Runner’s Knee

Patellofemoral pain syndrome (PFPS) is among the most common causes of knee pain. The injury impacts top runners and amateurs alike. In fact, there is evidence to suggest it may account for as much as 50 percent of lower extremity injuries in runners. PFPS is generally characterized by pain and discomfort behind or around the patella. It is often called runner’s knee because pain results from activities that require the knee to flex while bearing weight on the patellofemoral joint, such as running. If you’ve encountered this injury, you know how nagging it can be. Fortunately, there are a number of research-backed measures you can take to treat or prevent PFPS.

Runner's knee is generally characterized by pain and discomfort behind or around the patella. Illustration: Oliver Baker
Runner’s knee is generally characterized by pain and discomfort behind or around the patella. Illustration: Oliver Baker

Symptoms of Runner’s Knee

  • Tenderness around or behind your knee cap
  • Pain that is aggravated by downhill running
  • Dull pain when running on uneven terrain
  • Pain when you push on the patella

Causes of Runner’s Knee

Runner’s knee occurs as a result of improper tracking of the knee cap in the femoral groove. When the patella doesn’t track correctly, the result is pain while flexing the leg and bending the knee. Poor strength and flexibility in areas like the hips, hamstrings and quadriceps have all been shown to contribute to this problem.

Training errors are another potential culprit. This can include an accelerated build-up of mileage, as well as too much high-intensity running or hill work. Worn out or inappropriate footwear is also cited as a possible cause.

Runner’s Knee Treatment

The first line of treatment for runner’s knee is rest, along with the use of ice and NSAIDs. This may help diminish pain and swelling in the short term.

Take a day or two to rest. Do not run on a knee that is painful, as you will only make things worse. If you are unable to bear weight on the injured leg or if you have swelling of the joint, these are signs that you may have more important structural damage to the ligaments or cartilage. In these cases, evaluation by a physician is strongly recommended.

For long term care, research suggests strengthening the top of your leg if you’re struggling with runner’s knee. Poor hip strength and stability have been repeatedly shown to create knee problems. For instance, when researchers focused on a group of runners with PFPS, they found that their biomechanics were hampered by hip instability as a result of weak hip abductor muscles. Other research identifies the importance of hamstring and quadriceps strength in addressing runner’s knee.

Research published in the Journal of Athletic Training demonstrates that six weeks of hip strengthening exercises can help improve the symptoms associated with runner’s knee. Squats, balance exercises and movements that incorporate the hip abductors and hip flexors are paramount.

What’s more, when physical therapy researchers from the University of Pittsburgh compared patients with and without PFPS, they discovered that those with runner’s knee tended to have less flexibility in their quadriceps, hamstrings and calves. Some runners will find relief by foam rolling. Rolling out the quads, hamstrings and calf muscles can help stretch those areas and take strain off the knee.

There is also new research out of the University of Calgary that suggests orthotic insoles may help runner’s ailing from PFPS. They discovered that orthotics could change biomechanics by reducing knee loading and thereby alleviating pain. The researchers suggest that custom-made insoles, which can be tailored to a runner’s individual gait pattern, are optimal.

Remember that cutting back on mileage—or even taking a complete break from running—remains important. If pain has subsided after a few days of rest, begin a strengthening program for your legs. Replace your shoes if necessary with new ones that are suited to your running style. After a week or so, continue the strengthening exercises and resume running on a soft surface but at a much reduced volume and intensity. If the pain does not return, slowly increase the frequency, duration and finally intensity of the runs over a period of at least a month. If at any time the pain returns, evaluation by a physician is probably a good idea.

Preventing Runner’s Knee

It is important to be proactive with prevention measures, especially if you’ve suffered from runner’s knee in the past. Implementing a regular strength and flexibility routine should be a main focus. Strengthening the hips, quads, hamstrings and every muscle in between improves overall stability and helps the kinetic chain function by design. In addition to improving patellar tracking, these exercises will reduce undue pressure and load on the knees.

Working to improve mobility also remains necessary. Leg swings before or after workouts are a great way to improve hip mobility in particular. Simply stand next to something that you can hold onto for balance and swing one leg at a time forward and backward. Then swing each leg sideways, sweeping it across the front of your body. Foam rolling the iliotibial band, hamstrings, calves and quads can also assist in keeping your biomechanics in good working order.

Listen to your body and respond at the first sign of discomfort. Runner’s knee is an injury that worsens if you continue to run on it. Building mileage slowly will help ensure you remain healthy. Do not increase your mileage by more than 10 percent from one week to the next. Avoiding excessive downhill running and stairs are also good measures to take if you’re hoping to skirt injury.

New research has found that addressing running form can help to prevent runner’s knee. Converting from a rear-foot to a forefoot or mid-foot strike pattern has been promoted as a means to reduce patellofemoral stress. Adopting a forward trunk posture, meaning a mild lean, while you run, while simultaneously engaging lower abdominals subtly, can also help.

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