Runner’s Knee (Patellofemoral Pain) Rehab Guide
Momentum Physio & Rehab Group, Traralgon
If the front of your knee hurts when you run, and you can’t point to a moment where you did something to it, this guide is for you. It covers what patellofemoral pain actually is, why running brings it on, how we assess it, and the full pathway we use to get you back to the distances you want without the knee complaining afterwards.
This isn’t a generic overview. It’s how we treat runner’s knee at Momentum Physio & Rehab Group, based on the current evidence and the system we’ve built working with runners across the Latrobe Valley and the wider Gippsland region. Whether you’re building toward the Traralgon Marathon, running parkrun on a Saturday morning, or clocking preseason kilometres for footy or netball, the process is the same.
We’ve broken it into five phases. Each phase has a goal, a set of criteria to enter it, and a set of criteria to leave it. Progression is based on what your knee can tolerate and what your strength testing shows, not on how many weeks have passed. Two runners who start rehab on the same day can be in completely different phases at eight weeks. That’s normal.
What is runner’s knee?
Runner’s knee, properly called patellofemoral pain, is pain at the front of the knee. It sits either behind the kneecap or around its edges. Your kneecap sits in a groove at the end of your thigh bone and glides through that groove every time you bend and straighten the knee. That’s the kneecap joint, and it’s the joint we’re talking about for the rest of this guide.
The pain comes on gradually rather than from a single incident, and it’s brought on by the things that load that joint: running, squatting, going up and down stairs, hopping, and sitting with your knee bent for a long stretch, in the car or at a desk.
You might also notice grinding, clicking or a bit of noise from the knee, tenderness when you press around the edges of the kneecap, a small amount of puffiness, or pain when you first straighten your leg after sitting.
There’s no single test that confirms patellofemoral pain. We diagnose it by reproducing your symptoms with the movements that load the joint, and by systematically ruling out the other things that cause pain in the same area. A squat brings symptoms on in around 80% of people with runner’s knee, and tenderness around the edges of the kneecap shows up in roughly 71 to 75%.
Do you need a scan?
Sometimes, yes. If there’s something in your history or your examination that points elsewhere, a bone stress injury, a cartilage problem, something in the hip referring pain down to the knee, then imaging is genuinely useful and we’ll organise it. There are absolutely cases where a scan changes the plan, and we’d rather find those early.
Most of the time, though, it won’t tell us much. Changes seen at the kneecap joint on MRI aren’t associated with patellofemoral pain. They don’t predict how much pain you’ll have and they don’t predict how well you’ll recover. Plenty of runners with significant pain have clean scans, and plenty of people with no pain at all have scans that look untidy.
So a scan is a tool we use when there’s a specific question to answer, not a default first step. Come and see us and we’ll tell you whether yours is one of the cases where it’s worth doing.
It usually doesn’t sort itself out on its own
Runner’s knee isn’t self-limiting. Rest will settle the symptoms, because rest removes the thing that provokes them. The catch is that rest also lowers what your knee can handle, so when you go back to running at the volume you left off at, the pain comes back.
| Rest will settle the symptoms. It won’t rebuild what your knee can handle. |
That cycle is the single most common reason runners end up dealing with this for months or years instead of weeks. It’s not that the rest was wrong. It’s that resting was the only thing that happened.
What’s actually going on
Your knee has a tolerance. It’s the amount of load it can absorb, week after week, while staying comfortable. Stay inside that tolerance and everything feels fine. Go past it and the joint gets sensitive.
| Sensitive isn’t the same as damaged. |
Nothing has torn. But once the joint is sensitive, the tolerance drops, and things you handled easily last month start to hurt. The 12 kilometre run that was routine becomes a 4 kilometre run that aches for two days.
There are two ways to go past it. One big effort, like a long hilly run after a few weeks off. Or the more common one for runners, steady load week after week without enough recovery in between. It’s rarely dramatic.
The goal of rehab
The goal is not to get you to rest until it stops hurting. The goal is to temporarily change your load so the joint settles, then progressively rebuild the envelope so it’s bigger than it was when you got injured. If we only do the first part, you get short-term relief and the same problem in three months.
That’s the whole logic behind the five phases below. Settle it down, then build it back up, and don’t stop building until the knee can handle more than your sport asks of it.
Why running brings it on
Every time your foot lands while you’re running, somewhere between four and a half and seven and a half times your body weight goes through your kneecap joint.
Jumping is higher, around ten times body weight. But you jump a handful of times in a session. You run about 170 steps a minute, for half an hour or more, several times a week.
| No single step is the problem. The total is the problem. |
How hard, how fast, how often
Three things decide how much work your kneecap joint ends up doing:
- How hard each step lands
- How fast that force arrives
- How often you take a step, across a run and across a week
All three matter, and you can change all three. That’s why we don’t just tell runners to run less. Running less is one option out of several, and it’s usually the one you’d least like to take.
How hard. Bigger, longer strides mean more force through the joint each time you land. Taking slightly shorter, quicker steps, roughly 5 to 10% more steps per minute, drops the load meaningfully without you needing to slow down overall. Most runners can make that change in a single session with a metronome.
How fast. The same force is harder on the joint when it arrives quickly. This is why downhill running is worse than uphill. Going down, gravity does the accelerating and your thigh muscles have to do the braking, and the braking is the expensive part. Downhills are usually the first thing we take out and one of the last things we put back.
How often. Force per step, multiplied by every step in the session, multiplied by every session in the week. This is the one runners underestimate most, because it’s invisible. A comfortable pace still adds up.
What usually changed before it started
Almost every runner we see with front-of-knee pain changed something in the month or two before symptoms started. Usually more than one thing at once, which is why it’s rarely obvious in hindsight.
On the training side:
- Running faster
- Running further
- Running more often
- Adding hills, especially downhill
- A change in surface, road to trail, grass to track
- New shoes
- Deliberately changing something about your technique
On the recovery side:
- Less sleep
- Fewer rest days
- A stressful stretch at work or home
- Being unwell or run down
- Eating less than your training needs
The training side is the one everyone thinks of. The recovery side is the one that gets missed, and it matters just as much.
Sleep, stress, illness and under-fuelling don’t cause knee pain directly. What they do is lower the ceiling on what your body can absorb. Your training might not have changed at all, but if you’ve had three bad weeks of sleep and a rough run at work, the same kilometres are landing on a smaller tolerance than they were in April.
On sleep specifically: in young athletes, averaging under eight hours a night is linked with a clearly higher injury rate than getting more than eight. That research was done in 12 to 18 year olds rather than adult runners, so treat it as a signal rather than a target. The principle holds regardless.
The practical upshot: if your training hasn’t changed but your knee has, look at the recovery side before you assume something’s wrong with your running.
