The 4 Most Common Types of Knee Pain in Runners (And What They Really Mean)

Knee pain is one of the most common reasons runners seek physical therapy. It is also one of the most misunderstood. While many runners lump all discomfort into “runner’s knee,” the truth is that knee pain can show up in several distinct ways, each with different root causes and solutions.

Let's explore the four most common types of knee pain runners experience, what they typically feel like, and why they happen.

1. Runner’s Knee (Patellofemoral Pain Syndrome)

Where it hurts: Pain around or behind the kneecap, often described as a dull ache. Individuals struggling with runner's knee often report increased pain when sitting in a position with the knee bent for anywhere between 30 minutes to 2 hours (sitting in an airplane, sitting at a desk, sitting in a car, sleeping on the side with the knee bent). This condition can become chronic if the underlying causes are not addressed in a timely manner.

Common symptoms:

• Pain during or after runs

• Discomfort going up or down stairs

• Pain when squatting or sitting for long periods (the “movie theater sign”)

• Pain at night when side-sleeping with the knee bent

• Loud "cracking" sound when moving the knee into a straight position after prolonged sitting

What’s really going on: Runner’s knee isn’t a cartilage problem. It’s usually a patellar tracking issue. The kneecap is influenced by hip strength, quad control, foot mechanics, and running form. When those systems aren’t working together efficiently, the kneecap tracks asymmetrically and stress builds behind the kneecap.

Key contributors:

• Weak or poorly coordinated hips

• Sudden increases in mileage or intensity

• Poor shock absorption through the foot and ankle

• Impaired movement patterns

2. Iliotibial (IT) Band Syndrome

Where it hurts: Sharp or burning pain on the outside of the knee

Common symptoms:

• Pain that starts mid-run and worsens with distance

• Symptoms that improve when you stop running

• Tenderness on the outer knee

What’s really going on: Despite popular belief, the IT band isn’t “tight," it’s overloaded. IT band pain is often the result of poor load sharing between the hip, knee, and ankle. When the hip isn’t controlling motion well, the IT band takes the hit.

Key contributors:

• Hip abductor weakness

• Poor pelvic control during stance phase

• Running on uneven surfaces

3. Patellar Tendon Pain (Jumper’s Knee)

Where it hurts: Pain just below the kneecap, at the patellar tendon

Common symptoms:

• Pain at the start of a run that may “warm up”

• Increased pain with hills, speed work, or plyometrics (jumping)

• Tenderness directly over the tendon

What’s really going on: This is a load tolerance issue, not inflammation. The patellar tendon becomes painful when it’s asked to handle more force than it’s prepared for. This is often due to rapid training changes or inadequate strength.

Key contributors:

• Sudden increases in speed or hill training

• Quad and calf strength balance

• Insufficient recovery between hard sessions

4. Meniscus-Related Knee Pain

Where it hurts: Deep within the knee joint, often on the inside or outside

Common symptoms:

• Sharp pain with twisting or pivoting

• Sensation of catching, locking, or stiffness

• Swelling after longer runs

What’s really going on: Not all meniscus pain means a tear that needs surgery. Many runners experience degenerative or load-related meniscal irritation that responds very well to conservative care.

Key contributors:

• Poor shock absorption through the hips and ankles

• Reduced knee mobility or control

• Running through pain without addressing mechanics

Why Treating These Common Types of Knee Pain in Runners Requires More Than Just Rest

Knee pain in runners is rarely just a “knee problem.” It’s usually the result of how force moves through the entire body: from the foot, through the hip, and into the core.

Rest alone may calm symptoms temporarily, but without addressing:

• Running mechanics

• Strength and coordination

• Training load management

…the pain often comes back.

When to Seek Help

If your knee pain:

• Persists for more than 1–2 weeks

• Worsens with continued running

• Changes the way you move or train

…it’s time for a professional evaluation. A runner-specific physical therapy assessment can identify why your knee is overloaded and help you return to running stronger, not just pain-free.

At Stability In Wellness, we specialize in physical therapy for runners in Jupiter, focusing on identifying the root cause of your knee pain, not just treating the symptoms. Whether you’re dealing with runner’s knee, IT band syndrome, tendon or meniscus-related issues, a comprehensive evaluation can help you run without pain, improved efficiency, and long-term confidence. Schedule an evaluation today and get back to running the way your body was designed to move.