RUNNER'S KNEE 

That nagging ache around or behind the kneecap that gets worse when you run, squat or climb stairs? That's runner's knee (patellofemoral pain syndrome). It's one of the most common knee complaints we see, accounting for about a quarter of all knee injuries in sports medicine clinics.

Runner's knee is fundamentally a load management problem. The demands on the knee, from running, training or daily life, outpace what the surrounding muscles and tissues can handle. Weak glutes allow the thigh to rotate inward, changing how the kneecap tracks. Tight quads, hamstrings or ITB increase compressive forces. Training errors, like increasing volume too quickly, are a frequent trigger. Even stiffness in the lower back and pelvis can contribute.

This matters because without proper management, patellofemoral pain tends to stick around. Over 50% of people still have symptoms 5 to 8 years after diagnosis, and recurrence rates can reach 70 to 90%. Resting and hoping it resolves on its own rarely works.

A Cochrane review of 31 trials confirmed that exercise therapy produces meaningful improvements in pain and function. Importantly, combined hip and knee strengthening outperforms knee work alone. Targeting the glutes alongside the quads makes a clear difference. A 2024 meta-analysis also found that lumbopelvic manipulation significantly reduced knee pain when combined with exercise.

We assess the full kinetic chain: knee, hip, pelvis, lower back and foot. Treatment includes spinal and pelvic adjustments where needed, patellar mobilisation, soft tissue therapy and a structured rehab programme focused on progressive strengthening. For runners, we also look at training load and, where needed, movement retraining to reduce stress on the joint.