Strength, movement and how we measure it
What we usually find
Runners with front-of-knee pain generally have reduced quadriceps size and strength on the sore side. They also commonly have less strength in the glutes and the muscles around the hip, and those muscles tend to switch on later and work for less time during loaded tasks.
There’s a nuance here that gets misrepresented a lot. Hip strength being down doesn’t necessarily cause runner’s knee. The research doesn’t support that, and it may well develop as a result of the pain rather than a cause of it. But that distinction matters for preventing the problem, not for fixing it. If your hip strength is down now, it’s affecting how your knee is loading now, and it needs work regardless of which came first.
None of this means anything is wrong with your body. It means there’s a gap between what your legs can currently produce and what your running is asking of them. Gaps like that are trainable.
We measure it rather than guess
| Feeling stronger and testing stronger aren’t always the same thing. |
This is where our VALD testing equipment does the heavy lifting.
DynaMo and ForceFrame measure how much force you can actually produce through your quads, glutes, hip and calf. We test both legs and compare them, so you can see exactly where the gap is and how big it is. We repeat the same tests through your rehab, which means progress is something you can see rather than something you have to take our word for.
ForceDecks, our force plates, measure how you distribute load between your legs during squatting, balance and hopping, and how much force you produce and absorb when you jump and land. People compensate quietly, often without knowing it. The force plates pick that up before it becomes a problem.
AirBands are our blood flow restriction cuffs. In the early phase, when the joint won’t tolerate heavy loads yet, blood flow restriction lets us build real quad strength using light weights. It’s specifically recommended in the clinical guidelines for patellofemoral pain, and it’s one of the more useful tools we have in the first few weeks.
Every set of results gets shown to you and compared back to your baseline. When we say you’re ready to progress, we’ll show you the numbers that say so.
How you run
Runners with front-of-knee pain tend to run with the knee falling inwards a bit more, with the hip dropping on the opposite side, and with less bend through the knee. Going down stairs and squatting, they often use less bend at the hip and knee and lean forward more through the trunk.
We don’t treat any of that as a fault to be corrected on principle. Running technique varies enormously between healthy runners and there’s no single correct way to do it. What we test is whether yours is relevant to your symptoms.
During your assessment we’ll change the movement in real time. More width between the knees, a quicker step rate, a shoe insert, some tape. Then we ask what your knee did.
| If changing it changes your pain, it’s worth working on. If it doesn’t, we leave it alone. |
One more thing worth knowing: getting stronger doesn’t automatically change how you run. If your running pattern needs to change, we retrain it directly, and we start that in Phase 1 rather than saving it for the end.
What else could it be?
Runner’s knee is a diagnosis we reach by ruling things out, not by finding something on a test. Several other problems cause pain in roughly the same place, and a few of them need a different approach entirely. Getting this right at the start is the difference between twelve weeks of rehab and twelve months of it.
This is why your first appointment involves a full knee examination rather than just treatment of the sore spot. We check swelling, range of movement, the ligaments, the cartilage, the kneecap and the joints above and below, even when the story sounds like a straightforward case.
The common look-alikes
| What it might be | Where you feel it | What tends to give it away |
|---|---|---|
| Patellar tendinopathy (jumper’s knee) | A specific spot right at the bottom tip of the kneecap. You can usually find it with one fingertip. | It warms up as you run and feels worse a few hours later or the next morning. Runner’s knee usually gets worse during the run, not after it. |
| Fat pad irritation | Just below and either side of the kneecap. More spread out than a single point. | Worse when your knee is straight and locked out, standing for long stretches, or in certain shoes. Deep bending doesn’t usually aggravate it the way it does with runner’s knee. |
| ITB-related pain | The outside of the knee rather than the front. | Comes on at a fairly predictable distance or time into a run, and downhills make it noticeably worse. |
| Bone stress injury | A deeper, more specific ache that you can often point to. | It doesn’t warm up. It’s there at rest, sometimes at night, and each run starts hurting earlier than the last. This one needs assessing promptly. |
| Pain referred from the hip | Front of the knee, but often with thigh or groin symptoms too. | Your knee examination comes back clean and moving the hip reproduces the pain. |
Two we get asked about most
Patellar tendinopathy gets confused with runner’s knee constantly, and the treatment is different enough that it matters. The clearest distinction is what happens during a run. Tendon pain often eases once you’re warm and then bites hours afterwards. Kneecap joint pain typically builds as the run goes on, and downhills or stairs make it worse in the moment.
Fat pad irritation is worth knowing about because the fat pad is one of the most pain-sensitive structures in the knee, and it responds to almost the opposite advice. Where we’d often work a sore kneecap joint through a controlled range, an irritated fat pad hates being pinched at full extension. Standing around, locking the knee out, and some taping techniques make it worse rather than better.
If you’re a younger runner
In runners under about 18, front-of-knee pain has a few extra possibilities, and they’re common rather than exotic. Growth-related pain at the bony lump on top of the shin, or at the bottom of the kneecap, is frequent in this age group and usually settles well with the right load management. It tends to be tender to touch and sore to kneel on.
Front-of-knee pain in a teenager alongside a limp, or pain that also shows up in the groin or thigh, is worth getting looked at sooner rather than later. It’s usually nothing serious, but there are hip conditions in this age group that present as knee pain and are much easier to manage when they’re picked up early.
When to get it checked promptly
Most front-of-knee pain in runners is not urgent. A few things are worth a same-week appointment rather than a wait-and-see:
- Pain that wakes you at night or aches steadily at rest
- Pain that starts earlier in every successive run rather than staying stable
- A knee that’s hot, visibly swollen, or you feel generally unwell with it
- Calf swelling, warmth or tenderness
- The knee giving way, locking, or not letting you put weight through it
- A teenager with knee pain plus a limp, or knee pain plus groin or thigh pain
| None of these mean something is seriously wrong. They mean it’s worth a proper look rather than another fortnight of guessing. |
How we assess it
Assessment isn’t a single appointment. It’s spread across your rehab, and it gets more demanding as your knee can handle more. There’s no point testing someone’s hopping in week one, and no point clearing someone for a return to full training on how their knee felt during a conversation.
Here’s what actually happens and when.
The two markers we track
This is the part that changes how rehab feels, so it’s worth explaining properly.
At your first appointment we pick one or two specific things to track, and we come back to them every single session. Not “how’s the knee”. Something you can measure.
For a runner that’s usually something like:
- How far you can run before the pain starts
- How long it takes to settle afterwards
- How much it hurts going down a specific flight of stairs
- Whether you can sit through a film without needing to straighten your leg
We do the same on the physical side. One or two objective markers, often a squat to a set depth, how much puffiness is in the knee, or your pain during a single leg squat.
| “It feels a bit better” isn’t information. “I got to 6k before it started, up from 3k” is. |
Progress in this condition is rarely linear, and without markers it’s very easy to feel like nothing’s happening when you’ve actually moved a long way. It also works the other way. Markers catch a plateau early, before you’ve spent six weeks doing something that isn’t working.
