Updated: May 9
Patello-femoral pain (or pain in the kneecap) is often also referred to as runner’s knee as it’s a common injury in runners. The pain is usually felt over the front of the knee. It is thought that two of the main causes for this injury are poor running mechanics and decreased muscle strength.
Your kneecap runs in a shallow groove over the front of the main knee joint. If your knee turns in excessively or your leg adducts excessively when you run, it can cause the kneecap to take more strain in certain areas, resulting in patello-femoral pain.
Like with most injuries, the treatment for this condition usually consists of a mixture of different things but the main components are load management (reducing your training load to a pain free level), strength training exercises and running gait retraining.
Watch this video if you want a demonstration of the movements I discuss lower down in this article.
Strength training alone may not be enough
In the early days, we used to think that if you strengthened the muscles that control how much your hip and knee turns in when you run (glutes, quads etc.), you would automatically see an improvement in running style. But this is not the case. What the research is showing is that a strength training programme only produces an improvement in muscle strength. It doesn’t change anything in a runner's running style.
The reason for this is likely that we all have certain movements patterns that we’ve adopted and gotten used to throughout the years and you’re not necessarily going to change it just because you’ve now got stronger muscles.
It is clear from the research that the only way to improve or change a certain running style, is by retraining the runner to use a different pattern. These gait retraining programmes usually have 3 phases:
Phase 1: This phase takes a lot of thinking and concentrating as you learn the new pattern. You usually have to use feedback from devices or video to help keep you on track and make adjustments.
Phase 2: During this phase you consolidate and practice your new pattern and you usually become progressively less reliant on feedback from devices etc.
Phase 3: This is when the new running gait pattern has been practised so much that you can maintain it without having to think about it.
What elements in your running style may contribute to patello-femoral pain?
The following biomechanical variables are currently thought to contribute to patello-femoral pain:
Excessive hip adduction
Excessive internal rotation of the thigh and knee
Hard heel landings
How can you correct it?
Increased your cadence or step rate by 5 to 10% – this has been shown to help reduce impact forces, internal rotation, hip adduction angles and pelvic drop. Most of the running watches can show you your step rate these days, but you could also use a metronome app to help you keep pace. I’ve discussed this in more detail here.
Think about pointing your kneecaps forward when you run – this can help to reduce excessive internal rotation
Lean slightly forward with your trunk – this can help to reduce impact forces. See the video above for a demonstration of this.
Make contact with the ground nearer to your centre of gravity – I find that this goes hand in hand with leaning a bit further forward with your trunk. Both these strategies can help to reduce over-stride and impact forces.
Be careful that you don’t end up compensating in other part, by for instance turning your feet out excessively. I usually take my patients through some standing drills first so that they get a good idea of how to correct it using the right muscle groups etc. I would strongly suggest that you watch the video above as I’ve explained all of this in a bit more detail in there.
About the Author
Agresta, C. and A. Brown (2015). "Gait retraining for injured and healthy runners using augmented feedback: a systematic literature review." Journal of Orthopaedic & Sports Physical Therapy 45(8): 576-584.
Barton, C. J., et al. (2016). "Running retraining to treat lower limb injuries: a mixed-methods study of current evidence synthesised with expert opinion." British Journal of Sports Medicine 50(9): 513-526.
Noehren, B., et al. (2011). "The effect of real-time gait retraining on hip kinematics, pain and function in subjects with patellofemoral pain syndrome." British Journal of Sports Medicine 45(9): 691-696.
Willy, R., et al. (2016). "In‐field gait retraining and mobile monitoring to address running biomechanics associated with tibial stress fracture." Scandinavian Journal of Medicine & Science in Sports 26(2): 197-205.