonly deal with is Iliotibial Band Syndrome (ITBS). This is a substantially different injury so it’s important to not get them confused. I’ll have another e-article on ITBS coming out shortly. ITBS is a sharp pain on the lower OUTER portion of the knee and hurts DURING the run. Runner’s Knee hurts after the run and during the days off.

Causes of Runner’s Knee

It is caused by an irritation to the underside of the kneecap and/or cartilage. Through age and wear & tear with repetitive sports (like running) the cartilage can become soft and irritated. Misalignment of the kneecap can also cause rubbing on the adjacent knee joint(s).  Some report the feeling like arthritis. Unlike arthritis, however, it can be more easily treated and quickly recovered from if done right. The most common factors in causing it are:

  • Poor form.  Heel striking putting too much shock/impact through the lower limbs
  • Improperly fitted shoes / inserts
  • Muscular and Structural misalignment. Shoes and Orthotics can be a first step.
  • Weak/imbalanced strength in the Quadriceps muscles (thighs)

Treatment of Runner’s Knee

The pain/injury can take different levels, like most. For new and recent injuries, immediate treatment can include localized icing after your workouts, along with anti-inflammatories (Ibuprofen, Aleve, etc.) Your runs should also be cut back, or if the pain is worse, stopped all together for at least a few days until you can get back to slowly coming back online.  Some light stretching routines can be incorporated to keep all of the surrounding muscles loose.


There continues to be debate over icing and stretching. Never ice before runs. Icing can be applied after runs/workouts, and the hours or even "next morning" following. Never 'stretch' before runs or in the morning when your muscles are tight/cold. At the end of the day, if a few days or up to a week does not cut it, stop and seek professional help.


HOWEVER, these self-treatment techniques should only be performed for no more than a week or two. If it goes longer, seek proper treatment from a qualified sports medicine doctor or practitioner. Surgery is a last resort treatment, and is becoming rare in these days of cutting-edge rehab and therapy.

Knee Braces

There are two (2) types of braces that have positive effects on some runners.  An overall knee brace, outfitted with the "patellar" hole (literally, a hole in the front/center of the brace). And a patellar knee strap. This is a soft strap that is work below the knee-cap.  It helps by reducing discomfort and irritation, stabilizing your patella which improves tracking and by absorbing stress and vibrations.



Long Term Solutions

Treatment includes evaluating your biomechanics, form and leg strengthening.  Biomechanics & form can be evaluated by a form coach and/or doctor such as the folk at www.SDRI.net or www.RehabUnited.com. Proper shoes and possible orthotics should be evaluated and can be evaluated at places like www.RoadRunnerSports.com or www.SDRI.net Leg Strengthening should focus on the thighs (quadriceps - rectus femorus), the inner thighs (vastus medialis/adductors/gracilis) and the Hip Flexors/Adductors


  • Straight Leg Raises (Quads & Hips)
  • Hip Adducted Leg Raises (Inner Quads)
  • Quadricep Squeezes (Quads)
  • Hip Abductors (Hips)
  • Hamstrings/Calves* - *STRETCH THEM (to provide bioMechanical balance)

Do NOT strengthen the Quads using "extension" machines at the gym. This puts the knee in a bent position which causes too much force on the knee cap.

Related Articles

There are a plethora of related articles found online, and I recommend any of these:



As always, please let me know if you have questions.


See ya out there!


Coach Aaron

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