Answers written by Mr Tofunmi Oni, Consultant Orthopaedic Surgeon (MBChB BSc PGDip FRCS (Tr & Orth), GMC 7074916). Figures come from the NHS and the consensus statements and trials listed in the sources at the end. Last reviewed October 2026.
What is runner's knee, and what does it feel like?
Runner's knee is the everyday name for patellofemoral pain: an ache around or behind the kneecap that comes on with loading the joint, so squatting, stairs, hills, running and sitting for a long time with the knee bent. It usually builds gradually rather than starting with an injury, and it is as common in people who do not run as in those who do.
How do I test for runner's knee?
There is no single test. The diagnosis is clinical, made from the pattern of pain and an examination; pain reproduced by squatting is the most useful sign and is positive in about 80% of cases. X rays and MRI are usually unnecessary unless something else is suspected, and they commonly find incidental changes that are not the cause.
How do you fix runner's knee?
The treatment with the strongest evidence is a graded exercise programme combining hip and knee strengthening, underpinned by education and managing how much load you put through the knee. International consensus statements recommend exercise for pain relief in the short, medium and long term, hip and knee exercises together rather than knee exercises alone, and foot orthoses as a short term adjunct. Taping has uncertain evidence. Surgery is not part of standard treatment.
How long does runner's knee take to recover?
Improvement usually takes a programme of several weeks to a few months. It is not reliably self limiting: in one cohort 55% still had an unfavourable outcome at three months and 40% at a year, and pain that has been present for more than two months before treatment starts predicts a slower recovery. The message is to start proper rehabilitation early rather than waiting for it to go.
Will runner's knee heal by itself?
Sometimes, if the trigger was a short term overload and you ease back. Often it does not, as the figures above show, and the longer it has been present the less likely it is to resolve without a structured programme.
Can I keep running with runner's knee?
Usually yes, at a reduced level, if pain stays low. A common working rule is pain no more than 2 out of 10 during the run, settling within an hour and no worse the next morning. Shorter, more frequent runs, a slower pace, avoiding hills and stairs and increasing your cadence by 5 to 10% all reduce kneecap load. In a trial of runners with patellofemoral pain, education on managing training load did as well on its own as adding gait retraining or exercises.
Can I run a marathon with runner's knee?
Marathon training on a painful kneecap is not advisable until the symptoms are controlled; there is no evidence based rule for racing with it. If a race is close, the sensible approach is to cut volume, drop hills and speed work, do the strengthening, and make the decision on the day based on how the knee has responded.
Is walking okay with runner's knee?
Yes. Walking on the flat loads the kneecap far less than running, stairs or squatting and is a good way to stay active while the knee settles. Long downhill walks are the exception.
Does massage help runner's knee?
Massage and foam rolling have no high quality evidence of benefit on their own. Expert guides list massage only as a possible adjunct for tightness on the outer thigh. It will not do harm, but it is not a substitute for the strengthening programme.
What can be mistaken for runner's knee?
Patellar tendinopathy, which hurts at the lower pole of the kneecap on jumping; iliotibial band syndrome, which hurts on the outer side of the knee; irritation of the fat pad below the kneecap; a plica; and in teenagers Osgood Schlatter disease. Kneecap arthritis can give a similar pattern in older people. Each has a slightly different treatment, which is why an examination is worth having.
Will I need surgery for runner's knee?
Very rarely. Non operative treatment succeeds in the great majority of cases and the consensus statements do not include surgery as a treatment. The exception is a structurally unstable kneecap that dislocates, which is a different condition.
Sources
Collins NJ et al. 2018 consensus statement on exercise therapy and physical interventions to treat patellofemoral pain. Br J Sports Med 2018;52:1170-8.
Crossley KM et al. 2016 patellofemoral pain consensus statement, part 2: recommended physical interventions. Br J Sports Med 2016;50:844-52.
Neal BS et al. Best practice guide for patellofemoral pain. Br J Sports Med 2024;58:1486-95.
Barton CJ et al. The best practice guide to conservative management of patellofemoral pain. Br J Sports Med 2015;49:923-34.
Collins NJ et al. Prognostic factors for patellofemoral pain: a multicentre observational analysis. Br J Sports Med 2013;47:227-33.
Esculier JF et al. Is combining gait retraining or an exercise programme with education better than education alone in treating runners with patellofemoral pain? Br J Sports Med 2018;52:659-66.
van der Heijden RA et al. Exercise for treating patellofemoral pain syndrome. Cochrane Database of Systematic Reviews 2015, CD010387.
NHS inform, Patellofemoral pain syndrome (2023); NHS Ayrshire and Arran RefHelp, Anterior knee pain.
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