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5 things to know about runner’s knee

Summer jogging in Ottawa Rideau Canal

In the last few weeks, I have started running more regularly along the Rideau Canal. After living in Ottawa, Vancouver, Toronto, Regina, Saskatoon, and the interior of British Columbia, I can say I have experienced many different flavours of Canada’s urban running trails. I would say that the only location that may rival the Rideau Canal is Vancouver’s seawall trail around Stanley Park. This premiere road running training in Ottawa allows and encourages many people to get out and run. Even though spring has been slow arriving, the peak of running season fast approaches. Anyone interested in racing, or just getting fit will likely be looking to increase their volume of running for the summer. Unfortunately, this season also brings on a common source of pain for many runners in Ottawa, runner’s knee. Here, we will talk about some of the important things to know about runner’s knee before you begin your long runs along the Rideau Canal.


What’s in a name? When it comes to proper injury management it is important to understand that many injuries have multiple names. This happens because these problems are treated by different professionals and researched in different parts of the world. The names for runner’s knee include, but are not limited to Patellofemoral pain syndrome, patellofemoral syndrome, patellofemoral arthralgia, patellofemoral arthritis, chondromalacia patella(e), anterior knee pain, and anterolateral knee pain. The important thing is that we can recognize the pain pattern and agree on what that might look like. The 2016 Patellofemoral pain consensus statement from the 4th International Patellofemoral Pain Research Retreat defines the condition as “diffuse anterior knee pain, usually with activities such as squatting, running, stair ascent and descent”.

Do you have runner’s knee?


It is believed the area affected in runner’s knee is the patellofemoral joint. This is the joint between the back of the knee cap and the front of the lower femur (bone between the hip and the knee). The type of tissue that we believe is affected is considered to be articular cartilage. While there is a great deal of debate about the ability of this tissue to perceive pain, people with this condition will often describe this pain as being “behind the knee cap”.


This joint experiences sagittal plane (front to back) load with activities like running, going up and down stairs, and getting out of a chair, to name a few. The research on this injury suggests that there is a concern about transverse (side to side) plane and rotational (or torsional) loads that may occur when runner’s experience fatigue or muscle pattern changes. What is often described in the research is the concern that an abnormal pattern of increased adduction and internal rotation of the femur will change the position of the patella relative to the groove (on the femur) on which it sits. This change in pattern may be what leads to patellofemoral pain in the first place.


The Patellofemoral pain consensus statement mentioned above also outlines some of the most common treatment approaches that have been found to be effective. These types of interventions include exercise therapy, combined therapy (which often includes manual therapy, taping and bracing), and foot orthoses. Exercise therapy is the only approach that is recommended to produce long-term outcomes. The areas of the body that are the recommended focus of exercise therapy in cases of patellofemoral pain is the proximal hip musculature and quadriceps musculature.


Advice from research is very important for building recommendations. While research guided advice is essential and very helpful, it may not apply in all contexts. As a runner myself, I have sought out and thought about some of the best ways we can take action to prevent and treat this problem. Dr. Christian Barton (@DrChrisBarton on twitter) is a very interesting author on this topic. One of the most valuable recommendations I have heard him make on many podcasts is to consider things that can be modified easily. This list may include, footwear, running cadence, stride length, and training volume to name a few.  A good musculoskeletal practitioner (physiotherapist, chiropractor, osteopath, or athletic therapist) will be someone who helps to identify which modifiable factors are most likely to give you the greatest chance of success.

Runner’s knee, by any name, is a very common occurrence for runners. Like many injuries affecting athletes, there does not appear to be one clear cut solution. Like many problems in general, there appears to be a need to individually tailor solutions to fit the individual. Also, as is the case for many injuries, long term planning for prevention of recurrence or chronicity should be a priority. In summary, there is good news and bad news in the case of runner’s knee. The bad news: This problem is very common, and there does not appear to be one clear cut solution. The good news: There are many probable and simple solutions that, when thoughtfully applied, can provide relief, in the long-term and short-term outlook.

Written by Ben Matheson. If you like our blog, check out our other blog posts here.

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