Not All Runner’s Knee Is the Same: Understanding the Difference Between Patellofemoral Pain and Patellar Tendinopathy

If you’ve ever Googled "runner’s knee," you’ve likely come across two common culprits: Patellofemoral Pain Syndrome (PFP) and Patellar Tendinopathy. While both can feel like pain around or below the kneecap, these injuries are not the same—and treating them as if they are could delay your recovery or make things worse.

As a sports physical therapist who works closely with runners, I often see athletes confused about which type of knee pain they have. This blog will break down the differences between PFP and patellar tendinopathy, what causes each condition, and how we treat them differently to get you back on the road pain-free.

What Is Patellofemoral Pain Syndrome (PFP)?

PFP is a common overuse injury that presents as diffuse pain around or behind the kneecap, especially during activities like running, squatting, or going up/down stairs. It’s often described as a dull ache rather than a sharp or pinpoint pain.

Patella Femoral Pain

Common Causes of PFP:

• Weakness in the hip muscles, particularly the glutes

• Poor control of lower limb mechanics (like knees caving in during movement)

• Limited mobility in the hips, ankles, or feet

• Sudden increases in running volume or intensity

Treatment Approach:

The goal here is to improve movement quality and reduce excess stress on the kneecap. That often involves:

• Mobility work for the ankle, hip, and foot

• Strengthening the hip, especially the glutes and lateral stabilizers

• Adjusting training volume to allow inflammation to settle

What Is Patellar Tendinopathy?

Patellar tendinopathy, sometimes called "jumper’s knee," is a condition involving microscopic breakdown of the patellar tendon—the thick tendon connecting your kneecap to your shinbone. This type of pain is often localized just below the kneecap and is aggravated by jumping, sprinting, or running downhill.

Common Causes:

• Repetitive strain without adequate recovery

• A sudden spike in high-impact activities like hill sprints or speed work

• Weakness or poor load tolerance in the tendon itself

Treatment Approach:

Tendons need load to heal—but it has to be the right type of load. We typically start with:

• Effortful isometric exercises (like wall sits or isometric leg extensions)

• Gradually progressing to heavier, slow resistance training

• Eventually incorporating plyometrics and running-specific drills

This structured tendon loading program helps rebuild the tendon’s capacity to tolerate running without pain.

Why the Distinction Matters

Although both injuries fall under the umbrella of "runner’s knee," the treatment paths are very different. What works for PFP could actually irritate a patellar tendon, and vice versa. For example:

• Stretching and foam rolling may help with PFP, but have minimal effect on tendinopathy.

• Isometrics are essential for tendon rehab, but not usually the first step for PFP.

Getting a proper diagnosis from a sports physical therapist is key to choosing the right treatment and avoiding wasted time—or worse, further injury.

When to Get Help

If you’ve been dealing with knee pain that just won’t go away, don’t assume it’s “just runner’s knee” and try to push through it. The sooner you get a professional assessment, the sooner you can get back to doing what you love.

I offer running-specific injury assessments to help you figure out what’s going on and how to fix it. Whether it’s PFP, tendinopathy, or something else entirely, I’ll help you create a tailored plan to recover and stay strong.

Ready to Take the First Step?

👉 Book a running injury screen here: https://www.pin-pointpt.com/scheduling

👉 Download my free Post-Race Recovery Checklist here: https://mailchi.mp/55b1ddf631b5/post-race-recovery-check-list

👉 Or email me at PinPointPT1@gmail.com

Don’t guess—get better. Your knees will thank you.

Keep Moving,

Dr. Nick Anderson PT, DPT