Pain Condition
Runner's Knee (Patellofemoral Pain Syndrome)
By Dr. Anthony J. Gordon, Doctor of Acupuncture | Last reviewed September 2026
The ache sits around or behind your kneecap. It builds on runs, especially downhill, and flares with stairs, squats and sitting through a movie with your knees bent. Your X-ray is normal. Runner's knee is about how load moves through the kneecap, and that depends on the muscles above and below it.
Prefer to talk it through? Call (516) 597-5400. Most new patients are seen within one to two weeks.
Overview
Understanding Runner's Knee
Runner's knee, or patellofemoral pain syndrome, is pain around or behind the kneecap. It is one of the most common running injuries, and it also affects cyclists, jumpers, hikers and people who do a lot of squatting or stair climbing. Imaging is usually normal.
The kneecap glides in a groove on the thigh bone. When the quadriceps are tight or unbalanced, the IT band pulls laterally, the hip muscles are weak, or the foot rolls inward excessively, pressure behind the kneecap increases. A sudden increase in mileage or hills often triggers symptoms. Trigger points in the quadriceps, especially the vastus lateralis, commonly refer pain around the kneecap.
Dr. Gordon releases the muscles that increase pressure behind the kneecap and coordinates with your physical therapist or coach on hip strengthening and training load.
Runner's Knee at a Glance
Also called
Patellofemoral pain syndrome, PFPS, anterior knee pain
Who it affects
Runners, cyclists, hikers, jumpers, people who squat or climb stairs often
Common aggravators
Downhill running, stairs, squats, long sitting with bent knees
Typical imaging
Usually normal
Main drivers
Quadriceps tension, IT band pull, hip weakness, training spikes
The Gap in Care
What Tests Check, and What They Can Miss
Runner's knee is often treated with rest alone. When the muscle drivers are not addressed, it returns as soon as mileage increases.
What routine testing is looking for
- Kneecap cartilage damage
- Meniscus or ligament injury
- Patellar tendon tears
- Stress fractures
What often keeps symptoms going
- Vastus lateralis trigger points
- IT band and lateral thigh tension
- Weak hip abductors and rotators
- Tight calves and hamstrings
- Training volume and hill spikes
These are found with hands-on, strength and running assessment.
Signs & Symptoms
Does This Sound Like You?
Symptoms vary from person to person. These are the patterns Dr. Gordon sees most often.
Ache around the kneecap
Dull ache around or behind the kneecap.
Pain running downhill
Pain increasing on descents.
Pain on stairs
Especially going down.
Pain after long sitting
Aching after sitting with bent knees.
Pain squatting
Pain with deep knee bends.
Grinding sensation
A grinding feeling under the kneecap.
Root Causes
The Four Drivers Dr. Gordon Looks For
Most people have more than one of these in play. Finding which one leads makes treatment more efficient.
Quadriceps tension
Tight, unbalanced quadriceps increase kneecap pressure.
IT band pull
Lateral tension pulls the kneecap off track.
Hip weakness
Weak hips let the knee drift inward.
Training load
Mileage and hill spikes overload the joint.
Your First Visit
How Dr. Gordon Evaluates Runner's Knee
The initial evaluation runs 60 to 75 minutes. You leave with a clear picture of what is driving your symptoms, a written plan, a realistic timeline, and in most cases your first treatment.
- 1
Records and history review
Dr. Gordon reviews your running history, mileage, shoes and any imaging.
- 2
Kneecap and joint testing
Tests for patellofemoral irritation and other knee sources.
- 3
Muscle mapping
Assessment of the quadriceps, IT band, calves and hamstrings.
- 4
Hip strength and running mechanics
Hip strength tests and review of your running form.
- 5
Plan and coordination
A clear plan, plus communication with your physician, orthopedist or physical therapist when that helps your care.
When to see a physician first
- A joint that is hot, red and swollen, especially with fever
- Inability to bear weight or use the limb after an injury
- Visible deformity after a fall or injury
- Sudden swelling after a pop or twist
- Calf pain and swelling, which can signal a blood clot
- Numbness, coldness or color change in the hand or foot
If you have any of these, contact your doctor or go to the nearest emergency department.
Bring to your first visit
Records
Recent lab results, imaging reports and specialist notes. These can also be faxed ahead.
Treatment history
A short list of what you have tried and what did or did not help.
Clothing
Something comfortable and loose fitting.
Treatment
How Dr. Gordon Treats It
These are the tools Dr. Gordon uses most often for runner's knee, chosen from your exam findings.
Orthopedic Dry Needling
Dr. Gordon has used dry needling for more than 18 years. Treatment releases the vastus lateralis, IT band region, hamstrings and calves that increase pressure behind the kneecap.
See all servicesNeuro-Functional Acupuncture
Electro-acupuncture around the knee to calm pain.
See all servicesRunning Plan & Team Coordination
Training load and hip strengthening guidance, coordinated with your coach or physical therapist.
Referring provider? Contact the clinicWhat to Expect
A Typical Recovery Arc
Find the main driver
Dr. Gordon confirms which muscles and nerves are behind your symptoms and starts calming the most reactive areas. Many people notice early changes between visits.
Lower the baseline
Day-to-day symptoms ease, flares become shorter and less frequent, and normal routines start to feel more manageable.
Build resilience
Visits are spaced out as improvement holds. You leave with a maintenance and early-flare plan.
Most patients are seen weekly or every other week during active care. Individual results vary with how long symptoms have been present and how reactive they are. Progress is reassessed at every visit.
Not sure how to describe it? Put your pain or discomfort into words before your visit
My son plays soccer and runs Track and he couldn't run at all without having a pain level of 10. I had already brought him to two orthopedics, a podiatrist, a chiropractor and gotten MRIs and X-rays and nobody could give us any answers. ... He is so beyond knowledgeable and within 1 treatment my son felt a ton of relief and after 3 treatments my son was back on the track and soccer field!Kim Gordon, Google Review
Runner's Knee Questions
Answers About Runner's Knee
Still unsure whether this is the right fit? Reach out before you book and Dr. Gordon will talk through your history with you.
Before You Book
General Questions
About Dr. Anthony J. Gordon
Dr. Anthony J. Gordon is a Doctor of Acupuncture licensed in New York and board certified. He holds ASE certification in intrapelvic and extrapelvic dry needling, along with advanced certifications in Functional Dry Needling and Neuro-Functional Acupuncture. With more than 18 years of clinical experience and over 3,000 complex cases treated, he focuses on pelvic, spinal and orthopedic conditions that have not responded to standard care, and works closely with each patient's physicians and physical therapists.
Read Dr. Gordon's full bioFurther Reading
Runners and Knee Pain: What Dry Needling Adds to Rehab
From the blog: Exercise is the core of rehab for runner's knee. Where dry needling fits alongside physical therapy, what the research says, and how to ease back into running.
Book an Evaluation for Runner's Knee
Book a full evaluation with Dr. Gordon and get back to your miles.
Early morning, evening and weekend appointments available. Free on-site parking.
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