“Runner’s Knee” is the general term given to knee pain that occurs in the front of the knee joint. This pain is exacerbated by ascending or descending grades while walking or running as well as squatting, kneeling, or sitting.

The knee is the largest joint in the body and is under constant weight-bearing strain and subject to regular use. It handles multiple responsibilities of bending, straightening, and absorbing impact and is only able to do this by existing at the intersection of an array of helpers, in the form of cartilage, tendons, bones, ligaments and muscles. The kneecap (patella) is particularly vulnerable; it is a sesamoid bone embedded by tendons and is designed for mobility.

As with most overuse injuries there is rarely a single source of runner’s knee, rather a host of factors contribute over time. Strong supporting muscles, ligaments, and tendons are essential and, as always, the entirety of the kinetic chain must be taken into consideration.

Where to start? To help treat and avoid runner’s knee add both flexibility and strengthening to your routine. The flexibility is to promote joint range-of-motion and the strengthening is to provide structural stability.

Step 1: Quad Flexibility

The rectus femoris (one of four quad muscles) attaches at the kneecap, and decreased mobility of this muscle puts undue strain on this area. This exercise will open it up and improve circulation.

Knee Release/Quadriceps

quad flex 1 for runner's knee
photo: Michael Del Monte

Lie on your side.  Bring your bottom leg close to your chest (you may use a rope to stabilize as pictured below).  Keep the angle of the bottom leg at 90 degrees.  Place your hand on the ankle of your working (top) leg.

Quad flex 2 for runner's knee
photo: Michael Del Monte

Activate your rear thigh and butt muscles to bring your top thigh behind you. Exhale. Move into your natural end range of motion and hold for 1-2 seconds. Inhale and return to the start position—keeping the hand on the ankle of the working leg and allowing the leg to swing forward. Perform 1 set of 10 repetitions; if you are really tight you may want to do an extra set.

Step 2: Knee Stability/Quadriceps Strength

quad strengthening exercise 1
photo: Michael Del Monte

Sit in a chair. Place a rolled towel under the knee of your exercising leg. Wrap an ankle weight onto the ankle of your working leg (select appropriate weight for your experience and comfort level). Exhale.

quad strengthening exercise 2
photo: Michael Del Monte

Extend the working leg into a straight and locked position. Your goal should be to position your leg perpendicular to your body. Hold for 5 seconds. Gently lower the leg and return to the start position. Repeat 10 times.

Extra Credit:

Knee Stability/Quadriceps Inner Quad

Do the same exercise, but this time turn out your working leg (toes pointing away from the midline) and extend the leg up to target the inner thigh muscles. Again, hold for 5 seconds and then return to the start position. Repeat 10 times.

Knee Stability/Quadriceps Outer Quad

Repeat the same exercise again but this time turn in your working leg (toes pointing towards the midline of your body) and extend the leg up to target the inner thigh muscles. Again, hold for 5 seconds and then return to the start position. Repeat 10 times.

Phil Wharton is the coauthor of The Whartons’ Stretch Book, The Whartons’ Back Book, The Whartons’ Cardiofitness Book and The Whartons’ Complete Strength Book. His path to becoming a musculoskeletal specialist started when he was a young runner; he developed a 33-degree curvature of the spine/scoliosis, which produced constant pain. Through the work he now teaches, he was able to end the pain, correct the problem, and continue his running career—later going on to run a 2:23 marathon. Learn more about his method at Wharton Health and  PhilWharton.com.