Runner's knee (PFPS): Why it keeps coming back and how to actually fix it

If you're feeling pain at the front of your knee — on a run, on the stairs afterwards, or just standing up from your chair — there's a good chance you're dealing with Patellofemoral Pain Syndrome (PFPS), often called runner's knee. It's one of the most common injuries we see in runners, and the good news is: it's very treatable.

What's actually going on

Your kneecap doesn't sit still. With every stride, it glides up and down within a groove in your thigh bone (the trochlear groove), staying centred as it moves. When certain factors are off, the kneecap starts to drift out of that groove — and the resulting friction is what creates the pain at the front of your knee.

Why this happens in runners

The causes generally fall into two categories.

External factors — training-related, and the most common culprit we see. A sudden jump in weekly mileage, adding a second session before your body's ready, a new pair of shoes, or moving from flat roads to hills too quickly. Your knee can handle a lot of change — just not all of it at once.

Internal factors — physical factors specific to you. Hip and glute weakness is a big one: when your glutes aren't doing their job, other muscles around the knee end up compensating, and the kneecap can start tracking sideways instead of staying centred in the groove. Foot mechanics and running gait can play a role too.

What this means for your training

PFPS doesn't necessarily mean you need to stop running altogether — but it does mean managing your load while we address what's actually driving the pain. Running through significant pain will only set you back further.

How we can help

At Strides, we work out exactly which combination of factors is driving your pain — a runner who's ramped up mileage too quickly needs a different approach to one with longstanding glute weakness. From there, we build a program around your goals, whether that's getting back to parkrun, training for a half marathon, or just finishing your morning run without limping afterwards.

PFPS is common. It doesn't have to be something you just put up with.

If knee pain is holding back your running, book in for an assessment — we'll find the cause and get you back to it.