Knee Pain When Running - Common Causes and How to Fix It

Knee pain when running usually comes down to one of four common issues: patellofemoral pain syndrome, pain around or behind the kneecap, iliotibial band syndrome, pain on the outer knee that often starts 15 to 20 minutes into a run, patellar tendinopathy, pain just below the kneecap, or meniscus irritation, pain with twisting movements and sometimes swelling. Put simply, most of these are training load and strength issues rather than structural damage or straightforward wear and tear, and they generally respond well to the right treatment. A physiotherapist starts with a thorough assessment of your movement, strength and training history to work out exactly which of these is driving your pain, then builds a progressive strengthening and loading program so you can keep running where possible rather than stopping altogether. Getting assessed early avoids unnecessary imaging and gets you moving toward an actual fix.

What Causes Knee Pain When Running?

Knee pain is one of the most common issues that brings runners in to see us. It can range from a dull ache that builds through a run to sharp pain that stops you in your tracks. The good news is that most running related knee conditions respond well to the right treatment once we work out what is actually driving them. Below are the four most common causes we see, along with our separate guide to sports physiotherapy if you want to know more about how we approach running injuries generally.

What Is Patellofemoral Pain Syndrome (Runner's Knee)?

This is probably the most common knee complaint in runners. It involves pain around or behind the kneecap, typically worse when running downhill, going down stairs, or after prolonged sitting. The cause usually involves a combination of hip weakness, movement pattern and training load, rather than any structural damage to the knee. Treatment focuses on strengthening the hip and quad muscles, improving movement mechanics, and managing load. A 2025 systematic review and meta-analysis on strength exercises for patellofemoral pain supports strengthening as an effective conservative treatment, consistent with what we see clinically.

What Is Iliotibial Band (ITB) Syndrome?

ITB syndrome causes pain on the outer side of the knee, often starting around 15 to 20 minutes into a run. It is particularly common in runners who have recently increased their mileage or changed their running surface. Treatment involves reducing the load on the ITB in the acute stage, then building gluteal and hip strength, with a recent evidence review on ITB syndrome noting that stretching the ITB itself is no longer considered strong evidence based practice compared to strengthening and running retraining.

What Is Patellar Tendinopathy?

Pain at the front of the knee, just below the kneecap, is often patellar tendinopathy, particularly in runners who do a lot of hill work or high volume training. This is a tendon loading issue, not an inflammation you can simply rest away, and it responds well to a progressive tendon loading program under the guidance of a physio. A randomised clinical trial on progressive tendon loading exercise therapy found this approach effective for improving pain and function in patellar tendinopathy.

Could It Be Meniscus Irritation?

The menisci are cartilage pads inside the knee that absorb load and provide stability. Repetitive running can irritate the meniscus, particularly if your running form or footwear is not ideal. Symptoms include pain with twisting movements and sometimes swelling after activity. This is less common than the three causes above, but worth assessing properly rather than assuming, since the management approach differs.

Is Knee Pain a Sign of Serious Damage?

Usually not. Knee pain in runners is generally not a sign of serious structural damage. Most running related knee conditions are load management and strength issues, not wear and tear that signals the end of your running days. Getting assessed early avoids unnecessary imaging and lets you focus on actually fixing the problem, rather than sitting with uncertainty about what is going on.

What Can Physio Do About It?

At Physio Local in Glenmore Park and Blaxland, we see a lot of runners. Our approach to knee pain typically includes:

• A thorough assessment of movement, strength and training history
• Identifying the specific cause of your pain, not just treating symptoms generically
• A graduated running and strengthening program
• Load management guidance to keep you running where possible, rather than telling you to simply stop
• Gait analysis and running retraining where relevant

If you have had a more significant knee injury such as an ACL tear rather than a running related overuse issue, our separate guide to ACL graft options covers that territory instead. If knee pain is getting in the way of your running, book in with the team. If it is your first time seeing us, our guide to what to expect at your first physio appointment covers exactly what that first visit involves. We will work out what is actually going on and get you back on the road.

A note for Jordan: this is a natural spot for a real, anonymised patient story about a runner who worked through one of these conditions and got back to training. Nothing has been invented here to fill that gap.

Frequently Asked Questions

What is the most common cause of knee pain in runners?

Patellofemoral pain syndrome, pain around or behind the kneecap, is the most common knee complaint we see in runners.

Should I stop running if my knee hurts?

Not necessarily. Most running related knee pain responds to load management and strengthening rather than complete rest, and an assessment will tell you what level of running is safe to continue with while you address the cause.

Is knee pain when running a sign of long term damage?

Usually not. It is generally a load and strength issue rather than structural damage, and getting assessed early helps avoid unnecessary imaging and unnecessary worry.

How long does it take to fix knee pain from running?

It varies by condition and how long you have had it, but most of these issues improve with a structured strengthening and load management program over a period of weeks rather than days.

Do I need an X-ray or scan for knee pain when running?

Not usually as a first step. A thorough physical assessment often identifies the cause without imaging, which is reserved for cases where the assessment suggests something more significant is going on.

Sources

• Prognosis of Patellofemoral Pain and effectiveness of strength exercises, systematic review with meta-analysis
• Physio Network, ITB Syndrome, A Review of the Evidence
• Effectiveness of progressive tendon-loading exercise therapy in patients with patellar tendinopathy: a randomised clinical trial

Author

Jordan Baker is the Owner and Principal Physiotherapist at Physio Local, working across the Blaxland and Glenmore Park clinics. My approach to physiotherapy is to ensure that I listen to and understand each patient sitting in front of me. The one thing I want every patient to feel when they leave is that they were cared for and that we will do our best to help them get what they want and need out of their sessions.