Preventing Runner's Knee: Your Guide to Pain-Free Running

Have you started to notice a pain in your knee during or after your workouts? This could be a sign of patellofemoral pain syndrome - often known as runner’s knee. It’s one of the most common sports injuries out there, and can make running and other activities very uncomfortable. 

The good news is that runner’s knee can be treated, and many people return to training after a period of rest and recovery. The not-so-good news is that you will have to pause your training to give yourself time to heal.

In this guide, you’ll learn more about what patellofemoral pain syndrome actually is, we’ll describe runner’s knee symptoms and we’ll cover some key runner’s knee treatments. And since prevention is better than cure, we’ll also look at how to avoid it in the first place (or stop it coming back) using a variety of exercises and stretches. 

What is patellofemoral pain syndrome (runner’s knee)?

‘Runner’s knee’ is a term used to describe pain felt in the front of the knee during and after exercise. It’s a broad term, and covers a variety of symptoms and has several causes. People often describe runner’s knee as an aching pain in or behind the knee cap when they run, get up from a chair, or ascend and descend stairs. 

The medical name for runner’s knee is patellofemoral pain syndrome (PPS). This means that it is a pain in the part of your body connecting the patella (knee cap) with the femur (thigh bone). 

While it is often associated with running, PPS can affect people who play a variety of sports including tennis, cycling, football, handball and any activity where you bend and straighten your knees a lot. It also affects people who’ve suffered an impact injury to their knees (such as falling on them).

Learn more: Common running injuries to be aware of

What are the main runner’s knee symptoms?

People with runner’s knee experience a variety of symptoms, but some of the most common include:

• Pain in the knee cap or behind the knee cap when doing exercise. The pain is often dull and aching, but can be sharp. 

• The pain tends to be mild to begin with, but gets worse over time. 

• You may also experience pain after sitting with your knees bent.

• Your knee cap may feel sore or tender when touched. 

What are the main causes of runner’s knee?

Runner’s knee usually develops because of a variety of underlying problems - there often isn’t one single cause. Things that make runner’s knee more likely include:

• Overuse - particularly after a sudden increase in exercise

• Incorrect running form

• Weak hip and thigh muscles

• Tight hamstring muscles

• Genetics (some people are more prone to it than others)

• Problems with how your kneecaps are aligned

• Over- or under-pronation (how your feet move when they strike the ground)

• Lack of support from your running shoes

• Running in old shoes

• Having a leg that is longer than the other

• Having ‘flat’ feet

• Being overweight

• Impact injuries to the knee

• Being a teenager

• Runner’s knee appears to affect women slightly more than men 

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Do you need to see a doctor for runner’s knee?

For many people who develop runner’s knee, the problem will go away by itself with enough rest, home remedies, exercises and stretching (see below).

However, if you do rest and the pain hasn’t gone away after a week or two, then it is worth booking an appointment with the doctor. They will do various tests to find out the underlying cause of the pain. 

Runner’s knee shares symptoms with other conditions such as osteoarthritis, which requires different kinds of treatment. So it’s worth seeking medical advice for pain that isn’t going away by itself.

Acute runner’s knee treatment

If a doctor or physio has diagnosed you with runner’s knee, or you believe you have it, the following methods can help treat the condition during the acute phase (when it’s still very sore). 

• Rest

Resting your knee is a vital part of treating runner’s knee. It can be frustrating - especially if you’re training for an event. Nevertheless, your injury will only get worse if you keep stressing it.

The amount of time you need to rest depends on the severity of the injury, plus factors such as your age and weight. Milder cases can take around 4-6 weeks to heal, and you should be able to return to regular running within a few months. Unfortunately, more severe cases can take longer to heal. 

The good news is that resting doesn’t mean you need to stop exercising. There are many other kinds of low impact training you can do which won’t stress your knees -  including yoga, gentle cycling, swimming and more. 