The first appointment
The first appointment is a full knee examination, not just a look at the sore bit. We check for swelling, go through your range of movement, palpate around the kneecap and the surrounding structures, test the ligaments, and check the cartilage and meniscus.
We’re doing two jobs at once here. Confirming that this behaves like kneecap joint pain, and ruling out the things covered in the previous section.
We also want the story in detail. What your training looked like in the eight weeks before it started, what you changed, how you’re sleeping, what’s happening at work, what you’re training for and when. That’s not small talk. Most of the useful information in this condition sits in the history.
Checking above and below the knee
Once the acute pain has settled, usually from a few weeks in, we assess whether the rest of the leg has the capacity for what you’re asking of it.
- Lower back: range and quality of movement
- Hip: range, control and strength
- Ankle and foot: range (particularly how far your knee can travel over your toes), balance and coordination
The question we’re answering is simple. Does each of these have enough capacity for the demands of the running you want to do? If your ankle range is limited, your knee absorbs more. If your hip control is down, your knee position changes under load. Neither of those gets fixed by treating the knee.
Strength testing
We start strength testing once the acute pain has settled, and we build it out as you progress. It’s done on our VALD equipment so the numbers are consistent every time and directly comparable between legs and across sessions.
Maximum strength. Slow build to a maximal effort, measured through the knee, hip and calf. Knee extension is tested at two different angles, because strength at one knee angle doesn’t tell us about the other.
Strength endurance. Repeated efforts to a metronome until you can’t maintain the pace or the technique. Running is a repeated-effort task, so how long you can hold a contraction matters as much as how hard you can produce one. We test this through the hip, calf, hamstrings and quads.
Power. How quickly you can produce force, not just how much. This one gets skipped in a lot of rehab and it’s the reason people fail on their return to running. Running isn’t a slow, heavy task. It’s a fast, repeated one, and rehab has to end up looking like that.
Every result gets compared between your sore side and your other side, and against your own baseline. You’ll see the numbers.
Balance, hopping and landing
Later in your rehab, once strength is where it needs to be, testing moves onto the things that look more like running.
- Balance and control in single leg positions, reaching in different directions
- Hop tests, single hop for distance, three hops in a row, and hopping sideways, comparing left and right
- How you land, measured on our force plates, looking at how much force you produce and how well you absorb it
- Springiness, small repeated hops and skipping drills, watching for a quick, quiet, rhythmic contact rather than a heavy, slow one
Hopping is the closest thing we can test to running without you running. If the two sides are meaningfully different here, running will find that difference for us.
Watching you run
Where it’s relevant, we’ll assess your running directly. Not to correct your technique on principle, but to see whether anything in how you run is contributing to your symptoms.
The useful part isn’t the observation. It’s what happens when we change something. We’ll adjust your step rate, your step width, where your knees are tracking or what’s on your feet, and then ask what the knee did.
| If changing it changes your symptoms, we’ve found something worth working on. If it doesn’t, we stop looking there. |
That process is quick, it happens in the room, and it saves months of working on something that was never the problem.
Questionnaires
We’ll usually have you fill out a short knee questionnaire at the start and repeat it at intervals. It scores how the knee is affecting the things you actually do rather than how much it hurts on the day.
It’s a five-minute job and it’s genuinely useful, partly because pain is a poor measure of progress on its own, and partly because it picks up things people don’t volunteer. Confidence in the knee, avoiding stairs, dropping activities quietly.
How you move through the phases
Before we get into the phases, this is the part that determines whether any of it works.
Most rehab runs on a calendar. Six weeks and you start running. Twelve weeks and you’re back to normal training. We don’t work that way, and the reason is straightforward: the calendar doesn’t know anything about your knee.
You move to the next phase when you meet the criteria for it. Every transition is gated by specific things we can measure, how much you can run without symptoms, how much force each leg produces, how the swelling is behaving, how you land. Hit the markers and you move on. Miss one and we stay put and build until you hit it.
Two runners who start on the same day can be in completely different phases at eight weeks. One had six weeks of symptoms before they came in, the other had six months. One sleeps eight hours, the other works nights. That’s not one of them doing it wrong. It’s the reason we use criteria instead of dates.
The five phases at a glance
| Phase | Rough timeframe | How often we see you | What we’re doing |
|---|---|---|---|
| 1. Settle and Retrain | Weeks 0-2 | Twice a week | Calm the joint down, find the load you can currently handle, start changing how you run |
| 2. Build Capacity | Weeks 3-12 | Weekly | Rebuild strength through the quads, glutes, hips and calves. Start easy, progress hard |
| 3. Strength, Power and Testing | From around week 12, gated on your testing | Fortnightly | Heavy strength, power and hopping, then the full testing battery |
| 4. Return to Full Running | Around weeks 12-16 onward | Fortnightly | Structured return to your volume, then speed, then hills and racing |
| 5. Staying Out of It | Ongoing | As needed | Keep the strength you’ve built, manage how quickly you add load |
Treat those timeframes as a guide, not a schedule. Some runners are through Phase 1 in a week. Some sit in Phase 2 for four months, particularly if they’ve had symptoms for a long time before starting.
One honest expectation to set: rebuilding muscle strength properly takes longer than eight weeks. Not eight weeks to feel better, that often happens sooner. Eight weeks is roughly the point where meaningful strength change starts showing up, and the work continues well past it. Most of the runners who end up back in this situation are the ones who stopped when the pain stopped.
How much pain is acceptable
You do not need to be pain-free to train. Working through some discomfort doesn’t hinder recovery from this condition, and waiting for zero pain before you load the knee is one of the fastest ways to make the whole thing take longer.
Here’s the rule we use:
| Up to 2 or 3 out of 10 during and after exercise is fine. It needs to settle within about an hour, and it must be back to your normal by the next morning. |
That last part is the one that matters. If your knee is still worse 24 hours later, that session was too much. Not catastrophic, not damaging, just too much for right now. We pull the volume or the intensity back, you repeat it, and you build from there.
It’s a rule you can apply yourself between appointments, and it’s far more useful than trying to guess whether something is “safe.”
How quickly running goes back up
When we start rebuilding your running, we change one thing at a time and in a set order:
- Distance first. Get the volume back before anything else.
- Then speed. Faster running loads the joint harder and faster.
- Then hills. Downhill last, because it’s the most demanding thing you’ll do.
As a working range, we increase your weekly running load by somewhere between 10 and 30%. Where you sit in that range depends on how long you’ve had symptoms, how much running history you have behind you, and what you’re building toward. Someone coming off a long layoff sits at the bottom of it. An experienced runner with a short history of symptoms can often move at the top.
