If it sounds to good to be true, we’re supposed to believe it’s total hogwash. Plus, I’m a skeptic in general of big claims…but when it comes to runner’s knee, I’m absolutely not yanking your chain—this works.
I’ve found a process to help most of us figure out the root cause of why our knees hurt after running, and then fix it.
Patellofemoral pain syndrome, commonly referred to as runner’s knee, is a prevalent ailment that has the potential to disrupt a runner’s journey. It manifests as a nagging pain around or behind the kneecap, often exacerbated during or after running, and can even lead to swelling and discomfort.
Of course, there are a million ways to get injured, but if you feel like you’re stuck without answers, the good news is that with the help of a great physical therapist, we can almost always find the cause and fix it!
This article delves into the essence of this collaborative approach, offering insights into understanding, managing, and ultimately runner’s knee.
Patellofemoral Pain Syndrome: Runner’s Knee Pain
Unfortunately, runner’s knee (formally called “patellofemoral pain syndrome”) is a common issue that leads people to believe that running is bad for your knees.
Tons of doctors and studies agree that it’s not, and in fact, running can actually be helpful in providing joint strength and lubrication.
So what gives? Well….our desire to spend all our time running and not always looking at the other ways we need to strengthen our body for total health.
This is a long post so I can share both my story and the steps to resolve it. If you’ve ever had knee or IT Band problems, I want to make sure I give you all the details.
I know how frustrating it is to try and resolve, so you like me have probably spent wayyyy too many hours testing different things to figure out how to heal runners knee.
We are all different, listen to your body, test, try, repeat.
Symptoms of Runner’s Knee
- Pain around the kneecap or patella (where your knee connects with the thigh bone), especially when bending the knee, squatting, or going up and down stairs.
- A feeling of grinding or clicking in the knee joint.
- Stiffness or swelling in the knee, especially after sitting for a prolonged period with the knee bent.
- A feeling of weakness or instability in the knee, leading to a lack of trust in its strength.
How is Runner’s Knee Diagnosed?
Since the symptoms of runner’s knee can overlap with other knee-related issues, an accurate diagnosis is crucial for effective treatment and management.
A thorough physical examination is conducted to assess the patient’s knee and overall biomechanics. The examiner will check for tenderness around the kneecap (patella) and its surrounding structures. They may also evaluate muscle strength, flexibility, and joint range of motion in the hips, knees, and ankles, as imbalances or weaknesses in these areas can contribute to runner’s knee.
This is usually followed by a functional movement assessment.
They observe your movements, especially those that mimic the actions performed during running or other activities that trigger pain.
The examiner pays attention to the patient’s gait, alignment of the lower limbs, and the tracking of the patella during movements. Deviations from normal alignment or improper biomechanics may provide insights into the underlying causes of the pain.
What Causes Runner’s Knee?
There is no one single cause of knee pain in runners. It’s different for everyone and is often a combination of several different things. Here are some common things that can contribute to knee pain in runners:
- Overuse and Strain: Repeated stress on the knee joint, especially from high-impact activities like running, can lead to wear and tear.
- Muscle Imbalances or Weakness: If the muscles around the knee or in the thighs are weak or imbalanced, they may not support the joint properly. This lack of support can contribute to the pain associated with runner’s knee.
- Muscle Tightness: Tight hamstrings or quadriceps can contribute to knee pain.
- Misalignment: An alignment issue in the legs or feet might place extra stress on the knee, resulting in pain and discomfort.
- A condition called chondromalacia patella, which occurs when the cartilage under your kneecap breaks down.
- Trauma: A direct blow or injury to the knee can cause immediate problems or lead to issues down the line.
- Foot Problems: Flat feet or issues with the arches of the feet can translate to strain on the knee joint.
- Improper Equipment or Technique: Wearing shoes that don’t fit correctly or following improper running techniques can place undue stress on the knees. For example, if your shoes don’t have the right arch support, this could contribute to pain in the knees.
How to Fix Runner’s Knee
First we have to find the main culprit. Here are a few of the possible things to look at:
- Fix hip alignment
- Fix knee extension
- Fix any knee drift
- Fix weak hip, glutes, core
- Fix any bad running form issues
- Don’t just rest and expect healing
So if you really want to know how to cure runner’s knee, keep reading and then TAKE ACTION.
1. Hip Alignment for Runners
Hip alignment refers to the idea that your pelvis should be level from side to side and not rotated forward or backward.
Due to the constant pounding of running, it is not uncommon for runners to find their hips get out of whack….what resolves that is first the chiropractor and then allllll the hip, glute and core work I’m going to mention below.
