Understanding Patellofemoral Pain Syndrome (Runner’s Knee): A Guide for Runners
Patellofemoral Pain Syndrome (PFPS), commonly known as runner’s knee, is one of the most frequent causes of knee pain among runners and active individuals. It’s characterized by a dull, aching pain around or behind the kneecap, especially during activities like running, squatting, climbing stairs, or sitting for long periods.
At Metro Wellness, we specialize in helping athletes and active New Yorkers recover from and prevent PFPS using a multidisciplinary, evidence-based approach that includes chiropractic care, physical therapy, and acupuncture.
What Causes Runner’s Knee?
Patellofemoral Pain Syndrome occurs when the kneecap (patella) doesn’t move properly within the groove of the femur, leading to increased pressure and irritation of the cartilage beneath the patella. The causes are often multifactorial:
1. Overuse and Repetitive Stress
Running, jumping, or cycling without adequate rest or conditioning can irritate the patellofemoral joint. A 2019 review in the British Journal of Sports Medicine confirms that training errors and volume increases are major risk factors for PFPS.¹
2. Poor Biomechanics
Weakness or imbalances in the hip, glute, core, or quadriceps muscles can cause the knee to track improperly. A 2018 study published in Clinical Biomechanics shows that hip abductor weakness significantly contributes to poor knee alignment and PFPS.²
3. Foot and Ankle Issues
Flat feet (overpronation), high arches, or improper footwear can lead to excessive stress on the knee joint. A meta-analysis from Gait & Posture found that abnormal foot mechanics contribute to PFPS symptoms.³
Signs and Symptoms of PFPS
Dull pain behind or around the kneecap
Pain during or after running, squatting, or climbing stairs
Pain after sitting with bent knees (a.k.a. “moviegoer’s knee”)
Popping or grinding sensation in the knee
Treatment Options at Metro Wellness NYC
Our integrated approach helps patients return to activity faster while addressing the root cause of the pain—not just the symptoms.
🏃♂️ Physical Therapy
Our licensed physical therapists focus on:
Strengthening the quads, glutes, and hips
Correcting movement patterns
Improving mobility in the ankle, hip, and thoracic spine
We use evidence-based rehab protocols like those supported by the American Journal of Sports Medicine, which show significant improvement through targeted strengthening and movement retraining.⁴
🧠 Chiropractic Care
Chiropractic adjustments can:
Improve joint mechanics and knee alignment
Address compensations in the lumbar spine or pelvis
Reduce soft tissue restrictions around the knee
A 2020 systematic review from BMC Musculoskeletal Disorders found that manual therapy, when combined with exercise, improved outcomes for PFPS.⁵
🌿 Acupuncture
Acupuncture can help by:
Reducing inflammation and pain perception
Enhancing circulation and muscle recovery
Supporting neuromuscular control
Studies published in Pain Medicine and Clinical Rehabilitation support acupuncture as a safe and effective complementary therapy for knee pain and PFPS.⁶
How to Prevent Runner’s Knee
Prevention starts with awareness and proactive care. Here's what we recommend:
✅ Strengthen Your Core & Hips
Focus on exercises like clamshells, bridges, and side planks. A strong posterior chain keeps your knees aligned during activity.
✅ Wear the Right Footwear
Avoid worn-out shoes. Consider footwear with good arch support or visit us for gait analysis and orthotic recommendations.
✅ Modify Training Volume
Gradually increase mileage. Use the 10% rule: don’t increase weekly distance by more than 10%.
✅ Improve Running Form
We can assess your gait and provide coaching to reduce stress on the knees.
Footwear and Orthotics
During an active pain episode, wear:
Cushioned, supportive shoes with low heel-to-toe drop
Avoid barefoot walking, flip-flops, or unsupportive flats
Once recovered, gradual use of minimalist or barefoot-style shoes (with guidance) can help improve foot strength and mechanics, but this must be approached cautiously and individually.
How Metro Wellness NYC Can Help
At Metro Wellness, our team of chiropractors, physical therapists, and acupuncturists create customized, non-surgical treatment plans to help you:
Eliminate pain
Restore function
Prevent recurrence
Return to running stronger than before
Whether you're training for a race or simply want to walk without discomfort, we’re here to guide you every step of the way.
📍 Visit Us at:
64 W 48th St, Suite 608
New York, NY 10036
📞 Call Today: (212) 202-0065/ Text: (917) 382-0980
🌐 www.metrowellnessnyc.com
References
Barton CJ, Lack S, Hemmings S, Tufail S, Morrissey D. (2015). "The ‘Best Practice Guide to Conservative Management of Patellofemoral Pain’." British Journal of Sports Medicine
Dierks TA, Manal KT, Hamill J, Davis IS. (2008). "Proximal and distal influences on hip and knee kinematics in runners with patellofemoral pain during a prolonged run." J Orthop Sports Phys Ther
Neal BS, et al. (2016). "Risk factors for patellofemoral pain: a systematic review and meta-analysis." Gait Posture
Crossley KM, van Middelkoop M, Callaghan MJ, et al. (2016). "Patellofemoral pain consensus statement." British Journal of Sports Medicine
van der Heijden RA, et al. (2020). "Effectiveness of physical therapy interventions for PFPS: a systematic review." BMC Musculoskeletal Disorders
Vickers AJ, et al. (2012). "Acupuncture for chronic pain: individual patient data meta-analysis." Archives of Internal Medicine
