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Runner’s knee, or patellofemoral pain, is pain around or behind the kneecap. It is one of the most common causes of knee pain in runners, jumping athletes and active teenagers, and it can affect adults of all ages.1 The good news is that most people improve with the right exercise program. Dr. Andrew Dold, a board-certified, fellowship-trained sports medicine surgeon in Frisco, Texas, treats patellofemoral pain with a focus on rehabilitation and load management.

On this page:Symptoms · Causes · Diagnosis · Treatment · FAQs · Research
At a glance

  • Pain around the kneecap with running, stairs, squatting or prolonged sitting
  • Exercise therapy, especially combined hip and knee strengthening, is the cornerstone of treatment
  • Foot orthoses and combined treatment programs can help
  • Surgery is rarely needed

Symptoms

  • Dull, aching pain around or behind the kneecap
  • Pain with running, squatting, jumping, kneeling and going up or down stairs
  • Pain after sitting for a long time with the knees bent (the “movie-goer’s sign”)
  • Occasional grinding or clicking

What causes it?

Patellofemoral pain is usually related to load: a sudden increase in running or training, combined with factors such as hip and thigh muscle weakness, tight muscles and the way the leg moves during activity. It is different from patellar tendinitis (jumper’s knee), which affects the tendon below the kneecap, and from kneecap instability, in which the kneecap slips out of place.

Diagnosis

Dr. Dold reviews your training and symptoms, examines the knee, hips and alignment, and watches how you squat, step down and move. X-rays or an MRI are sometimes used to rule out other problems, such as cartilage injury or arthritis behind the kneecap.

Treatment

Treatment starts with physical therapy. An international consensus statement supports:1

  • Exercise therapy, especially a combination of hip-focused and knee-focused strengthening
  • Combined interventions, such as exercise together with other treatments
  • Foot orthoses to improve pain and function in some patients

The same panel did not recommend kneecap or knee mobilizations alone or electrical treatments, and found the evidence uncertain for patellar taping or bracing, dry needling and gait retraining.1 Dr. Dold uses taping, bracing and a review of running form and training load as additions to a strengthening program in selected patients, and injections only rarely, for pain that does not respond. Surgery is seldom needed for patellofemoral pain.

Getting back to running

Most runners can stay active by reducing the volume and intensity of running while they strengthen, then building back gradually. Dr. Dold and your therapist will guide the progression based on your symptoms.

What the research shows

Runner’s knee (patellofemoral pain) is one of the most common causes of knee pain in active people, affecting roughly one in five adults and more than one in four adolescents each year. International consensus statements and a 2024 clinical practice guide agree on the main points:

  • Exercise is the core treatment. Strengthening the hip and the thigh muscles reduces pain and improves function. Hip-and-knee programs and quadriceps-focused programs both work, and some patients respond better to one than the other.
  • Education and load management matter. Understanding the condition and adjusting running volume, hills, stairs and deep squats temporarily can be as important as the exercises themselves.
  • Helpful add-ons: foot orthoses and combined treatment packages help in the short term. Taping can relieve pain for some patients but does not improve function, and the evidence for knee braces, needling and blood flow restriction is limited.
  • For runners: running retraining, such as landing more softly or increasing cadence, reduced running pain in randomized trials, though the certainty of the evidence is low.
  • Surgery rarely helps. In a randomized trial with 5-year follow-up, adding knee arthroscopy to exercise gave no additional benefit. Surgery is reserved for specific structural problems such as kneecap instability or a loose body.
  • Outlook: many people improve with a dedicated program, but symptoms can linger for years in some, which is why a structured, progressive plan is worth the effort. Patellofemoral pain alone rarely leads to knee arthritis in the medium term.

Why see Dr. Dold

  • Board certified by the American Board of Orthopaedic Surgery, with subspecialty certification in Sports Medicine
  • Sports medicine and arthroscopy fellowship at NYU Langone / Hospital for Joint Diseases; orthopedic residency at the University of Toronto
  • Fellow of the American College of Surgeons (FACS), the American Academy of Orthopaedic Surgeons (FAAOS), the American Orthopaedic Association (FAOA) and the Royal College of Surgeons of Canada (FRCSC)
  • Published research on knee ligament and meniscus surgery, including The Posteromedial Corner of the Knee (JAAOS, 2017) and transtibial meniscal root repair (KSSTA, 2017)
  • Team physician and surgical consultant to Rugby Canada; has cared for professional athletes from the NFL, NBA, NHL, MLS, PGA Tour and Major League Rugby
  • D Magazine Best Doctors (Collin County), 2019–2026 · Rated 4.9 on Google

Frequently asked questions

What is the best treatment for runner’s knee?

Exercise therapy, especially combined hip and knee strengthening, has the strongest research support.1

Should I stop running?

Usually not completely. Reducing running volume and intensity while you strengthen, then building back gradually, works for many runners.

Do knee braces or taping help?

