Patellofemoral Pain Syndrome (Runner’s Knee): Recovery Time & Tips

What is the recovery time for patellofemoral pain syndrome, also known as runner’s knee? Can patellofemoral syndrome be cured?

👉 Many of you search for answers to this question on the internet every month. You worry about the duration of pain and discomfort.

You seek the opinions of your general practitioner, sports doctor, physical therapist, and people around you who also suffer from this knee problem.

As a physical therapist, I’ll share my opinion on the recovery time for patellofemoral syndrome. This opinion is based on:

• My experience as a physical therapist for over 10 years.
• A thorough study of all the research published on the subject in international medical literature (references at the end of the article).

What is patellofemoral pain syndrome / runner’s knee ?

Symptoms of patellofemoral pain syndrom

Do you have knee pain? Pain above the kneecap, around the kneecap, behind the kneecap, below the kneecap, on the side of the kneecap, at the tip of the kneecap, or even inside the kneecap?

Does the pain occur mainly during activities such as cycling (seated or on an elliptical), running, or hiking? When you perform knee flexion? When descending stairs? When doing squats?

👉 These are the main symptoms of patellofemoral pain syndrome: pain in the kneecap that is aggravated during exercise or prolonged sitting.

Different names for patellofemoral pain syndrome

Patellofemoral pain syndrom is also referred to as:

• chondromalacia patella (a condition associated with the degeneration of cartilage in the joint);
• anterior knee pain and/or syndrome ;
• runner’s knee.
• moviegoer’s knee (because some people feel pain during periods of prolonged sitting).

They all refer to the same condition.

Chondromalacia patella, patellofemoral pain syndrome, moviegoer’s knee… it’s all the same thing!

Frequency and diagnosis of runner’s knee

Patellar syndrome is highly common:

• Within a one-year period, 10% of adolescents will experience it.
• 5% of adults aged 18 to 60 will also be affected.

An interview, knee observation, and performing squats (often painful) are sufficient for diagnosis.

X-rays are not useful and are only recommended to rule out other conditions (such as arthritis) if the pain persists despite implementing various measures, or if it is severely debilitating. However, X-rays do not necessarily provide more therapeutic options.

Ultrasound, CT scans, and MRIs are also not useful for runner’sknee. Like X-rays, these examinations do not serve a purpose because the specific anatomical structures responsible for patellar syndrome pain are not definitively known.

It is believed that a fatty cushion located within the knee joint, beneath the patella, may be responsible, but this has not been confirmed. Furthermore, even if a lesion in this cushion is identified, there is no specific treatment required.

Patellar pain syndrome can be resolved without knowing the exact injured structure.

💡 Sometimes, crackling sounds in the knee may occur, which often raises concerns. However, they are not indicative of severity, and they are not related to structural issues or the presence of arthritis. These sounds should not prevent certain exercises, only the presence of pain should.

THE BOTTOM LINE

There are various terms used to refer to the same problem: patellofemoral pain syndrome. It is primarily characterized by pain around the kneecap, which is triggered especially during knee flexion, such as when sitting for prolonged periods, walking, climbing stairs, or engaging in sports. X-rays, MRIs, and CT scans are unnecessary.

How long does patellofemoral pain syndrome last?

First, it’s important to note that we have significant knowledge about this condition, as the first studies date back to the 1970s, and there have been over 1,800 studies published in the international scientific literature on this syndrome.

It’s worth mentioning that the studies examining the progression of patellar pain syndrome primarily focus on patients with more severe cases of the condition. Other patients may not necessarily seek medical attention and therefore are not included in the studies.

⚠️ Consequently, the available data may tend to be pessimistic and give the impression that patellar pain syndrome has a poorer recovery rate than it actually does.

Every year, I come across examples of people whose patellar syndrome lasted only a few weeks. These people never had to completely stop participating in sports and were able to fully resume all activities within a few weeks.

🙂 So, remain optimistic! You can be one of those individuals who recover quickly and effectively, even without undergoing specific treatments! We will discuss solutions later in the article to optimize the recovery time for runner’s syndrome.

