In this article, I’m going to share with you insights that many years of treating patients with patellofemoral pain syndrome (also known as runner’s knee) have taught me, particularly in terms of understanding the symptoms of this common running injury.
While every case is different, there are definitely consistent patterns to be found in the symptoms of patellofemoral pain, which help us understand and successfully treat this knee problem.
What are the symptoms of Patellofemoral Pain Syndrome?
Runners with patellofemoral pain syndrome usually describe a dull and diffuse ache under their patella (knee cap). This dull ache is often accompanied by intermittent sharp sensations during specific activities (e.g. running or climbing stairs).
Patellofemoral pain is usually of low to moderate severity (between 3-6 out of 10 on a pain scale), but can certainly be higher at times. It will usually have a low to moderate irritability, meaning that it will normally settle within a comparable period of time to what was required to aggravate the symptoms.
However, these symptoms can be more persistent in some cases.
Which activities typically aggravate patellofemoral pain?
Based on the 2016 Patellofemoral Pain Consensus Statement (source), the four most common aggravating factors for patellofemoral pain are:
- Squatting and Lunging
- Jumping and Hopping
- Climbing Stairs (up and down)
It is also relatively common to experience pain when sitting for a prolonged period of time, or when kneeling with your body weight resting directly on the patella (knee cap).
You may also notice an increase in clicking and crunching sensations coming from the knee (joint crepitus) or a small amount of swelling. These sensations can be rather disconcerting and are usually nothing to be concerned about, as long as they aren’t directly accompanied by sharp pain. If you are unsure, ask your physio to take a look!
Here’s a great video that explains why knees sometimes click and crack, and whether you should worry about strange noises coming from your knees:
In terms of easing factors for patellofemoral pain, it is usually as simple as trying to avoid as many of the thing(s) that are aggravating your knee. Easier said than done, I appreciate when activities of daily life are causing pain. You can certainly reduce your training load though.
For many runners with patellofemoral pain, a period of relative rest from running will usually bring about enough positive relief, to allow you to embark on an exercise based rehab programme to work on the weak links that may have predisposed you to this type of knee pain.
Do the symptoms of patellofemoral pain follow a predictable pattern?
Symptoms of patellofemoral pain syndrome often follow a mechanical pattern. Usually, the pain is fairly predictable in its nature.
What I mean by this is that runners are usually pain-free at rest, with their pain kicking-in after a defined period of exercise and usually. Once aggravated during a run, the symptoms usually get worse with additional time.
What should you do if knee pain begins on a run?
Whilst every case of patellofemoral pain syndrome is as unique as the runner themselves, my typical advice goes something like this:
- Score your pain from 0-10
0 = pain-free, 10 = unbearable pain.
- If your symptoms are 3 or below, you can probably continue.
However, if you score your pain as 4 or greater, then stop running.
- Pay attention to how you feel after a run:
If you ran for 30 minutes and subsequently experienced pain for no more than 30 minutes after stopping then again, you are probably getting things about right. However, if you ran for 30 minutes and then experience pain for the next few hours, then your irritability level is higher than I would like it to be and I would advise that you consider reducing your running training volume temporarily.
- How do you feel the next day?
During the rehabilitation phase, we usually advise runners to avoid running on consecutive days. However, I would like you to feel as though you could run again if required. I call this the ‘hangover effect’. If after a given run you wake the next day thinking that another run wouldn’t be a great idea, then again you are probably asking too much of your knee right now.
I do hope that this overview of the symptoms of patellofemoral pain syndrome has given you a helpful lens through which to view your knee pain, and make better decisions about managing your pain.
As ever, if you’re in pain, be sure to get your knee assessed by a physiotherapist, so that you can be set on the right path with your return to pain-free exercise.