Ultimate Guide to Knee Pain for Runners: So You Can Run Faster and Longer


by Mitchell Starkman

 Alright! It’s time to talk all about the knee, and more specifically, knee pain. When it comes to knee pain Patellofemoral Pain Syndrome is by far one of the most common knee problems for runners diagnosed by health care providers. This condition can go by other names such as  Anterior Knee Pain Syndrome and Iliotibial Band Syndrome (aka IT Band Syndrome). So to keep things simple, we are going to refer to all of these conditions in our Ultimate Guide as simply Patellofemoral Pain Syndrome.

The goal here is to teach you the basics about Patellofemoral Pain Syndrome so you can tackle the world one step at a time!

When I tell a patient they have Patellofemoral Pain Syndrome they generally respond with the same three general questions:

  • What…what is it called again? Yeah, that. What is Patellofemoral Pain Syndrome?
  • Why do I have it? How did it happen?
  • How do I get better? What do I have to do?

What is Patellofemoral Pain Syndrome?

Let’s start with what Patellofemoral Pain Syndrome is.

At its source, Patellofemoral Pain Syndrome is an issue of friction. Let’s break down the diagnosis, the name itself, to better understand it.

“Patello” refers to the bone called the Patella. You’ll likely recognize it by its more common name – the kneecap. “Femoral” refers to the long bone in your upper thigh called the femur.

“Pain” simply refers to the reason you went to your physiotherapist and the reason this blog exists in the first place.

“Syndrome” refers to the fact that it is an issue with these two bones and the pain they are causing you.

Which leads us to our next question.

Why Do I Have Patellofemoral Pain Syndrome?

What’s happened? What did I do? Why me?!

There is no short and simple answer here, but there are answers, and those answers begin with the knee. But you already knew that…

As you bend and straighten your knee during everyday things like running, climbing stairs, or even walking, your kneecap slides up and down the femur along two distinct grooves.

Trouble arises when the kneecap does not follow those grooves as smoothly as it should.

Think about trying to drive your car straight ahead while your wheels are set at a slight angle. You aren’t going to get where you want to go as quickly or as efficiently as you would expect. You can expect to end up with issues with your tires and your alignment because things will begin creating unwanted friction.

This is what happens when your kneecap doesn’t track correctly. It creates additional friction along the kneecap and causes you pain!

But Why Does My Kneecap Track Poorly?

This can be caused by a number of things. However, the most common reason is that your knee is turning inward towards the midline. When the knee falls in toward the midline the femur falls inward as well. This changes how the kneecap tracks along its groove and ends up causing issues.

Why Does My Knee Track Inward?

There can be a variety of reasons for this. For instance:

  • A stiff ankle can force the knee to fall inwards.
  • Weak hip muscles can lead to poor control of both the knee and the whole lower limb.
  • Tightness in the muscles that surround the kneecap, such as the quads and the IT band, can cause the knee to track inwards.

How Can I Make It Better?

Since there are so many potential underlying causes, the first challenge is to figure out what to do first. As with any medical issue, the first thing to do is get checked out by a healthcare practitioner that you trust, such as your family physician, to gain a proper diagnosis of your condition.

After you have diagnosed the problem you can figure what to do to correct it. This means finding out which exercises are best for you and your condition. This can be accomplished by going to a clinic to see a physiotherapistrehab specialist, or with a proper diagnosis, you can use an online tool like PhysioReady to address the injury and begin the healing process.

In the meantime to get you started, we’ve included some basic exercises to help address the underlying issues, whatever they might be!


1) The Calf Grinder

This is an amazing way to get more movement and mobility into your calves and ankles. It may not seem like it, but better ankle movement means a much happier and healthier knee!



2) The Quad Grinder

Tackling the tightness in the front of the quads can do wonders on what’s pressing on your kneecap. Grab a foam roller and get down to business with the the quad grinder demonstrated here.



3) Side Lying Leg Raise

Glute strength is SUPER important here. Now, both of these strength exercises are non-weight bearing. Why? Because we want to offload the knee cap as much as possible while we strengthen up the weak areas. Once your strength has improved we can return to activities such as squats and lunges!


Who Should I See to Treat my Patellofemoral Pain Syndrome?

A wide variety of health care providers can help you to treat this issue. If possible, seeing a sports medicine physician is a great place to get accurately diagnosed and, for most of you, this will be covered. Once you have a more accurate diagnosis completed you can enroll in the PhysioReady program and get started on your road to recovery!

For those of you with sufficient private health coverage, or who prefer a more hands-on approach, find a licensed physiotherapist or orthopedic specialist right away to get assessed and get started!


Patellofemoral Pain Syndrome occurs when there is friction within your kneecap and this begins causing pain. This can be for a variety of reasons but ultimately they all amount to the same thing – your knee is falling inwards and causing knee pain. When it becomes time to tackle this issue from home, the best place to get started is with the Affordable PhysioReady Patellofemoral program.



Mitchell Starkman is a Toronto-based Physiotherapist with a passion for sports, orthopedics, and human movement. Mitchell’s goal is to understand how the site of pain is impacted by the entire body– rather than pinpointing a specific disturbance. He is also the founder of www.TheMovementCentre.ca – a website which provides people the tools they need to self-manage, treat and prevent their injuries.

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