Runner’s Knee Treatment
Runner’s knee — clinically known as chondromalacia patella or patellofemoral pain syndrome — is one of the most common causes of anterior knee pain in active adults, occurring when the cartilage on the underside of the kneecap softens, roughens, or deteriorates from abnormal friction against the trochlear groove of the femur during repetitive bending and straightening of the knee. Despite its name, runner’s knee is not limited to runners — any activity that loads the patellofemoral joint repeatedly, including cycling, stair climbing, squatting, hiking, and prolonged sitting with bent knees, can produce the condition. The underlying problem is almost always a tracking issue: when the kneecap does not glide smoothly within its groove — due to quadriceps imbalance, hip weakness, flat feet, limb alignment, or anatomic variation in the shape of the kneecap or trochlear groove — the cartilage on the undersurface of the patella wears unevenly, producing the characteristic aching, grinding, and type of painful knee injury that worsens with activity and can become chronic if the contributing factors are not addressed.
Dr. Jonathan Glashow is a board-certified orthopedic surgeon and Clinical Associate Professor of Orthopedic Surgery at NYU Grossman School of Medicine, with published research on patellar viability and the contribution of the infrapatellar fat pad to patellofemoral mechanics — studies that directly inform his understanding of the cartilage health and tracking dynamics involved in runner’s knee. With over 30 years of sports medicine experience, membership in the Society for Tennis Medicine, and roles as Chief Medical Officer for the New Jersey Devils and Philadelphia 76ers, he has treated patellofemoral pain across every level of competition — from recreational runners training for their first race in Central Park to professional athletes managing chronic cartilage wear that threatens their career longevity. Named a Castle Connolly Top Doctor every year since 2000, Dr. Glashow evaluates and treats runner’s knee at his Upper East Side practice in New York City.
What Is Chondromalacia Patella?
Although chondromalacia patella is called “runner’s knee,” you do not need to be a runner to have this knee condition. Chondromalacia patella occurs when wear or friction on the bottom of the kneecap causes the cartilage to soften or deteriorate. Running (or other sports), flat feet, knee injuries, obesity and other factors can result in wear on the kneecap. Kneecap tracking issues can cause excessive wear of the underside of the patella. Symptoms of runner’s knee include:
- Aching pain below, underneath and on the sides of the kneecap
- Grinding sensation in kneecap when running downhill, going downstairs or doing knee bends (squats)
- Rubbing or grinding in the knee when standing after sitting for longer periods
In many cases, mild or moderate runner’s knee can be relieved with rest and using anti-inflammatory medications or treatments. If the symptoms are more severe or the condition keeps reoccurring, sports medicine treatments can help protect the knee from cartilage deterioration and reduce painful symptoms. Interventional treatments including injections, and physical therapy can be used to relieve inflammation and restore proper movement of the kneecap to reduce friction when running or performing other activities.
Jonathan Glashow, MD, Orthopedic Surgery & Sports Medicine offers advanced sports medicine treatments for our athletic patients. If you suffer from runner’s knee, contact our clinic in UES NYC to schedule an examination and consultation on treatment options.
Frequently Asked Questions About Runner’s Knee
What is the difference between runner’s knee and jumper’s knee?
Runner’s knee (chondromalacia patella) and jumper’s knee (patellar tendonitis) affect different structures and produce pain in different locations. Runner’s knee involves the cartilage on the underside of the kneecap and produces pain around, behind, and underneath the kneecap — particularly during squatting, stair climbing, and prolonged sitting. Jumper’s knee involves the patellar tendon below the kneecap and produces pain at the bottom of the kneecap, worsened specifically by jumping and landing. The distinction is important because the treatment strategies differ: runner’s knee treatment focuses on correcting patellar tracking and strengthening the muscles that control kneecap alignment, while jumper’s knee treatment focuses on tendon loading and eccentric strengthening.
What causes the cartilage under the kneecap to deteriorate?
The cartilage on the underside of the kneecap is designed to glide smoothly within the trochlear groove of the femur. When the kneecap tracks abnormally — shifting too far to the outside, tilting, or not engaging the groove at the right angle — some areas of cartilage bear disproportionately more load than others. Over time, the overloaded cartilage softens, roughens, and eventually breaks down. Common contributing factors include weakness in the quadriceps (especially the vastus medialis oblique), tightness in the iliotibial band or lateral retinaculum, hip abductor weakness that allows the knee to collapse inward during activity, flat feet or excessive pronation, and anatomic variations in kneecap shape or trochlear groove depth.
How is runner’s knee diagnosed?
Dr. Glashow diagnoses runner’s knee through a clinical examination that assesses patellar tracking, kneecap mobility, quadriceps strength, hip stability, and the specific movements that reproduce the patient’s pain. X-rays may be taken to evaluate kneecap alignment and rule out other causes of anterior knee pain. An MRI can reveal the degree of cartilage softening or damage on the undersurface of the patella and identify any associated issues such as plica irritation, loose bodies, or early arthritis. Same-day imaging is available at his Upper East Side practice.
Can I still run with runner’s knee?
Many patients with mild to moderate chondromalacia patella can continue running — but often with modifications to their training that reduce the repetitive stress on the patellofemoral joint while the underlying tracking issues are being corrected. This may include reducing mileage temporarily, avoiding hills and stairs, incorporating lower-impact cross-training, wearing supportive footwear or orthotics, and following a targeted strengthening program for the quadriceps and hip stabilizers. Dr. Glashow works with each patient to develop a plan that keeps them as active as possible while allowing the cartilage to recover.
What treatments are available for runner’s knee?
The majority of runner’s knee cases respond well to non-surgical treatment. The foundation is a physical therapy program focused on quadriceps strengthening (especially the VMO), hip stabilizer strengthening, iliotibial band stretching, and patellar taping or bracing to improve kneecap tracking. Activity modification, anti-inflammatory medications, and in some cases corticosteroid or hyaluronic acid injections can provide additional relief. For patients with severe or persistent chondromalacia that does not respond to conservative treatment, arthroscopic surgery may be considered to smooth damaged cartilage, release a tight lateral retinaculum, or correct a significant tracking abnormality. Dr. Glashow exhausts all conservative options before recommending surgical intervention.
Does runner’s knee lead to arthritis?
Chondromalacia patella and patellofemoral arthritis exist on a spectrum. In its early stages, runner’s knee involves cartilage softening that is often reversible with proper treatment — correcting the tracking issue, strengthening the supporting muscles, and reducing the abnormal load on the undersurface of the kneecap. However, if the condition is left untreated and the tracking dysfunction persists, the cartilage damage can progress from softening to roughening to fissuring to full-thickness loss — at which point the condition has progressed to true patellofemoral arthritis. This is why early evaluation and treatment of runner’s knee is important, even when the symptoms seem relatively mild.
