Runner’s Knee: Reviewing the Research

FREE DOWNLOAD: Runner’s Knee Rehab Resources [PDF]

Firstly, I want to apologise that it has been such a long time since my last post here on Kinetic Revolution, adding my viewpoint as a physio. I’ve been very busy adding to my family, treating patients and writing my PhD.

The aim of this short piece is to try and correct that and bring you guys up to speed with some new research we’ve been working on!

Recently, I was fortunate enough to work alongside an excellent team to produce a large systematic review. We hope will be an excellent addition to the running knowledge base, specifically informing how we help runners who suffer with Patellofemoral Pain, more commonly known as Runner’s Knee.

Runners with patellofemoral pain have altered biomechanics which targeted interventions can modify: A systematic review and meta-analysis

Click here for the abstract: Read Now

When I say ‘systematic review’ read: large piece of research designed to provide a common answer from a multitude of existing studies.

In this case we worked with data from 27 individual pieces of existing research.

The problem with traditional hard science is that it is often restricted to impacting it’s individual scientific field. Unfortunately some clinicians, and definitely most runners, miss out on benefiting from the new knowledge.

Key Findings

Running Form Matters

What our systematic review shows, in short, is that the way that you run seems to be linked to your chances of getting or continuing to suffer from Patellofemoral Pain.

This is especially true if you are female and run with a specific biomechanical feature known as ‘dynamic knee valgus’ or ‘medial collapse’.

The photo below should do a good job of showing what this is, but for the descriptive learners out there, we are describing those who run with their knee’s touching and their pelvis dropping.

Runners with patellofemoral pain have altered biomechanics which targeted interventions can modify: A systematic review and meta-analysis

To expand on this, we have limited knowledge to suggest that this medial collapse mechanically increases the risk of developing runners knee.

The stronger theme of evidence is around maintaining the condition and this review shows that people with runners knee are more likely to have the above biomechanics.

Now, this can get complicated if we start to discuss the interaction between biomechanics and pain (which are not mutually exclusive), but I’ll leave that topic for another day.

Running Re-training

Where I think this review gets really interesting (and I am a little biased here), is when we start to look at the results for interventions designed to reduce pain and increase running tolerance.

In short, both targeted exercise and ‘running re-training’ improve pain and function. However, we are not just interested in if treatments work, but also how they work…

For exercise, this is complicated. This review identified no changes in running biomechanics post exercise intervention, but despite this, pain and function improved. I’d suggest the studies were probably looking in the wrong place.

For running re-training however, there is a clear message to show that reducing medial collapse, or dynamic valgus, seems to be why runners get better after re-training.

If we think about running like a skill, this makes perfect sense. If we want a better golf swing or tennis serve, we practice the skills required to do so.

Running is now thought to require the same level of focus: if you want to run better, practice the skill of running.

FREE DOWNLOAD: Runner’s Knee Rehab Resources [PDF]


The way that you run has a big role to play in how much your knee hurts, and changing the way that you run can help reduce your pain and increase your running capacity.

If you are a patient with Runner’s Knee and you are not getting better, ask yourself this;

Has anyone looked at you run?

If not, they are doing you a disservice (a note on this, the sales person who sold you your current running shoes does not count!).

If the answer is no, perhaps consider seeking the advice of a running specialist physiotherapist, who can also perform a gait analysis. If you decide to seek a second opinion, make sure it’s with somebody who is able to assess your running biomechanics.

As always, thanks for reading, please post any questions/comments below and I will try to answer swiftly.

Last updated on March 7th, 2021.

1 Comment

  1. Thanks for the post Brad. It’s nice to see the evidence base start to acknowledge the role that running ‘retraining’ has on conditions such as PFPS. Congratulations on your family addition!

    Brad Beer