📚 Now that we have addressed this precaution, let’s discuss what the studies following individuals with patellar pain syndrome for several years have revealed. One study even tracked patients for 20 years! Here’s what they found:

• Two-thirds of people with patellar pain syndrome no longer experience any pain or discomfort within one year of symptom onset.
• One-fourth of people still occasionally experience symptoms 20 years later, without necessarily preventing them from working or participating in sports.

📚 Other studies are more pessimistic, estimating that 50% of people with runner’s syndrome still experience discomfort and pain 5 to 8 years after initial symptoms. However, it’s important to keep in mind that only the most affected people participate and remain in these studies, which may lead to more concerning figures than the reality.

Some people with patellar pain syndrome become pain-free within 3 to 4 weeks and may not necessarily need to stop participating in sports. On the other hand, others may take several months or even years to fully recover, without it being a cause for concern, although it can be challenging.

What can be done to accelerate the recovery time for patellofemoral pain syndrome?

Wondering how to accelerate the healing of patellofemoral pain syndrome actually boils down to seeking effective solutions and treatments.

👉 So, what should you do to relieve or eliminate the pain and be able to resume your previous activities without discomfort? Here are three things to consider:

1️⃣ Identify the activities or situations that trigger or significantly worsen your knee pain.

2️⃣ Stop or reduce these activities. Only continue them if they don’t cause a lot of pain. Finding the right balance is crucial—gradually reintroduce them at a slow pace. Some people can manage this gradual reintroduction of intensity, frequency, and duration on their own, while others may benefit from occasional or regular supervision by a physiotherapist.

3️⃣ Have confidence in your recovery. Many people spontaneously recover within a few weeks by simply following these recommendations. You might be one of them! 🙂

By being confident and gradually reintroducing activities that strongly trigger or worsen the pain, you increase your chances of a speedy recovery from runner’s knee.

The best treatment of runner’s knee: exercise

Is there a specific treatment to follow that has proven its effectiveness? The treatment with the most evidence (although of low quality) on hundreds of patients is as follows: engage in exercises.

📚 What exercises? We don’t have enough robust evidence to specify, but it appears that exercises involving both the knee and hip muscles’ strength🧎🏻 are more effective compared to less comprehensive exercises.

Whether these exercises are performed with a home physiotherapist, unsupervised, or at a physiotherapy clinic, the role of the physiotherapist is mainly to help you identify the appropriate level and type of exercise for you.

What improvements can be expected from the exercises?

📉 Reduced pain in the short and long term.
🚴🏼‍♀️ Increased ease of using the knee in daily activities in the short and long term. 🤩 Fewer symptoms of patellofemoral syndrome in the long term.

More specifically, in two groups of 1,000 patients, an additional 88 people achieved complete recovery from patellofemoral pain syndrome after one year in the exercise group compared to those who did nothing specific.

Other treatments of runner’s knee

What about other treatments sometimes proposed by physiotherapists?

📚 Here are more specific treatments that have been tested in several studies. In each case, the conclusion is the same: recovery is just as good in people who only engage in exercise compared to those who combine exercise with these additional treatments.

Bluntly speaking, these treatments do not provide any relief or accelerate recovery. Some low-quality studies occasionally show a slight reduction in short-term pain, but these results are not consistent across studies. Here is the list:

• Cold therapy;
• Electrostimulation with electrodes on the quadriceps (often using brands like Compex);
• EMG biofeedback;
• TENS (Transcutaneous Electrical Nerve Stimulation: very few side effects);
• Ultrasound therapy;
• Wearing a patellar brace or strap (sleeve or support, such as Zamst or knee brace);
• Custom or off-the-shelf orthopedic insoles;
• Kinesiotaping (colored adhesive tapes applied to the anterior side of the knee);
• Dry needling (trigger points);
• Manual therapy.

And what about medication? Nonsteroidal anti-inflammatory drugs (e.g., naproxen) may provide short-term pain relief (less than a week). However, once again, some studies do not show a significant effect, and they do not speed up complete recovery.