The reason the ceiling exists at all is that the most common way runners re-aggravate this is a good fortnight followed by an ambitious weekend.
Phase 1: Settle and retrain (weeks 0-2)
We’ll usually see you twice a week during this phase. Your first appointment runs 45 minutes because there’s a lot to get through, and it isn’t all treatment.
What we’re trying to achieve
Three things. Get the joint less irritable. Work out how much running you can actually do right now without setting it off. And start changing how you run, because that’s the lever with the fastest effect on symptoms.
Exercise is not the main event in this phase. That surprises people, and it’s deliberate. If we hand you a program of eight exercises while your knee is still sore every time you walk down stairs, you’ll do them badly, they’ll aggravate you, and you’ll conclude that rehab doesn’t work. The strength work starts properly in Phase 2 and it doesn’t stop for months. Right now the priority is settling the joint and getting your running dose right.
Finding your baseline
This is the most important conversation in Phase 1, and it’s not “stop running.”
We’re looking for the amount of running you can currently do that doesn’t leave the knee worse the next day. That’s your baseline, and everything gets built from there. To find it we adjust one of four things:
- How far you run
- How often you run
- How hard you run
- How much your knee has to bend, meaning hills, stairs, and deep squatting in the gym
Which one we change depends entirely on what matters to you. A distance runner building toward an event will often keep their distance and cut the frequency or the intensity instead, because the long run is the thing they’d least like to lose. Someone who runs four times a week to clear their head might prefer to keep the frequency and shorten each one.
| There’s no single correct modification. There’s the one that settles your knee and that you’ll actually stick to. |
The first thing off the list is almost always downhill running. It’s the most demanding thing you do and it gives us the biggest reduction in load for the smallest change to your week.
Retraining how you run
We start this in Phase 1 rather than saving it for later, because changing how you run can reduce symptoms within a session or two. Getting stronger takes months. Both matter, but only one of them works quickly.
The principle is simple: find the thing in your running pattern that’s loading the kneecap joint hardest, and change it. Not to make you a textbook runner, but to take pressure off the joint while we build its capacity back up.
Step rate is the first thing we look at. Increasing how many steps you take per minute by 5 to 10%, without changing your pace, meaningfully reduces the load through the kneecap joint. It’s the highest-value change available and most runners can do it in one session with a metronome or a playlist at the right tempo.
The cue is: “shorter, quicker, lighter steps.”
Beyond that, it depends on what we see when we watch you run. Common changes and the cues we use:
| What we’re changing | Cues that tend to work |
|---|---|
| Running taller through the trunk | “Stand up taller.” “Imagine a hook through the crown of your head lifting you up and slightly forward.” |
| Stopping the knee falling inwards | “Push your knees out.” “Keep the distance between your knees.” “Your knees are headlights, keep them pointing forward.” |
| Running slightly wider | “Imagine you’re running on a train line, feet a little wider apart.” |
| Driving the hip through | “Drive through your hips.” |
| Landing more softly | “Run softly.” Usually combined with a higher step rate. |
We’ll often use a mirror or video feedback while you’re on the treadmill, because seeing it changes it far faster than being told about it. Real-time feedback works particularly well for the knee falling inwards and the hip dropping on the opposite side.
One honest caveat. Not every runner needs their technique changed, and we won’t change yours just because we can. We test it in the room first. If a cue changes your symptoms, we keep it and drill it. If it doesn’t, we move on and put the time somewhere more useful.
Hands-on treatment
Every appointment in this phase includes hands-on work. It’s not the thing that fixes the problem, but it makes the joint less irritable, which makes everything else possible sooner.
Soft tissue work through the quads, the hamstrings and calf, and around the outside and back of the hip.
Joint work, where it’s useful. Gentle movement of the kneecap itself, of the knee joint into bending and straightening, and occasionally the small joint on the outside of the shin just below the knee if it’s stiff enough to be limiting how you squat. How firmly we work depends on how irritable your knee is on the day.
Taping
We’ll usually tape the knee in this phase. Rigid tape is our preference because it holds better through a run, though we’ll use kinesiology tape if you’d rather.
The research can’t tell us exactly what taping does structurally. What we do know is that it can be extremely helpful for the right person, and it tends to earn its keep in the first twelve weeks while we’re getting on top of symptoms. Less pain now means you can run more, load more and progress faster, and that’s the part that changes your outcome.
So we trial it and see how your knee responds. If it helps, we keep using it and teach you to apply it yourself. If we’re taping regularly, use it two days on, one day off so your skin doesn’t react.
What you do at home
Two things in Phase 1. Both small.
Self massage, about five minutes a day, through the quads, calf and around the hip. Foam roller, massage gun, a rolling pin or just your hands, whatever you’ll actually use.
Self taping, if it’s helping and you’re comfortable applying it.
That’s it. Keeping the home program tiny in the first fortnight is intentional. The compliance you’ll need in Phase 2 is significant, and burning people out on a long exercise list before the knee has even settled is how that gets lost.
Footwear
Footwear is one of the first things we’ll ask about, because a shoe change sits in the weeks before symptoms started more often than people realise.
Some shoes put more load through the kneecap joint than others, and the main thing driving it is heel-to-toe drop, the height difference between the heel and the forefoot of the shoe.
Higher drop shoes increase the load through the kneecap joint. In lab testing, shoes with a 10 to 15mm drop produced more than 15% higher peak stress at the kneecap joint than a zero drop shoe. It starts to show up above roughly 5mm. The mechanism is straightforward: a higher heel encourages you to land on your heel with the knee more bent, the quad has to work harder, and the kneecap is pressed harder into its groove.
Lower drop shoes reduce it. Low drop and minimalist shoes shift you toward landing further forward on the foot, which lowers the demand at the knee.
The load doesn’t vanish though. It moves down to your calf and Achilles. That’s exactly why a higher drop shoe, or a heel lift, is a useful short-term tool for someone with an Achilles problem. It’s the opposite prescription to the one that suits a sore kneecap joint.
| A lower drop shoe doesn’t remove load. It moves it from your knee to your calf. |
So the right shoe depends on what your knee and your calf can each handle right now. If a footwear change is worth trialling we’ll do it gradually, and build the calf strength to support it first. Switching abruptly is one of the more common ways runners trade one problem for another.
Worth being clear on one thing: this research measures load at the joint, not whether changing your shoes fixes your pain. Footwear is one lever among several, and on its own it’s rarely the answer.
The other direction
Drop isn’t the only thing a shoe changes, and lowering it isn’t the only option.
For some runners the issue is how much the knee rotates under load rather than how bent it is. A more stable shoe, one built with firmer foam through the inside of the midsole, has been shown to reduce that rotation more than a neutral shoe or an insert. If that’s your picture, a stability shoe is the sensible trial rather than a flatter one.
Orthotics
If your foot posture and how you load through the foot suggest they’d help, we may trial an orthotic and wean you into it gradually.
