Medically reviewed by 
If you’ve ever experienced a prolonged bout of pain right behind or around the knee cap, you could have what’s called patellofemoral pain syndrome. Better known as “runner’s knee,” thanks to its prevalence among runners, it’s one of the most common injuries in our sport. In fact, it can affect up to 30 percent of female runners and 25 percent of male runners, according to one estimate.
“This injury is usually due to movements that load the knee joint on a flexed position,” says Kimberly Kaiser, M.D., associate professor of orthopaedic surgery and sports medicine at the University of Kentucky and team physician for UK athletics.
Any time you hit your stride, you add impact to a bent knee as you take that leap forward, and this is what can cause the pain, especially if your mechanics are off. Running stairs and doing squats can cause the same reaction. In fact, a telltale sign of runner’s knee is more pain when you’re running downstairs or descending Health - Injuries.
The good news: Runner’s knee isn’t a structural problem, meaning your ligaments and cartilage are okay, Kaiser says. The problem lies in how your muscles function through the repeated movement of a run.
“Running Kaiser says, which is not a bad idea if youre looking to abnormal mechanics caused by problems up- or downstream from the knee, forcing the patella to bump against the femoral groove,” says 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. 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.
A Part of Hearst Digital Media legs and core. So, we laid out the best ways to ignore these issues so you can start treating your runner’s knee.
One quick caveat: Before you dive into an at-home program, it’s smart to get assessed for your pain by a doctor so they can make sure it’s runner’s knee and offer guidance on treatment. (More on that below!)
If you have a big race coming up, we can also help speed up
Runners tend to have strong hip flexors and weaker posterolateral muscles, with the gluteus maximus as a primary posterior muscle and the gluteus medius as a primary lateral muscle.
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.
Runner’s Knee 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
Start lying on one side, propped up on forearm, shoulder over elbow and hips stacked. Externally rotate top hip while lifting top knee toward the ceiling, keep feet glued together. Lower leg back down. Repeat.
Donkey Kick
Start on all fours, shoulders over wrists and knees right under hips. Extend one leg up and back, foot flexed. Press heel toward the ceiling, making sure back stays flat and knee points straight down. Lower knee back toward floor. Repeat.
Fire Hydrant
Start on all fours, shoulders over wrists and knees right under hips. Keeping knee bent 90 degrees, lift it out to the side and up toward the ceiling. Make sure you don’t drop the opposite hip. Lower knee back down to the floor. Repeat.
Straight Leg Raise
Sit or lie faceup, legs straight out. Lock legs out straight as you lift one straight up toward the ceiling. Hold for three to four seconds, then lower back down and repeat. The key is to keep the leg totally straight to activate the vastus medialis oblique (VMO), rather than just the quad. 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.
Cause: Tight Hamstrings or Hips
While weak muscles can cause a misalignment in running form that leads to knee pain, so can tight muscles. Typically, runners will find this limited range of motion in their hamstrings or hips, Kaiser says.
Runner’s Knee 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.
To stretch your hamstrings—which is best performed after a workout when muscles are warm—simply lie on your back and pull one leg gently back toward chest. For your hips, perform a running lunge: With one foot in front, place the opposite knee on the ground and press hips forward, engaging back glute to release the hip.
steep hills, Kaiser says piriformis—the small muscle under the glute max that helps with hip rotation and can also cause tightness—do a figure four stretch. Lying on your back, cross left ankle over right knee, grab the back of the right thigh and pull it toward chest.
Using 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 exactly what’s causing the issue and rule out any structural damage, as well as provide a gait analysis to help improve your run mechanics.
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.
“While weak muscles can cause a misalignment in running form that leads to knee pain, so can recovery,” Kaiser says, which is not a bad idea if you’re looking to around your thigh, right above the knee joint. Aim for three sets of 15 reps each 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, tape the knee cap in a certain direction, or use a 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 Patellofemoral pain is most often a result of.
A Part of Hearst Digital Media 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 too. To gain the steep hills, Kaiser says when it comes to injury protection, give it a permanent place on your weekly schedule as well.
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.”
Mallory Creveling, an ACE-certified personal trainer and RRCA-certified run coach, joined the Runner's World and Bicycling team in August 2021. She has more than a decade of experience covering fitness, health, and nutrition. As a freelance writer, her work appeared in Women's Health, Self, Men's Journal, Reader's Digest, and more. She has also held staff editorial positions at Family Circle and Shape magazines, as well as DailyBurn.com. A former New Yorker/Brooklynite, she's now based in Easton, PA.
John Vasudevan, M.D. is an associate professor at the University of Pennsylvania. He is board-certified in Physical Medicine & Rehabilitation and Sports Medicine. He is a Team Physician for UPenn Athletics and medical director of the Broad Street Run and Philadelphia Distance Run, and previously for the Rock 'n' Roll Half-Marathon and Tri-Rock Triathlon in Philadelphia. He is a director of the running and endurance Sports Medicine Program at Penn Medicine. Dr. Vasudevan provides non-operative management of musculoskeletal conditions affecting athletes and active individuals of all levels, and combines injury rehabilitation with injury prevention. He utilizes a variety of ultrasound-guided procedures and regenerative approaches such as platelet-rich plasma and percutaneous ultrasonic tenotomy. He sees patients at the Penn Medicine and the Philadelphia Veterans Administration hospital. Dr. Vasudevan attended medical school at the University of Wisconsin School of Medicine and Public Health in Madison. After his Transitional Year in Tucson, Arizona, he went to residency in PM&R at Thomas Jefferson University in Philadelphia and onwards to Stanford University for his fellowship in Sports Medicine. He has been in practice at the University of Pennsylvania since 2012.