👉 A more detailed article on the treatment of patellofemoral pain syndrome and exercises is being prepared for my website. Enter your email below if you would like to be notified of its publication:

⭐ The best course of action for faster recovery after runner’s knee is as follows: 1) identify activities that trigger or significantly worsen your knee pain; 2) stop or limit these activities; 3) gradually reintroduce them in terms of frequency, intensity, and duration; 4) be confident; 5) engage in exercises or activities involving the contraction of the knee and hip muscles.

Running, cycling, sport with patellofemoral pain syndrome?

Having runner’s knee is not a contraindication for participating in sports, any sport, in fact. On the contrary, sports and exercise, when practiced at a reasonable and progressive frequency and intensity, have a positive impact on many aspects of physical and mental health 🧠.

For example, in people with knee osteoarthritis, sports provide as much pain relief as taking anti-inflammatory medication, and it does not worsen the arthritis.

💡 Therefore, you can continue or resume running, cycling, hikking and other sports even with patellofemoral pain syndrome. However, your pain should guide you. It is important to find the right frequency, intensity, and duration of exercise to prevent or minimize pain triggered by physical activity.

If these general guidelines are not sufficient, rate your pain during and after sports activity on a scale of 0 to 10:

0 = no pain
10 = maximum tolerable pain.

If the pain remains between 0 and 5 and decreases the day after the activity, you can continue. If it increases over the following days, stop and resume more gradually.

Sports can be practiced even with patellofemoral pain syndrome. It is simply important to monitor and manage your pain, reducing or temporarily ceasing activity if it becomes too significant.

Learning to manage the frequency, duration, and intensity of exercise, running and cycling is key to resolving patellofemoral pain syndrome issues.

Can I take time off from work if the recovery time is too long?

Yes, it is possible to be on sick leave due to patellofemoral pain syndrome. In fact, there is no specific list of conditions that can lead to sick leave. What is taken into account are:

• Your discomfort and pain
• The nature of your job
• The possibility of adjusting your work activities to some extent

Your specific condition doesn’t matter in this context.

The same reasoning applies to being on disability or being recognized as a disabled worker. What matters is your level of discomfort, not the specific condition.

However, please keep in mind that it is very rare to require sick leave, let alone disability, due to runner’s knee. So, remain optimistic :)!

Even though it remains extremely rare, if your discomfort is significant enough, you can be on sick leave or disability due to patellofemoral pain syndrome.

Is it possible to prevent runner’s knee?

Here are several things that have been tested and concluded to not prevent the development of runner’s knee:

1. ❌Doing muscle strengthening exercises
2. ❌Stretching
3. ❌Wearing orthotic insoles

On the other hand, it is reasonable to believe that avoiding starting (or increasing) a new exercise too frequently and intensively can help prevent the onset of patellofemoral pain syndrome. For example, if you’re starting running, begin with 5 minutes once a week and gradually increase. Starting with 20 minutes, three times a week is too much!

Studies conducted on approximately 200 to 350 individuals have shown (with low certainty) that:

• Wearing a patellar orthosis while running slightly reduces the risk of knee pain.
• The same applies to a retraining program for running at a slower pace.

The best way to prevent patellofemoral pain syndrome is to always introduce a new leg-intensive exercise gradually. Alternatively, gradually increase the frequency or intensity of an activity you already practice.

I reviewed the titles and abstracts of these over 1,000 studies to select the most relevant ones to answer this question: What is the healing time of patellofemoral syndrome? How can we influence this healing time?

Here are the selected studies. The figures and factual information in this article are derived from these studies.

Fréquence, pronostics, terminologie

Crossley KM, Stefanik JJ, Selfe J, Collins NJ, Davis IS, Powers CM, McConnell J, Vicenzino B, Bazett-Jones DM, Esculier JF, Morrissey D, Callaghan MJ. 2016 Patellofemoral pain consensus statement from the 4th International Patellofemoral Pain Research Retreat, Manchester. Part 1: Terminology, definitions, clinical examination, natural history, patellofemoral osteoarthritis and patient-reported outcome measures. Br J Sports Med. 2016 Jul;50(14):839-43. doi: 10.1136/bjsports-2016-096384. Epub 2016 Jun 24. PMID: 27343241; PMCID: PMC4975817.

