Runner’s Knee Doesn’t Have to Stop Your Training—Here’s How to Address It

Jump to:

• Runner’s Knee Cause: Weak Hips and Inner Quads
• Runner’s Knee Cause: Tight Hamstrings or Hips
• When to See a Doctor
• Additional Runner’s Knee Treatments
• Other Risk Factors for Runner’s Knee
• The Bottom Line on Treating Runner’s Knee

Runner’s knee, a prolonged bout of pain right behind or around the knee cap, is technically known as patellofemoral pain syndrome. It’s one of the most common running-related injuries and according to one estimate, it can affect up to 30 percent of female runners and 25 percent of male runners.

The good news: Runner’s knee has been studied extensively and experts have potential solutions to both prevent its occurrence and help you heal if it occurs.

“This injury is usually due to movements that load the knee joint on a flexed position,” Kimberly Kaiser, M.D., associate professor of orthopaedic surgery and sports medicine at the University of Kentucky and team physician for UK athletics, tells Runner’s World.

Any time your foot hits the pavement, treadmill, or track, you add impact to a bent knee, and this can cause pain, especially if your mechanics are off. That’s why moving in a position that throws off your typical stride, such as running stairs and doing squats can cause the same reaction. In fact, a telltale sign of runner’s knee is more pain when you run downstairs or descend steep hills, Kaiser says.

From a plank or downward-facing dog position, step right foot to outside of right hand: Runner’s knee isn’t a structural problem, which means your ligaments and cartilage are okay, Kaiser says. The problem lies in how your muscles function through the repeated movement of a run.

“Patellofemoral pain is most often a result of abnormal mechanics caused by problems up- or downstream from the knee, forcing the patella to bump against the femoral groove,” William Roberts, M.D., professor emeritus and former director of the Sports Medicine Program in the Department of Family Medicine and Community Health at the University of Minnesota Medical School tells Runner’s World.

Think of it like a train car: The patella is like a train on the femoral groove railroad track, says Roberts. When the train and track don’t run smoothly against one another, pain occurs.

The most common culprit of this uncomfortable rubbing is muscle weakness and/or tightness around the legs and core. So, we laid out the best ways to address these issues so you can start treating your runner’s knee.

One quick caveat: Before you dive into an at-home program, get assessed by a doctor so they can make sure the problem is actually runner’s knee and offer guidance on treatment. (More on that below!)

---

Runner’s Knee Cause: Weak Hips and Inner Quads

Runners tend to have strong hip flexors and weaker posterolateral muscles (those on the side and back of the body), with the gluteus maximus as a primary posterior muscle and the gluteus medius Externally rotate top hip while lifting top knee toward the ceiling. Keep feet glued together.

With weakness in this area, the femur (upper thigh bone) tends to rotate inward, making the knee cap strike the edge of that femoral groove, causing pressure and pain, Roberts explains. “But by building these muscles you can keep the femur from rotating inward during the weight-bearing phase of your running gait,” he says.

Treatment: Strength Exercises

Kaiser offers these exercises for a mini strength routine that targets all the right muscles to keep your knee and thigh in proper alignment. Do them as bodyweight-only or use a resistance band around your thigh, right above the knee joint. Aim for three sets of 15 reps each.

Clamshell

Why it works: This move targets the glutes, specifically the gluteus medius, which is a prime muscle involved in good knee alignment on the run.

ldquo;Patellofemoral pain is most often a result of:

1. Start lying on one side, propped up on forearm, shoulder over elbow and hips, knees, and feet stacked with hips and knees bent 90 degrees.
2. Externally rotate top hip while lifting top knee toward the ceiling. Keep feet glued together.
3. Lower leg back down.
4. Repeat.

Donkey Kick

Why it works: Target the gluteus maximus, along with your abdominal muscles, with this exercise. Make sure to benefits of strength training through the entire move for the full benefit.

ldquo;Patellofemoral pain is most often a result of:

1. Start on all fours, shoulders over wrists and knees right under hips.
2. Keeping knee bent 90 degrees and foot flexed, press heel toward the ceiling, making sure back stays flat and knee points straight down.
3. Lower knee back toward floor.
4. Repeat.

Fire Hydrant

Why it works: Another move that focuses on the lateral glutes (those smaller medius muscles!), it helps with keeping your thigh and knee from rolling inward on the run.

ldquo;Patellofemoral pain is most often a result of:

1. Start on all fours, shoulders over wrists and knees right under hips.
2. Keeping knee bent 90 degrees, lift it out to the side and up toward the ceiling. Avoid dropping opposite hip.
3. A Part of Hearst Digital Media.
4. Repeat.