Same story as the tape. The research can’t pin down exactly what orthotics change structurally, but they can make a real difference for the right person, particularly through the first twelve weeks. Sometimes an off-the-shelf option is enough, and that’s usually where we’ll start before considering anything more involved.
Either way they sit alongside your exercise program rather than in place of it. The orthotic buys comfort while the strength work does the lasting work.
| VIDEO: Self-taping demonstration, filmed so someone can follow it at home. Include the two-days-on, one-day-off instruction and what skin irritation looks like. This one earns saves and shares, and it reduces admin time in clinic. |
Before you move to Phase 2
Phase 2 starts when all four of these are true:
| Exit criteria – Phase 1
Minimal pain during your daily activities and your current running dose No inflammatory pattern, meaning no night pain and no morning stiffness that lingers No swelling in the knee Full range of movement, bending and straightening, matching your other side |
If one of these isn’t there, we stay in Phase 1. It’s usually a short phase, often just the two weeks, but there’s no benefit in starting a strength program on a knee that’s still reactive.
Phase 2: Build capacity (weeks 3-12)
We’ll usually see you weekly through this phase. It’s the longest phase and it’s where the outcome is actually decided.
What we’re trying to achieve
Phase 1 settled the knee. Phase 2 rebuilds what it can handle, and it does that by making your quads, glutes, hips and calves considerably stronger than they are right now.
The evidence on this is about as clear as it gets in our field: working the hip and glutes alongside the knee produces better results than working the knee on its own, in the short, medium and long term. So we train the whole leg, not the sore bit.
We also assess the rest of the chain properly in this phase now that the knee tolerates more. Your lower back, your hip range and control, your ankle range, balance and coordination. If your ankle doesn’t bend far enough, your knee absorbs more. If your hip control drops off under fatigue, your knee position changes. Neither of those improves by treating the knee.
Where your knee likes to be loaded
This is the most useful thing in this section, and almost nobody explains it to patients.
How much work your kneecap joint does during an exercise depends on how bent your knee is, and whether your foot is planted or free. And the two work in opposite directions.
| Type of exercise | Examples | Where the joint works hardest | Where it’s easiest |
|---|---|---|---|
| Foot planted | Squats, step-ups, wall sits, lunges | The more your knee bends. Load climbs sharply past about 60 degrees | Shallow. Roughly the first 45 degrees of bend |
| Foot free | Leg extension machine, seated knee kicks | The straighter your knee gets. Hardest in the last 30 degrees | Bent. Roughly 90 down to 60 degrees |
So in the early part of Phase 2, when the joint still has limited tolerance:
- Foot planted, we stay shallow. Wall sits starting around 30 degrees, squats to a box, step-ups to a low step.
- Foot free, we stay bent. Short-range knee extensions from 90 to 60 degrees rather than kicking all the way out.
| Leg extensions aren’t bad for your knee. Heavy leg extensions in the last 30 degrees, on an irritable joint, are a bad idea. Those aren’t the same statement. |
As tolerance improves we open both ranges up, because you need full range strength eventually. Deep squatting and full range extension aren’t off the table permanently. They’re just not where we start.
How the program progresses
We move through five stages, in order. You don’t skip ahead and you don’t stop early.
- Activation. Light loads, high repetitions, slow and controlled, focused on getting muscles switching on properly and holding tension. Often done daily.
- Size. Moderate loads, moderate repetitions, building actual muscle. Usually two to three times a week.
- Strength. Heavier loads, fewer repetitions.
- Power. Producing force quickly rather than just producing a lot of it.
- Plyometrics. Jumping, landing and hopping. Teaching the leg to absorb force and give it back.
A worked example of how that looks in practice: hip strength might start as side-lying leg raises for 3 sets of 30 with slow controlled reps, progress to 3 sets of 12 to 15 with resistance, then to 3 sets of 12, then to 3 sets of 6 with real load on a cable machine.
Roughly every three to four weeks we cut the repetitions and add load. 3 sets of 15 becomes 3 sets of 8 becomes 3 sets of 5.
Set your expectations for the first few weeks. The early exercises will feel easy. They’re not the destination, they’re the first step of a ladder that ends in loaded single leg work and hopping. People who quit at this stage quit because nobody told them what the ladder looked like.
The four ladders
Your program is built from four progressions running alongside each other. You won’t be at the same rung on all four at once, and that’s normal. How fast you climb each one depends on your symptoms, your starting strength and how much time you’ve got, not on a fixed schedule.
The doses below are typical starting points. Yours will be set to what you can currently do.
Ladder 1: Quads and knee
This is the one that most directly loads the kneecap joint, and the one we’re most careful with early.
| Step | Exercise | Typical dose | What changes at this step |
|---|---|---|---|
| 1 | Wall sit | 3 x 60 seconds | Start around 30 degrees of bend. Increase the depth over the phase toward 90. Position over load. |
| 2 | Squat to a chair | 3 x 12-15 | Both legs, controlled, to a fixed depth you can repeat. |
| 3 | Single leg squat to a chair | 3 x 12 | The jump from two legs to one is the biggest step in this ladder. |
| 4 | Step-up | 3 x 12 each side | Adds a push through one leg with the other unweighted. Height increases before load does. |
| 5 | Loaded squat | 3 x 12 → 3 x 8 → 3 x 5 | Depth opens up here. Load starts climbing properly. |
| 6 | Rear foot elevated split squat | 3 x 12 → 3 x 8 → 3 x 5 | Hip-dominant version first, then shift the shin angle forward to load the quad harder. |
| 7 | Front foot elevated split squat | 3 x 8 → 3 x 5 | More range through the front knee. A real step up in demand. |
| 8 | Decline squat | 3 x 8 → 3 x 5 | The hardest position for the kneecap joint. If you can load this well, you’re in good shape. |
Ladder 2: Glutes, sideways
| Step | Exercise | Typical dose | What changes at this step |
|---|---|---|---|
| 1 | Side-lying leg raise | 3 x 30, slow | Activation. High reps, slow tempo, top of the hip doing the work. |
| 2 | Side-lying leg raise, loaded | 3 x 12-15 | Band or ankle weight added. |
| 3 | Side plank with leg raise | 3 x 30 → 3 x 12-15 | Now the whole side of the body is holding position while the hip works. |
| 4 | Side plank with leg raise, loaded | 3 x 12 | |
| 5 | Standing cable hip abduction | 3 x 12-15 → 3 x 12 → 3 x 6 | Upright and on one leg, which is what running actually asks for. |
Ladder 3: Glutes, hip extension
| Step | Exercise | Typical dose | What changes at this step |
|---|---|---|---|
| 1 | Double leg bridge with band | 3 x 15, 5 second holds | Long holds. This is about switching things on, not lifting heavy. |
| 2 | Double leg bridge with band + knee extension | 3 x 15, 5 second holds | Straightening one knee at the top adds a quad demand on top. |
| 3 | Split stance bridge | 3 x 15, 5 second holds | Weight shifts toward one side. |
| 4 | Single leg bridge | 3 x 15, 5 second holds | Progress by adding weight or by moving faster. |
| 5 | Standing cable hip extension | 3 x 12-15 → 3 x 12 → 3 x 6 | Upright, single leg, driving the hip back. |
| 6 | Hip thrust | 3 x 12-15 → 3 x 12 → 3 x 6 | Where the heavy loading lives. |
Hip work responds well to frequency and time under tension. Long holds, slow repetitions, and done most days rather than twice a week. That’s different to how we dose the quad ladder.