The evidence is uncertain.1 Some patients find them helpful in the short term as part of a strengthening program.

Do I need an MRI?

Not usually. Imaging is used when the diagnosis is unclear or another problem, such as a cartilage injury, is suspected.

Will I need surgery?

Rarely. Most people improve with a structured rehabilitation program.

Do I need surgery for runner’s knee?

Very rarely. A randomized trial found that adding knee arthroscopy to an exercise program gave no extra benefit at 5 years. Exercise therapy, education and adjusting training load are the main treatments.

Related pages

Research cited on this page

  1. Collins NJ, Barton CJ, van Middelkoop M, et al. 2018 Consensus statement on exercise therapy and physical interventions (orthoses, taping and manual therapy) to treat patellofemoral pain: recommendations from the 5th International Patellofemoral Pain Research Retreat, Gold Coast, Australia, 2017. Br J Sports Med. 2018;52(18):1170-1178. PubMed
  2. Smith BE, Selfe J, Thacker D, et al. Incidence and prevalence of patellofemoral pain: A systematic review and meta-analysis. PLoS One. 2018;13(1):e0190892. PubMed
    Systematic review: annual prevalence of patellofemoral pain is about 23% in the general population and 29% in adolescents.
  3. Crossley KM, Stefanik JJ, Selfe J, et al. 2016 Patellofemoral pain consensus statement from the 4th International Patellofemoral Pain Research Retreat, Manchester. Part 1: Terminology, definitions, clinical examination, natural history, patellofemoral osteoarthritis and patient-reported outcome measures. Br J Sports Med. 2016;50(14):839-43. PubMed
    International consensus statement on patellofemoral pain terminology, definitions, assessment and outcomes.
  4. Neal BS, Lack SD, Bartholomew C, et al. Best practice guide for patellofemoral pain based on synthesis of a systematic review, the patient voice and expert clinical reasoning. Br J Sports Med. 2024;58(24):1486-1495. PubMed
    Practice guide: exercise therapy and education should be the primary treatment; other options support, not replace, them.
  5. Neal BS, Bartholomew C, Barton CJ, et al. Six Treatments Have Positive Effects at 3 Months for People With Patellofemoral Pain: A Systematic Review With Meta-analysis. J Orthop Sports Phys Ther. 2022;52(11):750-768. PubMed
    Network meta-analysis: hip-and-knee exercise, combined interventions and foot orthoses were among the treatments with evidence of benefit.
  6. van der Heijden RA, Lankhorst NE, van Linschoten R, et al. Exercise for treating patellofemoral pain syndrome. Cochrane Database Syst Rev. 2015;1(1):CD010387. PubMed
    Cochrane review: very low-quality but consistent evidence that exercise reduces pain and improves function and long-term recovery.
  7. Alammari A, Spence N, Narayan A, et al. Effect of hip abductors and lateral rotators’ muscle strengthening on pain and functional outcome in adult patients with patellofemoral pain: A systematic review and meta-analysis. J Back Musculoskelet Rehabil. 2023;36(1):35-60. PubMed
    Meta-analysis: strengthening hip abductors and lateral rotators improved pain and function more than quadriceps exercises alone.
  8. Hansen R, Brushøj C, Rathleff MS, et al. Quadriceps or hip exercises for patellofemoral pain? A randomised controlled equivalence trial. Br J Sports Med. 2023;57(20):1287-1294. PubMed
    Randomized trial: 12-week quadriceps-focused and hip-focused programs gave equivalent improvements.
  9. Hansen R, Rathleff MS, Brushøj C, et al. Differential Effects of Quadriceps and Hip Muscle Exercises for Patellofemoral Pain: A Secondary Effect Modifier Analysis of a Randomized Trial. J Orthop Sports Phys Ther. 2024;54(11):732-742. PubMed
    Randomized trial analysis: some subgroups responded better to hip-focused exercise and others, with severe pain, to quadriceps exercise.
  10. Hott A, Brox JI, Pripp AH, et al. Effectiveness of Isolated Hip Exercise, Knee Exercise, or Free Physical Activity for Patellofemoral Pain: A Randomized Controlled Trial. Am J Sports Med. 2019;47(6):1312-1322. PubMed
    Randomized trial: education combined with knee-focused, hip-focused or free training gave similar short-term results.
  11. de Oliveira Silva D, Pazzinatto MF, Rathleff MS, et al. Patient Education for Patellofemoral Pain: A Systematic Review. J Orthop Sports Phys Ther. 2020;50(7):388-396. PubMed
    Systematic review: education alone may produce outcomes similar to exercise plus education.
  12. Zhang Z, Zhang Z, Zheng B, et al. Effects of lower limb strengthening training on lower limb biomechanical characteristics and knee pain in patients with patellofemoral pain: a systematic review and meta-analysis. Eur J Med Res. 2025;30(1):90. PubMed