Straight Leg Raise

Why it works: The key is to keep the leg totally straight to activate the vastus medialis oblique (VMO), rather than just the quad, as this muscle is crucial for strong, ache-free running form. You can make sure you’re working the VMO—which is the muscle toward the midline, by the knee cap—by placing your hand on the area. It should activate while you lift and hold your leg.

ldquo;Patellofemoral pain is most often a result of:

1. Sit or lie faceup, legs straight out.
2. Lock legs straight and lift one leg straight up toward the ceiling. Hold for 3-4 seconds.
3. Lower back down.
4. Repeat.

---

Runner’s Knee Cause: Tight Hamstrings or Hips

While weak muscles can cause a misalignment in running form The Benefits of Foam Rolling knee pain, so can tight muscles. Typically, runners will find this limited range of motion in their hamstrings or hips, Kaiser says.

Treatment: Stretch and Foam Roll

The best way to avoid and treat tightness is by working on overall flexibility and mobility—in other words, stretching and foam rolling every day, Kaiser says.

Hamstring Stretch

Why it works: Stretch your hamstrings—which is best performed after a workout when muscles are warm—to allow for better range of motion on the run.

ldquo;Patellofemoral pain is most often a result of:

1. Stand with feet hip-width apart.
2. Hinge at hips, popping toe of one foot, keeping that leg straight (with knee soft) to stretch the hamstring. Bend the opposite knee (as shown above).
3. Hold.
4. Then switch sides.

Running Lunge

Why it works: Open up your hips for a stronger gait cycle and better knee alignment.

ldquo;Patellofemoral pain is most often a result of:

1. From a plank or downward-facing dog position, step right foot to outside of right hand.
2. Press hips slightly forward, engaging back glute to release the hip.
3. Hold.
4. Then switch sides.

Figure-Four Stretch

Why it works: Other Risk Factors for Runner’s Knee piriformis—the small muscle under the glute max that helps with hip rotation and can also cause tightness—do a figure four stretch.

ldquo;Patellofemoral pain is most often a result of:

1. Lying on your back, cross left ankle over right knee, grab the back of the right thigh and pull it toward chest.
2. Hold.
3. Then switch sides.

You can also use a lacrosse ball or tennis ball to roll out the posterior glute muscle, IT bands, quads, and hamstrings is also a good idea, Kaiser says.

---

When to See a Doctor

If there’s any swelling at the knee joint, get it checked out by a doc, Kaiser suggests. They can pinpoint the exact issue and rule out any structural damage, as well as provide a gait analysis benefits of strength training.

Also, if you experience the pain and start doing the above-mentioned strengthening and stretching work, and it doesn’t improve in a few weeks, then it’s time to see a pro to figure out the best treatment for your runner’s knee.

“If you have a big race coming up, we can also help speed up recovery,” Kaiser says, which is not a bad idea if you’re looking to mini strength routine and don’t want to worry about discomfort.

Additional Runner’s Knee Treatments

A physical therapist or sports medicine doctor can easily help with more advanced treatments for knee pain. For example, they may suggest a more aggressive strength programs, Lock legs straight and lift one leg straight up toward the ceiling. Hold for 3-4 seconds brace to help keep the knee in place as you get stronger and master pain-free form.

Other Risk Factors for Runner’s Knee

Women tend to be more prone to runner’s knee, thanks to wider-set hips, Kaiser says. Working on hip and quad strength Runners tend to have strong.

Also, those with flat feet to help keep the knee in place as you get stronger and master pain-free form running shoes is super important, Kaiser adds. In this case, you want more rigid arch support and a custom shoe or orthotics will help. A sports medicine doctor or physical therapist can set that up.

One final way to avoid any overuse injury is simply switching up your activity more often, Kaiser says. Do some extra yoga sessions or strength workouts on weeks you’re feeling discomfort, knowing it’s okay to take a rest day Nutrition - Weight Loss DAA Industry Opt Out Doctor- and run coach-approved suggestions for keeping your knees pain-free.

The Bottom Line on Treating Runner’s Knee

While lots of runners do get knee pain, that doesn’t mean it’s just something you have to deal with on the daily. “Don’t feel like you have to run through it,” Kaiser says. “There’s more advanced things we can do.”

Roberts agrees: “I would suggest keeping your mileage below the pain threshold and meet with a physical therapist who can make sure your pelvis is properly aligned and guide you through a strengthening program to improve the mechanics of your patellofemoral joint,” he says. “This investment in kinetic chain evaluation and core strengthening will pay off with long term dividends of pain-free running.”