Ladder 4: Calves
Under-trained in almost every runner we see. Your calves absorb a large share of the force your knee doesn’t have to.
| Step | Exercise | Typical dose | What changes at this step |
|---|---|---|---|
| 1 | Double leg calf raise | 3-4 x 15-25, slow | Three to four seconds per rep. Full range, all the way up and all the way down. |
| 2 | Single leg calf raise | 3-4 x 15-25, slow | Off a step for full range. |
| 3 | Loaded standing calf raise | 3-4 x 8-12 | Weight added. Targets the calf muscle with the knee straight. |
| 4 | Loaded seated calf raise | 3-4 x 8-12 | Knee bent, which shifts the work to the deeper calf muscle. Both are needed for running. |
Ladder 5: Learning to land
Toward the end of Phase 2, once strength is coming along, we start teaching the leg to absorb force. This is the bridge between the gym and running, and it’s the part that gets skipped most often.
| Step | Exercise | What it’s teaching |
|---|---|---|
| 1 | Snap down, both legs | Drop into a landing position fast and stop dead. Absorbing force with no jump involved. |
| 2 | Snap down, split stance | Same, with the weight uneven. |
| 3 | Snap down, single leg | Same, on one leg. Now it looks like running. |
| 4 | Altitude landing, both legs | Step off a low box and stick the landing. Gravity does the loading. |
| 5 | Altitude landing, single leg | Same on one leg. Box height goes up slowly. |
| 6 | Depth jump | Step off, land, and jump straight back up. Absorbing and producing in one movement. |
| 7 | Depth hop | Same on one leg. |
What we’re watching for is quiet. A soft, controlled landing with the knee tracking properly. A heavy or noisy landing means you’re not absorbing force, you’re catching it.
What the running looks like
You’ll be running through this phase. We’re building your weekly load back up at the same time as we’re building strength, using the same rules as before: distance first, then speed, then hills, increasing 10 to 30% a week, judged against how the knee is 24 hours later.
Hands-on treatment continues where it’s useful, but it steps back as the exercise does more. Same with tape. We’ll deliberately reduce how much you rely on it as your tolerance improves, rather than letting it become permanent.
Dosage rules
- Low-load activation work can be done daily. For those exercises, more frequent is generally better.
- Work at about 6 to 7 out of 10 effort, or a weight where you could manage 12 repetitions with good technique but it’s genuinely hard.
- Keep applying the 24-hour rule. If the knee is worse the next day, that session was too much. Pull it back and rebuild.
Quality is the whole thing
This matters more in this phase than any other, and it’s the difference between a program that works and one that doesn’t.
| Doing the exercise and getting through the exercise are different things. |
In a split squat, we want a tall torso and the right shin angle, because that’s what puts the load through the quad rather than letting the hip take it. In landing and jumping work, we want a soft, controlled landing with the knee tracking properly, not a heavy one that gets the rep done.
Two poor sets of ten do less than one good set of eight. If you’re not sure whether you’re doing it right, ask us to film you. That’s a two-minute job in a session and it saves weeks.
| VIDEO: Split squat coaching. Show a poor rep, torso tipping forward, knee falling inwards, and a good one side by side, and give the cue for the shin angle. Then the same treatment for a landing. Quality-of-execution videos are the most watched rehab content we can make because people genuinely can’t tell from a written program. |
Before you move to Phase 3
This is the first gate that has numbers attached to it.
| Exit criteria – Phase 2
Minimal pain and no inflammatory pattern No swelling Full range of movement 95% strength symmetry between legs on quad, calf and hip testing, measured on our VALD equipment Completion of the functional testing battery |
That 95% figure means your sore side is producing at least 95% of the force your other side produces. We test it rather than estimate it, and we’ll show you the numbers.
If you’re sitting at 80%, you’re not ready, regardless of how the knee feels or how many weeks it’s been. That gap is exactly what running will find.
Phase 3: Strength, power and testing (from around week 12)
Appointments drop to fortnightly here. That’s a deliberate change, not us losing interest. By this point you’re doing the bulk of the work independently in the gym. Our job shifts from treating to checking, progressing and testing.
What we’re trying to achieve
Phase 2 got both legs producing similar force. Phase 3 makes the whole leg genuinely strong, then adds the two things running actually demands and gym work alone doesn’t deliver: producing force quickly, and absorbing it repeatedly.
This is the phase people skip. They hit their symmetry numbers, feel fine, and go back to running. Then they end up back where they started three months later, because a leg that’s symmetrical at slow speeds isn’t necessarily a leg that copes with four to seven times bodyweight arriving 170 times a minute.
| Running is a fast, repeated task. Your rehab has to end up looking like one. |
Heavy strength
The strength work from Phase 2 continues, but heavier and with fewer reps.
Every three to four weeks we cut the repetitions and add load: 3 sets of 15, to 3 sets of 8, to 3 sets of 5. Heavy strength work happens two to three times a week. That’s less frequent than the activation work in Phase 2, because heavy sessions need recovery between them.
Two specific targets we work toward on the calf, since it’s the one runners consistently under-build:
| Calf exercise | Target added load | Sets and reps |
|---|---|---|
| Single leg standing calf raise (Smith rack) | 0.3 to 0.4 x your body weight | 3-4 x 6-8 |
| Single leg seated calf raise (Smith rack) | 1.2 to 1.5 x your body weight | 3-4 x 6-8 |
Those look wildly different because they are. Standing, you’re already lifting your own body weight and adding to it. Seated, your body weight isn’t loading the calf at all, so the bar has to do all of it.
Power
Strength is how much force you can produce. Power is how fast you can produce it. They’re trained differently and improving one doesn’t automatically improve the other.
This matters more than it sounds. The time your foot spends on the ground during running is very short, and how much force you can generate in that window is what counts. Slow, heavy gym work builds the capacity. Power work teaches you to access it quickly.
