Sudden sharp pain behind kneecap

Hi there,

I really hope someout out there can help me as I've started to experience very sudden onset sharp pain centrally behind my right kneecap.  The pain is so sharp that it stops me in my tracks when out running.  I first experienced it about 3 weeks ago but as quickly as it came, it went again although I was conscious that it might come back.   However, it keeps reappearing and today I was aiming to do 23 miles but had to cut it short as the pain didn't go away.  It started out as the sudden sharp pain I had previously experienced and did subside but then came back again after 2-3 more miles.  When it happens it helps to change my running stance slightly and I feel like I change my foot strike so that I'm almost running on the outside of my foot if that makes sense.  This does help as does massaging the knee.  I thought I would really struggle to get back home today as I was 9 miles out before I decided that the pain was getting worse and that I should turn round.  However, it really subsided and pretty much disappeared again after around 14-15 miles and in the end I did 19 miles and felt quite comfortable at the end.  It's starting to concern me though as this time the pain definitely lasted for much longer and I just know it'll come back on my next long run.  I have recently bought new trainers and am in the process of wearing them in but Im still using my old ones for my long runs. I always get my trainers properly fitted at a running shop and have been told I overpronate.

I'm doing the Edinbugh Marathon in May, but I'm classing this as a warm up event as Im running the coast to coast (from Whitehaven in Cumbria to tynemouth in North Tyneside - approx 30 miles per day over 5 days) 2 weeks later.  I really need to get a few more back to back long runs in and was planning on doing around 16 miles tomorrow but am worried this will make my knee worse.  I had 3 months off earlier in the year with a foot injury and cannot afford any more time off!  From a money point of view I really can't afford to see a physio privately and so desparately need any help and advice going!  Would a sturdy knee support help?  I'm doing the usual icing etc.

Thanks for any help you can give me!



  • Hi Holly,

    If the pain is centrally under your knee cap it tends to suggest that there's probably no involvement of the ITB or the collateral ligaments, which generally cause discomfort at the side of the knee. I suspect it's unlikely to be the anterior or posterior ligaments either, even though they criss-cross centrally in your knee, as these are less likely to be aggravated by running alone. The fact that it came and went just as quickly (though is getting more intrusive) also suggests that it may be more to do with the way your kneecap is tracking over the groove formed by your femur-tibia joint.

    While there may be some involvement of your knee cartilage (menisci) It sounds more likely to be the early signs of patellofemoral syndrome. This is not untypical in runners who do high mileages and have a tendency to pronate. It's also interesting that when you ran more on the outside of your foot (you were effectively decreasing your foot pronation) the pain subsided.

    The fact that you have changed your shoes recently may also be significant for two reasons.

    First, it implies your current shoes (which presumably are due for retirement) may not be having the same anti-pronating effect that they originally gave you as the midsoles may have deteriorated significantly - this would have a cumulative effect with mileage and may just have broken surface now.

    Second, your new shoes, even though you are still breaking them in, may have antagonised your knee just enough to tip the balance.

    Either way, if you can't see a professional then apply the usual RICE, use ibuprofen discriminately, try a patella stabilizing knee support - but make sure you get one from a specialist injury support retailer - not some cheapo off-the-shelf thing that may make things worse.

    Regards, Groz


  • Hi Groz,

    thanks so much for your response.  i'll definitely purchase a good knee support asap and continue with the RICEand ibuprofen.  I think I'll just attempt a 7 miler or so tomorrow rather than the 16 I'd planned and see how it feels.

    Thanks again,


  • I know this is an old post but how did you get on with this. I have a similar issue and have been managing it, but would be interested to see if your resolved it?

  • I had a knee pain injury that went from the kneecap down the shin. It hurt to walk up and especcially down any sort of incline.  I had patella formoraral pain or pfps (runner knee).  4 months off running altogether and now just starting to return.  hope its not that as that does cause major problems with mobility and driveing etc.

  • Hi Niall,

    I took the advice of grozzlybear and bought myself a patella stabilizing knee support.  I did manage to complete the coast to coast and used the knee support for the whole thing without too much bother from my knee considering the milage I was doing.  At the time, I continued with the usual RICE and Ibuprofen which helped.  Since then I have had a baby and the amount of mileage I am currently doing has dropped significantly and I havent had too much bother with it.  I have a feeling though that when I up my mileage again and do 20+ miles at a time, the problem may well return, but I'll cross that bridge when I come to it!

    Good luck and I hope it resolves,


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