Smith BE, Selfe J, Thacker D, Hendrick P, Bateman M, Moffatt F, Rathleff MS, Smith TO, Logan P. Incidence and prevalence of patellofemoral pain: A systematic review and meta-analysis. PLoS One. 2018 Jan 11;13(1):e0190892. doi: 10.1371/journal.pone.0190892. PMID: 29324820; PMCID: PMC5764329.

Matthews M, Rathleff MS, Claus A, McPoil T, Nee R, Crossley K, Vicenzino B. Can we predict the outcome for people with patellofemoral pain? A systematic review on prognostic factors and treatment effect modifiers. Br J Sports Med. 2017 Dec;51(23):1650-1660. doi: 10.1136/bjsports-2016-096545. Epub 2016 Dec 13. PMID: 27965435.

Efficacité des traitements

McClinton SM, Cobian DG, Heiderscheit BC. Physical Therapist Management of Anterior Knee Pain. Curr Rev Musculoskelet Med. 2020;13(6):776-787. doi:10.1007/s12178-020-09678-0

Gaitonde DY, Ericksen A, Robbins RC. Patellofemoral Pain Syndrome. Am Fam Physician. 2019 Jan 15;99(2):88-94. PMID: 30633480.

Winters M, Holden S, Lura CB, Welton NJ, Caldwell DM, Vicenzino BT, Weir A, Rathleff MS. Comparative effectiveness of treatments for patellofemoral pain: a living systematic review with network meta-analysis. Br J Sports Med. 2020 Oct 26;55(7):369–77. doi: 10.1136/bjsports-2020-102819. Epub ahead of print. PMID: 33106251; PMCID: PMC7982922.

Wallis JA, Roddy L, Bottrell J, Parslow S, Taylor NF. A Systematic Review of Clinical Practice Guidelines for Physical Therapist Management of Patellofemoral Pain. Phys Ther. 2021 Mar 3;101(3):pzab021. doi: 10.1093/ptj/pzab021. PMID: 33533400.

Martimbianco ALC, Torloni MR, Andriolo BN, Porfírio GJ, Riera R. Neuromuscular electrical stimulation (NMES) for patellofemoral pain syndrome. Cochrane Database Syst Rev. 2017 Dec 12;12(12):CD011289. doi: 10.1002/14651858.CD011289.pub2. PMID: 29231243; PMCID: PMC6486051.

Hott A, Brox JI, Pripp AH, Juel NG, Liavaag S. Patellofemoral pain: One year results of a randomized trial comparing hip exercise, knee exercise, or free activity. Scand J Med Sci Sports. 2020 Apr;30(4):741-753. doi: 10.1111/sms.13613. Epub 2020 Jan 5. PMID: 31846113.

Macri EM, Hart HF, Thwaites D, Barton CJ, Crossley KM, Bierma-Zeinstra SMA, van Middelkoop M. Medical Interventions for Patellofemoral Pain and Patellofemoral Osteoarthritis: A Systematic Review. J Clin Med. 2020 Oct 23;9(11):3397. doi: 10.3390/jcm9113397. PMID: 33114034; PMCID: PMC7690719.

van der Heijden RA, Lankhorst NE, van Linschoten R, Bierma-Zeinstra SM, van Middelkoop M. Exercise for treating patellofemoral pain syndrome. Cochrane Database Syst Rev. 2015 Jan 20;1:CD010387. doi: 10.1002/14651858.CD010387.pub2. PMID: 25603546.

Callaghan MJ, Selfe J. Patellar taping for patellofemoral pain syndrome in adults. Cochrane Database Syst Rev. 2012 Apr 18;(4):CD006717. doi: 10.1002/14651858.CD006717.pub2. PMID: 22513943.

Prévention du syndrome rotulien

Culvenor AG, van Middelkoop M, Macri EM, Crossley KM. Is patellofemoral pain preventable? A systematic review and meta-analysis of randomised controlled trials. Br J Sports Med. 2020 Oct 28:bjsports-2020-102973. doi: 10.1136/bjsports-2020-102973. Epub ahead of print. PMID: 33115705.