07922 884 788

Knee

Runner's knee and front-of-knee pain

Pain around or behind the kneecap, or on the outside of the knee when running — usually a loading problem, not damage.

What it typically feels like

  • Ache around or behind the kneecap
  • Worse going down stairs or downhill
  • Pain after sitting with the knee bent for a while
  • Sharp pain on the outside of the knee after a set distance

Knee pain in runners and lifters is usually not the knee’s fault. The knee is a hinge caught between the hip and the foot, and when either of those is not doing its job, the knee is where it gets noticed.

The two common patterns

Around the kneecap — an ache at the front, worse on stairs, hills, and after sitting a while with the knee bent. The kneecap is not tracking well through its groove, usually because the hip is not controlling the thigh.

Outside of the knee — sharp, often arriving at a predictable point in a run, then easing with rest. Typically the IT band and the tissue around it, again usually a hip control problem rather than a band that needs “breaking down”.

What usually causes it

  • Doing more, suddenly — mileage, hills, a new plan.
  • Weak or lazy glutes, letting the knee drop inwards on every step.
  • Restricted ankles, which changes how the knee loads on every stride.
  • Worn-out shoes, or a change of surface.

What treatment involves

Assessment first — including watching you move, because this is a problem you can rarely find by pressing on the sore bit.

Soft tissue work through the quadriceps, the lateral thigh and the glutes to release what is pulling the knee out of line, then strengthening the hip so the knee stops taking the load. Almost all of the lasting improvement comes from the hip work, not from treating the knee itself.

What is actually in the knee

A hinge that also has to rotate slightly, carrying several times body weight with every step, and stabilised almost entirely by ligaments and muscle rather than by its own shape.

Menisci
Two crescents of cartilage that deepen the joint and spread load. The outer rims have a blood supply and can heal; the inner portions largely cannot, which shapes what is realistic after a tear.
Cruciate ligaments
ACL and PCL, crossing inside the joint, controlling the shin bone sliding forward and back. ACL injuries usually happen on a twist or an awkward landing rather than a collision.
Collateral ligaments
MCL on the inside, LCL on the outside, resisting sideways force. The MCL is the more commonly injured and the more forgiving.
Patella and patellar tendon
The kneecap runs in a groove on the thigh bone and acts as a lever for the quadriceps. It has to track properly in that groove, and the tendon below it takes a heavy load in jumping and squatting.
Bursae and fat pad
Cushions around the front of the joint. They are easily irritated and produce sharp, well-localised pain that is often mistaken for something more serious.

Why it goes wrong

Front-of-knee pain in runners and cyclists is usually a loading problem rather than damage — the tissue is being asked for more than it has been prepared for. What controls the knee mostly sits above and below it, at the hip and the foot, which is why an assessment that only looks at the knee misses the cause. A knee that gives way, locks, or swells substantially within an hour of an injury needs assessing properly.

3D anatomy See the structures involved on the interactive model

The honest next step

This page describes what is common, not what you have. The only way to know is to have it assessed — and your first session includes a full assessment, so you leave knowing what is actually going on.

Book an assessment Call 07922 884 788