My right leg is shorter than my left, and I’ve heard this from many chiro’s, so we agreed that was probably not an issue since I’ve been running just fine with it for many, many years.
- Yes, you can run pain free with one leg shorter.
- If you’ve always done it without issue and didn’t even know it existed, it’s fine.
- BUT if this is a new shift in your pelvis that could be causing issues.
2. Improve Knee Extension
This move from Kelly Starrett worked the first time I tried it. (It may not be necessary for YOU, so test it out and see if you notice a change.)
All these doctors and not a darn one of them recommended or even looked at this, which makes me crazy!!!
For months I kept telling David it seemed really bizarre to me that I could move my right leg into hyper-extension, but I had zero extension with my left leg.
I didn’t know what to call it or why it mattered since when I pointed it out to the PTs, they all just said, “hmm, that’s weird.”
The acupuncture guy said I had a tight IT Band, but even I knew that didn’t make sense. So I texted the best doctor on Earth, Dr. Lorenzo, and he said the popliteus muscle needed to be stretched.
Here’s another video with moves and an explanation of the muscle.
Which led me to “terminal knee extension,” and immediately I knew I was heading in the right direction because it finally described what I felt.
I recognize that this issue is probably not one most of you have, but in case someone else out there is banging their head against a wall, I had to share it.
I have been doing this and a couple of others for the last 2 weeks and have regained almost complete range of motion…that’s right, 5 months of no answers, and in 2 weeks I’m almost back to normal just doing something for free at home!
3. Fix Knee Pain by Resolving Knee Drift
After talking with my new stellar sports physical therapist, we agreed that my hips are pretty much always a little off, even after adjustment.
Then he looked down at my foot and said, “Look how your foot is falling inward while you simply stand still”.
Below is an image of me running to help you understand what falling in means (i.e. pronation).
What’s called knee valgus, is particularly common in female runners, due to what’s known as the Q-angle from wider hips. The result is more common issues with runner’s knee, IT Band pain and ankles, if we don’t do the right strength work.
The knee drift could be caused by foot pronation, weak hips or misaligned hips.
- Checkout my 30 Day Core Runner Program – 10 minutes a day will help resolve so many runner injuries
- Start with hip and glute strength BEFORE adding a running insole to your shoe
- Don’t think it’s something you have to live with, running should not be painful.
Best running shoes for knee pain?
When I switched to the Kinvara’s around 2009 they seemed to resolve my IT Band pain, so I stuck with them for many years.
But it’s highly logical that after many more years of running some things have changed in my body and my stride. YES, you may need a different shoe now than you used to!!
I have a full article on the best running shoes for knee pain, but a few tips:
- Lower profiles shoes tend to help prevent overstriding and heel striking and as noted seem to help IT Band issues (low profile means a low heel to toe drop, not always a minimal shoe)
- Rotate your running shoes to work different muscles and prevent reliance on a shoe to fix a weakness
- Zero drop shoes do not guarantee no knee pain if you have poor form (checkout what matters in a gait analysis)
- Stability shoes often hide your weak hips and glutes, so as noted do the work before moving to a shoe that corrects your foot
- Finally, it’s time to look at orthotics when you’ve done the core strength and noticed you need just a little more help (especially if running with flat fee). I like insoles because you can still get a neutral shoe and it’s a smaller adjustment many times than a firmer stability shoe.
4. Fix Runner’s Knee Pain with Total Core Strength
According to Dr Lisa Mitro, “the hip movement patterns can play a big role in patellofemoral pain syndrome specifically if your glutes are weak into hip extension and external rotation. Weakness in big toe stability can also cause compensations up the kinetic chain including poor glute activation and poor foot control. ”
This is an absolute must focus on area to prevent knee pain.
Core doesn’t just mean abs, it means glutes and hips, too. All together they provide the stability you need to prevent knee, ankle, hip, and IT Band pain from running.
You don’t have to go to a PT, as I do share tons of moves here on RTTF…but it’s never bad to get someone to evaluate your movement patterns.
Once I realized that I needed to first do the knee extension stretch, next was learning to reactivate the glute medius and external rotators.
Squats and lunges are going to work the glute maximus, but you need to activate other muscles for complete hip stability.
Here are some additional movements, you can start doing right now to help fix your running knee pain.
I can also tell you since having knee surgery (due to a trampoline), my PT repeatedly said that my focus on core strength is what helped me to recover and get back to higher mileage faster than normal.
