Why Your Knee Hurts When You Run: The 3 Most Common Culprits

Knee pain in runners is rarely random. It’s usually the result of a mismatch between what your body is doing and what it’s ready for, whether that’s a lack of strength, poor running mechanics, or a sharp increase in training load. Below are the three most frequent types of knee pain we see in our clinics in Rozelle and Panania:

1. Patellofemoral Pain Syndrome (PFPS)

Also known as “runner’s knee,” PFPS is one of the most common injuries we see in runners of all levels. The pain typically shows up around or behind the kneecap and tends to flare with things like running downhill, squatting, lunging, or even just sitting for long periods (like during a car ride or at a desk).

What causes it?

The kneecap (patella) needs to glide smoothly within a groove in your thigh bone (femur). If there’s poor alignment or uneven pull from the muscles surrounding the knee (especially the quadriceps and glutes) it can cause irritation under the kneecap. Weak hips, tight quads, and poor running technique (like overstriding or knee collapse) are often involved, as these are all factors that can lead to excessive stress going through the knee whilst running.

What it feels like:

  • A dull ache around or behind the kneecap
  • Pain during stairs, squats, or after prolonged sitting
  • Worsens with increased running volume, especially hills or speedwork

Why physio helps:

A running physio can assess your strength, mobility, and running technique to identify movement patterns contributing to the issue. With targeted hip and quad strengthening, cadence adjustments, volume adjustments and taping (in some cases), PFPS can usually be managed without long breaks from running.

2. Iliotibial Band (ITB) Syndrome

This one tends to sneak up on you mid-run, often in the outer part of the knee. You may feel great at the start of your session, only for a sharp or burning pain to kick in around the 5–10km mark, especially on long runs or descents.

What causes it?

The ITB is a thick band of connective tissue that runs from your hip to the outside of your knee. It helps stabilise the leg during running. If the glutes are weak or your stride mechanics are off (like a crossover gait or excessive hip drop), the ITB can rub repeatedly against the femur, irritating the structures underneath.

What it feels like:

  • Sharp or burning pain on the outside of the knee
  • Starts during a run and may worsen over time
  • Often aggravated by downhill running or longer distances

Why physio helps:

Your physio will assess the stability of your hips and pelvis, check for movement compensations, and guide you through a progressive strengthening program. Contrary to popular belief, ITBs don’t need to be endlessly foam rolled, they need load tolerance and proper biomechanics.

3. Patellar or Quadriceps Tendinopathy

These tendon issues tend to affect runners who do a lot of hill work, sprinting, or strength training. Especially if you’ve recently ramped up your intensity. Pain is usually located just below (patellar) or above (quadriceps) the kneecap and may be worse at the start of activity or after a period of rest.

What causes it?

Tendons become irritated when they’re overloaded without enough recovery or foundational strength. A sudden jump in training intensity (such as adding stairs, hills, or intervals) is a common trigger. You might also notice symptoms when switching from base mileage to more explosive workouts.

What it feels like:

  • Localised pain just above or below the kneecap
  • Stiffness in the morning or after sitting, easing with movement
  • Pain during jumping, running, or strength training

Why physio helps:

Tendinopathy responds best to a very specific kind of rehab. Not rest, not stretching, and not random exercises. Your physio will guide you through a slow, progressive loading program, adjust your training load, and ensure the tendon adapts properly over time.

Source url : https://imovephysio.com.au/knee-pain-when-running/ 

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