Runner’s Knee: What It Is, Why It Happens, and How a Biokineticist Can Help
You’re a few weeks out from your next race. Training is going well — maybe even better than expected. And then it starts. A dull, nagging ache just behind or around your kneecap. It’s worse on the downhills, flares up on stairs, and tends to kick in around the 8km mark. You try to push through. You take a rest day. It comes back.
If this sounds familiar, you’re likely dealing with runner’s knee — one of the most common running injuries I see in my practice here in Somerset West. The good news? It’s very treatable. The frustrating truth? Rest alone almost never fixes it.
What exactly is runner’s knee?
Runner’s knee is the common name for patellofemoral pain syndrome (PFPS) — a condition where the cartilage underneath the kneecap becomes irritated due to abnormal pressure or tracking. In simple terms, your kneecap isn’t moving the way it should as you run, and over time, that causes pain.
It’s particularly common in recreational runners — especially those training for a 10K or half marathon who have recently increased their weekly mileage. The knee is taking on more load, and if there are any underlying weaknesses or imbalances, they start to show up.
What causes runner’s knee?
This is where most people get it wrong. Runner’s knee isn’t simply a knee problem — it’s usually a hip and glute problem that shows up at the knee. The most common causes I see are:
Weak glutes and hip stabilisers. When your hip muscles aren’t strong enough to control the movement of your leg, your knee compensates — and takes strain.
Increasing training load too quickly. Jumping from 20km to 40km a week gives your body very little time to adapt. Tissues that aren’t conditioned for the load will eventually protest.
Tight quads and a weak VMO. The vastus medialis oblique (the teardrop muscle on the inside of your knee) plays a key role in kneecap tracking. When it’s underdeveloped relative to the outer quad, the kneecap gets pulled off-track.
Poor running form or cadence. Overstriding, excessive forward lean, or a slow cadence all increase the load through the knee with each footfall.
Why rest alone won’t fix it
Rest reduces inflammation and gives the irritated tissue a break — which is why it feels better after a few days off. But rest doesn’t strengthen your glutes, improve your hip stability, or correct your running mechanics. So when you lace up again and head out, the same forces are acting on the same structures, and the pain returns.
This is the cycle I see constantly: run, get sore, rest, feel better, run again, get sore again. Every iteration costs you training time and chips away at your confidence. The only way to actually break the cycle is to understand what’s driving the problem — and address it directly.
How a biokineticist treats runner’s knee
When a runner comes to see me with knee pain here in Somerset West, I don’t just focus on the knee. I look at the full picture — how you move, where your weaknesses are, and how your training load has changed. A thorough assessment will typically look at:
Hip and glute strength. We test whether your stabilisers are doing their job — because if they’re not, your knee is doing too much.
Running mechanics. A basic gait assessment can reveal a lot about where the excess stress is coming from.
Muscle balance and flexibility. Tight structures and imbalances between muscle groups are common contributors that go unnoticed until there’s pain.
From there, we build a targeted programme — specific strengthening exercises for the glutes, hips and VMO, load management guidance so you can keep running while you recover, and a clear plan for getting back to full training.
What does recovery actually look like?
With proper rehabilitation, most runners see significant improvement within 4 to 8 weeks. What “better” looks like isn’t just pain-free running — it’s understanding why it happened, having the strength to prevent it happening again, and feeling more confident in your body going into your next training block.
In most cases you don’t need to stop running entirely. We manage your load carefully so that you’re still building fitness while the underlying causes are being addressed. The goal is always to keep you moving — just smarter.
Runner’s knee is frustrating — but it’s one of the most treatable running injuries when addressed properly. If you’re based in Somerset West or the wider Helderberg area and want to know what’s really driving your knee pain, book an assessment with Gary.
Book your assessment at garymillerbio.co.za or call/WhatsApp 082 089 7248.
