All About Runner's Knee

What is Runner’s Knee?

Runner’s Knee, otherwise known as patellofemoral pain syndrome, is characterized by pain around or behind the kneecap (patella). Symptoms can be triggered by repetitive motions such as running, walking, climbing stairs, squatting, or with static positioning such as kneeling and prolonged sitting. Your knee might also make a popping or grinding sound when bending.

Runner's Knee is a broad term that encompasses many structures and symptoms, which often makes it difficult to diagnose. In addition, the pain can be diffuse and non-specific because it is not coming from an internal structure such as the meniscus or ACL. Runner’s Knee is a result of repetitive irritation of structures, so even non-runners can have symptoms of Runner’s Knee, much like non-tennis players can have Tennis Elbow.  

In addition, certain mechanical faults can predispose you to developing Runner’s Knee.  Alignment issues like the kneecap sitting higher than normal, being “knock-kneed” or “pigeon toed,” having high arches, flat feet or weak hip musculature can result in greater friction between the kneecap and femur, causing wearing out of cartilage behind the kneecap.

The Keys to Successful Recovery

  1. Reduce the forces behind your knee:

    • Stairs can often cause strain on your knee. Try walking up the stairs sideways.

    • Avoid sitting for prolonged periods of time. Try to stand at least every 30 minutes.

    • Avoid sitting with legs crossed.

    • Walking up/down steep hills can create irritation since the incline makes your knee go into deeper bending ranges.

    • If you feel pain while squatting, do not go down as far into the squat. Deep squats can create excess pressure on the structures at the front of your knee. Keep your weight on your heels or try a lunge position instead.

  2. Take time to warm up before you work out. This brings blood flow to your knee and helps lubricate the joint.

  3. Wear supportive shoes to reduce impact on your joints.

If You are a Runner:

Runner’s Knee is one of the most common running injuries. Runners are particularly susceptible because of the repetitive nature of running. This is paired with the fact that running requires significantly more strength and body stability than walking. When you run, you are spending a brief amount of time with no contact on the ground. When your lead foot hits the ground, that leg has to stabilize your entire body! If you have weakness in your hips, quadriceps (particularly the vastus medialis), calf, or foot muscles, you will have difficulty controlling how and where your kneecap is moving. Since this injury is often due to instability, you will need to strengthen the muscles surrounding the knee. On average, it takes about five weeks to feel a difference! Below are some suggestions on how to manage your running until you are stronger:

  • Stop Running (or at least significantly reduce your mileage): If you continue to run at the same intensity, you will only exacerbate the problem and lengthen the recovery time.  It is only safe to run under your symptom threshold (i.e. stop running just before your knee starts to hurt). While you are recovering, try different cardiovascular exercise alternatives such as biking (as long as it does not bother your knee) or swimming.  During this time the focus should be on strengthening the muscles surrounding your knee. Our favorite strengthening exercises are listed later. We recommend focusing on the quadriceps, the four big muscles in your thigh that help hold your kneecap in place. We also recommend strengthening your hips and calves to better distribute the forces away from your knee. In addition, stretching (also listed later) with strengthening can help improve the mobility of the muscles around your knee to allow for more balanced knee motion.

  • Teach your Brain your New Movement Patterns (Neuromuscular Re-education): When your body’s biomechanics are off, your brain gets used to these dysfunctional movement patterns and continues to perform them anyway. This only worsens and prolongs the problem. Therefore, you must retrain your brain to learn the correct movement patterns, and then practice so they become more automatic. For example, once you get back to running, a good tip is to think about rotating your upper thigh outward every time you strike the ground. Your knee should almost pop to the outside and your hip muscles should activate as you rotate your leg outward.

  • When is it safe to resume running?

    • You must have the ability to fully bend and straighten your knee without pain before running.

    • When you feel no pain while you walk, squat, jog, sprint or jump.

    • The injured side should be just as strong as your uninjured side.

For more information on Runner’s Knee, including exercises and self-treatment techniques you can do to help it, see our DIY Guide on Runner’s Knee that is available for purchase.

Krystle Howald