5. Focus on some Basic Running Form
While strength issues are often the primary driver of knee pain while running, there are some stride issues that could be culprits as well.
- Your foot should land under your body, if it’s in front, you are heel striking, which causes a braking effect and sends a lot of pressure up to the knee.
- If you are running on the balls of your feet and overtaxing the calf muscles, they could be pulling on your knee and IT Band.
- If you swing your arms across your body, that causes your hips to twist, and that radiates down the leg to your knees.
6. Rest Isn’t the Only Answer
But just not running isn’t going to resolve runner’s knee.
- You must figure out if your body is out of alignment.
- You must work on overly tight muscles.
- You must add in the lacking strength (trust me, every runner could do more strength training).
- Take joint health for runners seriously
One idea is Manual Muscle Manipulation. Tight muscles pull your body out of alignment, and your knees often take the brunt of that!
7. Try Additional Therapies
Beyond just seeing a PT to figure out your alignment, they can also work more deeply with your muscles.
This could mean A.R.T., a deep tissue massage, dry needling, or even electric stem; you have to experiment to find out what works best for you.
I found that daily foam rolling, combined with a monthly sports massage, is one of the best ways to prevent running knee pain. I think for me it helps work workout muscle kinks that might restrict motion and when combined with my absolute consistency in strength training it’s made a huge difference.
Runner’s Knee Not Going Away?
This article initially started with me detailing an off and on issue that lasted for a few years. I would have some pain, I would rest and it would come right back when I started running very much.
Which is why I keep telling you that rest along isn’t going to resolve the issue.
You have to commit to the ongoing physical therapy. You don’t stop the strength work when it feels better.
This is an ongoing process of keeping your body strong and in alignment, so commit to the process and I promise it’s something you shouldn’t have to keep dealing with!
Exercises to Help With Runner’s Knee
As noted above, I like having people follow a complete program that’s going to guide them day by day like the 30 Day Core. Otherwise I find you do a few and then stop!!
But if you are ready to do the work and maybe don’t have the resources to get to a Physical Therapist here are a few more movements.
Here are some physical therapy exercises that are commonly prescribed to individuals with runner’s knee (patellofemoral pain syndrome). These exercises aim to address muscle imbalances, improve knee alignment, and enhance joint stability. Remember to consult with a healthcare professional or physical therapist before starting any new exercise program, especially if you have existing injuries or medical conditions.
Straight Leg Raises
Lie on your back with one leg straight and the other bent. Lift the straight leg a few inches off the ground and hold for a few seconds. Lower it back down. Repeat for both legs.
Why: Strengthening the quadriceps helps improve the stability of the knee joint. Weak quads can lead to improper patellar tracking and increased pressure on the kneecap, contributing to runner’s knee.
With a mini band around your feet or ankles, take 10 steps to the left keeping tension on the band. Then 10 steps to the right.
Why: Strengthening the hip abductors, particularly the gluteus medius, helps stabilize the pelvis and prevent excessive hip drop during running. This can lead to improved alignment and reduced stress on the knee joint.
Lie on your back with your knees bent and feet flat on the floor. Lift your hips off the ground, engaging your glutes and core. Hold for a few seconds and lower back down.
Why: Engaging the glutes and core through bridging exercises helps stabilize the pelvis and control hip movements. This stabilization can lead to improved biomechanics and reduced strain on the knees during running.
Sit on the floor with one leg straight and the other bent, foot against the inner thigh of the straight leg. Lean forward from your hips, reaching towards your toes. Hold the stretch for 20-30 seconds and switch legs.
Why: Tight hamstrings can alter the mechanics of the lower limbs, potentially contributing to knee pain. Stretching the hamstrings can help improve flexibility and reduce tension that may affect knee alignment.
Spend time rolling your glutes, hips, quads and calf muscles. All of these can be tight and pull on the knee while running. Do not foam roll your IT Band!!
Single Leg Balance
Stand on one leg, keeping your knee slightly bent. Hold the position for as long as you can maintain good balance, then switch legs.
Why: Balance exercises challenge the muscles responsible for stabilizing the knee joint, promoting better proprioception (awareness of body position) and reducing the risk of sudden movements that can trigger knee pain.
These exercises are just a starting point and should be tailored to your individual needs and capabilities. A physical therapist can provide a customized exercise program based on your specific condition and progress.
I hope this was helpful to anyone having issues, I know how frustrating it can be to try and find answers!
Please do share with your running friends, I want us all to figure out what works for us individually to stay running as long and healthy as we can.
Moral of the story, you know your body…keep looking for answers.
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