The plyometric program
Jumping and landing work progresses through four stages. Each one adds a demand rather than just adding volume.
| Stage | What it’s developing | Example exercises |
|---|---|---|
| 1 | Eccentric strength and stability. Controlling the landing. | Box jump 3-5 x 5. Single leg box jump 3-5 x 5 each. Single leg lateral box jump. Lateral bound and stick 3 x 5 each side. |
| 2 | Gravity does more of the work, and the movement adds a forward and sideways element. | Hurdle jump and stick 3 x 5. Single leg hurdle hop and stick 3 x 5 each. Single leg lateral hurdle hop and stick. 45 degree bound and stick 3 x 5 each. |
| 3 | Same movements plus a bounce, so the leg loads and unloads in one continuous action. | As stage 2, with a rebound rather than a stick. |
| 4 | Reacting to the ground and cutting the time your foot spends on it. | As stages 2 and 3, plus power skips. |
The word “stick” matters in stages 1 and 2. You land and you hold it. No wobble, no second hop, no knee falling inwards. If you can’t stick the landing, you’re not ready to bounce out of it.
Hands-on treatment
Minimal by now, and that’s the point. The bulk of your appointment is strength, endurance and plyometric work.
We’ll still do some soft tissue work if you need it, some joint work if stiffness is genuinely limiting your range, and tape for specific situations, a heavy training block, or a flare-up while you’re building load. But hands-on becomes a tool for managing the load you’re doing, not a treatment in its own right.
The full testing battery
This is the most thorough testing you’ll do, and it’s what decides whether you’re cleared for a full return to running.
| What we test | How | What we want to see |
|---|---|---|
| Maximum strength | Quads, hamstrings, hip (out and in) and calf on our VALD dynamometry | At least 95% symmetry between legs |
| Strength endurance | Repeated contractions to a metronome until you can’t hold the pace or the technique. Quads, hamstrings, calf | At least 95% symmetry between legs |
| Balance and control | Single leg balance with reaching in three directions (Y-balance test) | Symmetrical reach distances |
| Hop testing | Single hop for distance, three hops in a row, and hopping sideways | Symmetrical, and pain-free |
| Springiness | Small repeated hops on the spot (pogos) and skipping drills | Quick, quiet, rhythmic contacts with good form |
The last one gets underrated. Pogos and skipping drills are the closest thing to running you can do standing still. If your contacts are heavy, slow or uneven, running will be too, and we’d rather find that in the clinic than at kilometre eight.
Everything gets compared to your other leg and to your own baseline from earlier in your rehab. You’ll see all of it.
Before you move to Phase 4
| Exit criteria – Phase 3
Minimal pain, no inflammatory pattern, no swelling, full range 95% strength symmetry on maximum strength testing across quad, hip and calf 95% symmetry on strength endurance testing Symmetrical, pain-free hop testing Symmetrical balance and reach testing Controlled pogos and skipping drills with good form |
Meet these and you’re ready to rebuild your running properly. Not “start running”, you’ve been running since Phase 1. Ready to take the brakes off.
Phase 4: Return to full running (from around week 12-16)
Fortnightly appointments continue through this phase.
What we’re trying to achieve
Getting you back to your full training, at the volume, the speed and on the terrain you actually want, without the knee reacting.
You can’t get here through gym work alone. Resistance training can’t replicate how quickly force arrives during running, or how much of it accumulates over an hour. No matter how well you’ve built the leg, the only way to prepare for running is to run, and to add it back in a structured order.
If you’ve been off running completely
Most people reading this will have kept running at a reduced dose the whole way through. If your knee was irritable enough that you had to stop entirely, we rebuild with walk-run intervals first.
A typical starting point and progression:
| Week | Session structure | Total running time |
|---|---|---|
| 1 | 1 min run / 2 min walk x 8 | 8 minutes |
| 2 | 2 min run / 2 min walk x 8 | 16 minutes |
| 3 | 3 min run / 1 min walk x 7 | 21 minutes |
| 4 | 5 min run / 1 min walk x 5 | 25 minutes |
| 5 | 9 min run / 1 min walk x 3 | 27 minutes |
| 6 | Continuous, easy pace | 30 minutes |
Three sessions a week, easy pace, flat ground. Judged against the 24-hour rule every time. If the knee is worse the next day, you repeat that week rather than moving on. Nobody gets penalised for repeating a week.
The order we rebuild in
Once you’re running continuously, we change one variable at a time. Never two at once, because if something flares we need to know what caused it.
- Volume first. Get your weekly distance back to where you want it, increasing 10 to 30% a week depending on your history and how you’re responding. Easy pace, flat ground, boring on purpose.
- Then speed. Intervals and tempo work go back in once your volume is stable. Faster running means more force and less time on the ground, which is a genuine step up in demand for the kneecap joint. Start with short efforts and long recoveries.
- Then hills. Uphill first. It’s harder work aerobically but easier on the kneecap joint than the alternative.
- Downhill last. This is the most demanding thing you’ll do, it’s the thing we took out first in Phase 1, and it’s the last thing to come back.
Getting downhill running back
Worth its own explanation, because it’s where most re-aggravations happen.
Going downhill, gravity accelerates you and your quads have to do the braking. That braking is the expensive part, and it arrives fast.
We reintroduce it in small pieces:
- Gentle gradient before steep gradient. A slight decline for a few minutes before anything genuinely steep.
- Short segments before long ones. A minute or two of downhill inside an otherwise flat run.
- Softer surface first where you have the option. Grass or trail before sealed road.
- Shorter, quicker steps on the way down. The same cue from Phase 1 matters most here. Long strides downhill are the highest load you can put through the joint.
- Change gradient or duration, not both.
Getting back to racing
If you’re building toward an event, we work backwards from the date. The rule we use:
| Complete two to four full weeks at your target training load, then race something shorter than your goal event, before you race the goal event. |
That gives us two checkpoints. Whether your body handles the training load, and whether it handles race intensity, which is always higher than what you produce in training. Finding out on the day of your goal race is a bad plan.
Don’t stop the strength work
This is the single most important sentence in this phase.
| The gym work does not stop when the running comes back. |
The most common way runners end up back at the start is dropping the strength work as soon as the running feels good. The running load goes up, the strength support comes down, and the knee ends up back in the same position it was in six months ago.
Through Phase 4, heavy strength continues two to three times a week alongside your running. It reduces later, in Phase 5, but it never disappears.
The end goals
These are the targets for the whole program, not just this phase. Meet them and your knee has more capacity than your running is asking of it, which is exactly where we want you.
| End goals
Back to your full training, at full intensity, frequency and duration, with minimal or no pain No inflammatory pattern and no swelling Leg press 1.5 x your body weight 95% symmetry on strength endurance testing Hop testing symmetrical and pain-free Single leg drop hops performed with good control and stiffness Repeated forward hops over hurdles with rhythm and genuine absorption on each landing |
Phase 5: Staying out of it (ongoing)
We’ll see you as needed from here. No fixed schedule.