    Meta-analysis: lower-limb strengthening improved knee function and hip strength.
  13. Alexander JLN, Culvenor AG, Johnston RRT, et al. Strategies to prevent and manage running-related knee injuries: a systematic review of randomised controlled trials. Br J Sports Med. 2022;56(22):1307-1319. PubMed
    Meta-analysis: running retraining to land softer may reduce knee injury risk; running-related patellofemoral pain may be helped by gait retraining (low certainty).
  14. de Souza Júnior JR, Rabelo PHR, Lemos TV, et al. Effects of two gait retraining programs on pain, function, and lower limb kinematics in runners with patellofemoral pain: A randomized controlled trial. PLoS One. 2024;19(1):e0295645. PubMed
    Randomized trial: running retraining programs reduced running pain at 6 months compared with no intervention.
  15. Luo Y, Chen X, Shen X, et al. Effectiveness of Kinesio tape in the treatment of patients with patellofemoral pain syndrome: A systematic review and meta-analysis. Medicine (Baltimore). 2024;103(23):e38438. PubMed
    Meta-analysis: Kinesio taping relieves pain but does not improve function.
  16. Smith TO, Drew BT, Meek TH, et al. Knee orthoses for treating patellofemoral pain syndrome. Cochrane Database Syst Rev. 2015;2015(12):CD010513. PubMed
    Cochrane review: little evidence to guide the use of knee braces for patellofemoral pain.
  17. Zeitlin C, Shepherd M, Lack SD, et al. Blood flow restriction training compared to conventional training in people with knee pain: a systematic review with meta-analysis. Phys Ther Sport. 2025;74:65-74. PubMed
    Systematic review: blood flow restriction training gave a small short-term pain benefit of questionable importance.
  18. Rethman KK, Mansfield CJ, Moeller J, et al. Kinesiophobia Is Associated With Poor Function and Modifiable Through Interventions in People With Patellofemoral Pain: A Systematic Review With Individual Participant Data Correlation Meta-Analysis. Phys Ther. 2023;103(9). PubMed
    Systematic review: fear of movement is associated with poorer function; taping and bracing may reduce it in the short term.
  19. Kettunen JA, Harilainen A, Sandelin J, et al. Knee arthroscopy and exercise versus exercise only for chronic patellofemoral pain syndrome: a randomized controlled trial. BMC Med. 2007;5:38. PubMed
    Randomized trial: adding arthroscopy to exercise gave no additional benefit at 9 months and cost more.
  20. Kettunen JA, Harilainen A, Sandelin J, et al. Knee arthroscopy and exercise versus exercise only for chronic patellofemoral pain syndrome: 5-year follow-up. Br J Sports Med. 2012;46(4):243-6. PubMed
    Five-year follow-up: knee arthroscopy plus exercise was no better than exercise alone.
  21. Lankhorst NE, van Middelkoop M, Crossley KM, et al. Factors that predict a poor outcome 5-8 years after the diagnosis of patellofemoral pain: a multicentre observational analysis. Br J Sports Med. 2016;50(14):881-6. PubMed
    Cohort: 57% reported unfavorable recovery 5 to 8 years later, but 98% had no signs of knee arthritis on X-ray.
  22. Rathleff MS, Vicenzino B, Middelkoop M, et al. Patellofemoral Pain in Adolescence and Adulthood: Same Same, but Different?. Sports Med. 2015;45(11):1489-95. PubMed
    Analysis: success rates with the same exercise treatment differed between adolescents and adults.
  23. Neal BS, Lack SD, Lankhorst NE, et al. Risk factors for patellofemoral pain: a systematic review and meta-analysis. Br J Sports Med. 2019;53(5):270-281. PubMed
    Meta-analysis: quadriceps weakness in military recruits was a risk factor for developing patellofemoral pain.
  24. Wallis JA, Roddy L, Bottrell J, et al. A Systematic Review of Clinical Practice Guidelines for Physical Therapist Management of Patellofemoral Pain. Phys Ther. 2021;101(3). PubMed
    Systematic review of guidelines: recommendations from higher-quality guidelines sometimes conflict with routine physical therapy practice.
Ready to get it checked? Request an appointment online or call 469-850-0680. Our staff will contact you by phone and text within an hour of your request (during business hours, Monday–Friday, 8 am–5 pm). Walk-in visits are welcome Monday, Wednesday and Friday, 8:30–10:30 am at 6700 Dallas Parkway, Suite 100, Frisco, TX 75034. We see patients from Frisco, Plano, McKinney, Prosper, Little Elm, The Colony, Allen, Dallas and across North Texas. Same-day appointments available. Dr. Dold accepts most major insurance plans, including Medicare and Tricare. Please call 469-850-0680 to confirm your coverage.

Request an AppointmentCall 469-850-0680

Medically reviewed by Andrew P. Dold, MD, FAOA, FAAOS, FACS, FRCSC. Last reviewed October 2026. This page is general information, not medical advice. Individual results vary.