The Guru believes Anna has an issue with the way her kneecap tracks across the front of her femur

September 25, 2014

Hi Guru,

I’m a runner …a very frustrated runner right now.

I have a pain on the out of my knee cap, quite close into the cap-a dull pain that’s only there when running. It all started about a year ago when I was training for my first marathon – I would run for about an hour and then feel the pain, it would get gradually worse and then hurt a bit the next day.

I don’t think it’s ITBS as I have been doing everything to treat that and not running for a long time. I ran last night and the pain -although subtle-is there. I have changed trainers etc etc…..

I’m so frustrated and can’t tell you how much I just want to run!! Any help would be much appreciated.



September 25, 2014


Thousands upon thousands of runners have exactly the same. The symptoms vary a little – inside, outside, underneath BUT it’s the cause that’s the issue. This is where your intervention needs to be directed.

The rule of thumb (and it’s a great rule) is that we’ll do anything to keep our kneecaps pointing forward. And if they don’t naturally we’ll cheat to get then there. We’ll allow our feet to roll in without enough control (shoes….check!). We’ll point our feet out if our thigh rolls in. We’ll let our hips collapse when loading to get the kneecap pointing forward. That’s the mechanics bit which we can deal with, within reason.

But if we do too much of the wrong with the wrong mechanics too soon and keep doing it, we’ve – you’ve (!) got issues.

I think you’ve got an issue with the way your kneecap tracks across the front of your femur.

It’s only slight but with constant poor load it’s never given the chance to recover and so your symptoms persists. It’s time to go back to go forwards.

Rest, great stuff but very under rated. Use rest as a time to improve things like kneecap control and endurance of the muscles that keep your kneecap in the right place. This is from your gluts at the top, in fact your  thoracic spine above this, the control around your knee, but not only your VMO and your foot beneath, especially tib post. Dr google get ready. Rehab must be functional and control not strength biased.

When it’s time to run again (you must have super mild symptoms)  then you return to running very slowly. Walk 1 minute then run 1 minute for 5 cumulative minutes. Repeat every 3rd day for a week then run 2 minute for 10 cumulative minutes and repeat. At week 3 run for 5 minutes and build from here….

The Guru

Six Physio

Guru Responded

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