You’re through the rehab. This phase is about keeping the capacity you spent months building, and recognising the early signs if it starts slipping.
Keep lifting, just less of it
You don’t need to keep training like you’re in rehab. You do need to keep training.
One to two solid lower body strength sessions a week is enough to hold what you’ve built. Heavy enough to be meaningful, covering the quads, glutes and calves. That’s it. It’s a fraction of what Phase 2 and 3 asked of you.
The runners who end up back with the same problem are almost always the ones who stopped completely once the pain went. Strength fades. Running volume doesn’t. The gap between those two is where this problem lives.
The 10 to 30% rule, in practice
Your weekly running load shouldn’t jump by more than 10 to 30% week on week. Where you sit in that range depends on your history and how much running you have behind you, and in a settled maintenance phase most runners sit toward the lower end.
What that means in practice:
- A 40km week becomes a 44 to 52km week, not a 60km week
- Recovery weeks are part of the plan, not a sign of weakness. Build for three weeks, pull back for one
- Adding a hill session, a speed session and extra distance in the same week counts as three changes, not one
- Coming back from a break, restart lower than where you left off. Two weeks off means your capacity dropped, even though your ambition didn’t
Watch the capacity side
The training side is easy to track. The other side is the one that catches people.
Your knee’s tolerance isn’t a fixed number. It moves with your sleep, your stress, whether you’re unwell, and whether you’re eating enough for the training you’re doing. The same 50km week lands very differently on eight hours of sleep than it does on five.
So when life gets heavy, that’s the week to hold your training steady rather than build. Not because you’re fragile, but because the ceiling has temporarily dropped and the load you were planning was set against the old one.
The boom-bust cycle
This is the pattern to watch for, and once you’ve seen it named you’ll recognise it:
| Feel good, do too much, flare up, back off, feel good, do too much. |
Each cycle feels like bad luck. It isn’t. It’s a load that keeps exceeding a capacity that never gets the chance to build, because every time you start feeling good you spend the improvement immediately.
Breaking it means holding steady when you feel good, which is a lot harder than it sounds, and building from there instead.
Early warning signs
You’ll usually get a few weeks of notice before this becomes a real problem. What to look for and what to do:
| What you notice | What to do |
|---|---|
| The knee talks to you after runs when it hadn’t been | Hold your current load for a week or two. Don’t build. |
| It’s taking longer to settle after a run than it used to | Drop your weekly load 20 to 30% for a week, then rebuild slowly. |
| Stairs or squatting start to niggle again | Get your strength sessions back to twice a week if they’ve slipped. |
| It’s there during the run, not just after | Pull the downhill and speed work out first. They’re the highest load. |
| Any of the above lasting more than two or three weeks | Come and see us. |
| The difference between a two-week problem and a six-month problem is usually how long someone waited before doing something about it. |
Come back for a retest
Worth doing every six to twelve months, and worth doing before a big training block rather than during one.
If you’re building toward a marathon, an ultra, or a preseason, a testing session beforehand tells us whether your strength has held or quietly drifted. Fixing a 15% side-to-side gap before you start adding volume takes a few weeks. Fixing it halfway through a marathon build, while you’re already sore, takes a lot longer.
Frequently asked questions
Can I keep running, or am I making it worse?
You can almost always keep running, and in most cases you should. Pain at the front of the knee is a sensitivity problem, not a damage-in-progress problem, and running within your current tolerance doesn’t harm the joint. Use the rule: up to 2 or 3 out of 10, settling within about an hour, and back to normal by the next morning. If that holds, the running is part of the treatment rather than working against it. Stopping completely is what lowers your capacity, which is exactly why it comes back when you start again.
How long does this take?
Two different questions in one, and they have different answers. Feeling better usually happens within a few weeks once we get your running dose right and settle the joint down. Being properly rehabilitated takes considerably longer, because meaningful strength change starts showing up around the eight week mark and the full program typically runs three to four months at a minimum. If you’ve had symptoms for a year before coming in, expect the longer end. Almost everyone who ends up dealing with this repeatedly stopped at the first answer and never got to the second.
How many appointments will I actually need?
Somewhere between 15 and 20 appointments across four to six months for a more involved case, and many people need fewer. The shape is twice a week for the first fortnight, weekly through the main strength-building block, then fortnightly once you’re working more independently. It’s front-loaded on purpose, and the gaps get longer as you get better at running the program yourself. If you’ve caught it early, or you’re already training consistently and reasonably strong, it can be considerably shorter. We’ll give you a realistic estimate after your first assessment rather than leaving you to work it out as you go.
Do I need a gym membership?
Not at the start. The first few weeks are bodyweight, a resistance band and some hands-on work, all of which you can do at home. From the strength-building phase onward you’ll need access to real load, dumbbells, a cable machine, a leg press and ideally a Smith rack, because bodyweight stops being enough fairly quickly. You can do that work in our gym as part of your sessions, or at any gym you already use. We’ll write the program around whatever you actually have access to, not around ideal equipment you don’t.
Should I be stretching?
It’s not a priority for this problem. Full range of movement does matter and we check it at every stage, but a tight-feeling quad isn’t the issue, and stretching it doesn’t build the capacity that’s actually missing. If your range is genuinely restricted we’ll address it with hands-on work and loading through range rather than static stretching. Calf and hip mobility are worth attention if they’re limiting how you move, and we’ll tell you if yours are. Otherwise, the time is better spent on the strength work.
Do I need different shoes?
Buying a new pair is the first thing most runners reach for, and it’s rarely the fix on its own. The timing is the part worth getting right: changing shoes while your knee is irritable introduces a new loading pattern at exactly the moment we’re trying to work out what your knee can currently handle. If your current pair is genuinely past it, replace them with something similar rather than something different, and do it early rather than mid-rehab. If footwear does look like part of your picture, we’ll test it in the room before you spend anything, and there’s a fair amount we can change with lacing and insoles at no cost.
I’ve had this for years. Is it too late?
No. Long-standing symptoms take longer to turn around, mostly because the strength gaps are bigger, the running capacity has usually dropped a long way, and confidence in the knee takes time to rebuild. The process is the same one described in this guide, we just spend longer in the early phases and progress more gradually. Having had it for years doesn’t mean you can’t get back to full running. It usually means nobody has taken you through a complete program, all the way through to power and hopping, rather than stopping when the pain settled.
Written by Chris Calabrese, Physiotherapist and Director, Momentum Physio & Rehab Group, Traralgon.
Momentum Physio & Rehab Group is a physiotherapy and rehabilitation clinic in Traralgon East, working with runners and active people across the Latrobe Valley and Gippsland. Our purpose-built facility includes a full rehabilitation gym and VALD testing technology, so your progress is measured rather than estimated at every stage.
If you’re dealing with front-of-knee pain and you’d like it assessed properly, call us on 03 4148 8900 or book online.