Why Your Runner’s Knee Won’t Go Away (The Hidden Cause)

Read Blog Here: https://sharpphysiotherapy.co.uk/runn... This is part three of my runner’s knee series. In part one I covered what causes it, and in part two I went through the exercises that fix it for most people. But if you’ve done all of that properly and you’re still stuck, there’s a good chance something structural is going on, and that changes everything about how it needs to be managed. When I say structural, I mean something about the way the knee is physically built that means the kneecap was never going to track properly, no matter how strong your muscles are. You can have strong glutes, good VMO activation and perfect foot control and still have a kneecap that tracks badly, because the problem isn’t in the muscle at all. In this video I explain the two main structural issues I see driving this, in plain terms. The first is patella alta, where the kneecap sits too high, so it spends too much of its time above the groove that’s meant to stabilise it, leaving it relying on soft tissue alone to stay centred. The second is an increased TT-TG distance, where the bony bump the kneecap tendon attaches to sits too far to the outside, so every time the quad fires, the kneecap gets dragged sideways rather than pulled straight. The measurement that matters is 12mm, and once it goes significantly beyond that, no amount of exercise will fix it. You cannot strengthen your way out of a geometry problem. The reason this gets missed so often is that it doesn’t show up without the right imaging, not on examination, not on a standard X-ray. A lot of people spend months or years doing everything right, getting temporary relief and then the pain returning, because nobody has ever measured their TT-TG distance or assessed the height of their kneecap. So if you’ve been through proper physio, done the right exercises consistently, and the pain keeps coming back, this is the conversation that needs to happen. You need the right imaging, an X-ray for kneecap height and an MRI to measure TT-TG distance, and you need an experienced knee consultant who specialises in patellofemoral problems looking at it. If the measurements come back significant, there are surgical options that can correct the mechanics. The takeaway is simple... if you’ve done everything right and the pain on those stairs still isn’t shifting, don’t keep going round in circles. Ask for the right investigations and get in front of the right specialist, because once a structural problem is identified, there’s a clear path forward. Watch Part One Now! :    • What Causes Runner’s Knee? The Real Reason...   Watch Part Two Now! :    • Top 3 Knee Pain Exercises (For Runners Knee)   -------------------------------------------------------------------------------------------------------------------- Book a Free Discovery Call: https://sharpphysiotherapy.co.uk/free... Find Your Nearest Clinic: Doncaster | Lincoln | Newark Welcome to Sharp Physiotherapy, we specialise in keeping people active, pain-free, and away from medication. This video is for educational purposes only and not a substitute for medical advice. If you're dealing with pain, book a free call with our team to find out what’s going on. Check out our website at...https://www.sharpphysiotherapy.co.uk Follow Our Socials... Instagram:   / sharp_physio   TikTok:   / sharp_physiotherapy   Facebook:   / jsphysio1   © Sharp Physiotherapy {{2025}}. All rights reserved. Chapters 0:00 – Intro: Why Exercises Aren't Fixing Your Kneecap Pain 0:16 – Recap: Runner's Knee Series (Parts 1 & 2) 0:33 – Structural Causes of Knee Pain Explained 0:58 – The 2 Structural Issues Behind Persistent Knee Pain 1:18 – Patella Alta: When Your Kneecap Sits Too High 2:20 – TT-TG Distance Explained (Tibial Tubercle to Trochlear Groove) 3:22 – The 12mm Rule: Is Your TT-TG Distance Normal? 3:48 – Why You Can't "Strengthen Away" a Geometry Problem 4:04 – Why Doctors Miss This (X-ray vs MRI) 4:52 – Next Steps: Imaging & Finding a Knee Specialist 5:37 – Surgical Options for Patella Alta & TT-TG Issues 5:52 – Key Takeaway: When to Stop Doing Exercises and Get Investigated