• Ice

Apply an ice pack (or even a bag of frozen peas) wrapped in a tea towel to your sore knee for 10 minutes a few times per day. This will help reduce inflammation and pain. 

• Elevate your leg

Elevating your legs - particularly in the early days of recovery - helps reduce the pressure on your knee. Lie in bed or on the couch and use a pillow to raise the leg higher than your heart. 

• Compression

You can wrap compression bandages around your knee in the first few days after an injury. This encourages nutrient-rich blood to flow to your knee, helping to speed up recovery. 

• Massage

Physiotherapists may recommend massage (which you can also do to yourself) around the knee and lower thigh. It’s best to get advice about how to do this directly from a physio. 

Runner’s knee stretches

Once the initial pain from runner’s knee starts to subside, you can begin using simple runner’s knee stretches. Patellofemoral pain syndrome is associated with tight leg muscles, so the following stretches can help relieve some of the tension in these muscle groups. 

• Quad stretch

While standing up, balance on your left leg and use your right hand to grab your right foot and stretch it behind you. Place your left hand against a wall for balance. Hold the stretch for 15 seconds, then switch legs. 

• Hamstring stretch

Stand up straight. Bend your left knee, and step your right foot forward, so that only the heel is touching the ground and the toes are pointing upwards. Place both hands on your upper right thigh, and lean into the stretch. Hold it for 15 seconds, then switch legs. 

• Calf stretch

Stand up, facing a wall. Step forward with your left leg, and place the palms of your hands against the wall. There should be a bend in your left knee, while your right leg is straight behind you - you’ll feel the stretch in your right calf. Hold the pose for 15 seconds, then switch legs. 

• Iliotibial band stretch

Your iliotibial (IT) band is a tissue running down the side of your hips to your shin. Stand up, with a wall to your right hand side. Place your right hand palm against the wall, then cross your right leg behind your left leg. Lean your right hip towards the wall, until you feel a stretch along the IT bands. Hold for 10 seconds, then switch legs. 

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6 tips to prevent runner’s knee

Whether you’ve recovered from runner’s knee and want to avoid getting it again, or simply wish to reduce your chances of experiencing this injury in the first place, the following six tips can help. 

1. Warm up before exercise

When you run, you place much more strain than usual on your joints - research shows that forces up to four times your bodyweight pass through your knees. And this is why it’s so important to warm up. Warming up encourages blood to flow to your muscles, it loosens up your joints, and gets your knees primed for action. 

If you run without warming up, the tendons, bones and muscles around your knee could become damaged. That damage can accumulate over time and contribute towards runner’s knee. 

Our guide to running warm-ups provides a complete overview of warming up exercises, how to do them, and how long for. 

2. Check your running form

If your running form is not correct, it could mean your body compensates by placing more stress on your knees. Over time, this can cause damage and result in runner’s knee symptoms. 

We’ve written a complete guide to running form, but key points include:

• Holding your head high and keeping it centred between your shoulders

• Keeping your back straight

• Looking ahead of you and not at the floor

• Relaxing your jaw and neck

• Keeping your shoulders relaxed and parallel to the ground

3. Think about your footwear

Wearing unsuitable footwear may increase your risk of developing runner’s knee. If your running shoes don’t offer the kinds of support and cushioning you need, then you may be more likely to place stress on your joints. Similarly, inappropriate shoes may force your body to overcompensate for the lack of support by changing how you move your legs. Again, this places unnatural strain on your joints. 

Consider changing your running footwear if:

• Your shoes are too old: As a rule of thumb, you should replace your running shoes after 400-500 miles. Although modern running shoes are built with highly durable materials, the foams and gels used in the cushioning will eventually degrade after extensive use and give you less support. That could start to increase your risk of runner’s knee. 

• You need stability shoes: If you overpronate when running (your ankles roll inwards) or underpronate (they don’t roll in so much), your knees will be under much more strain than for people with a ‘neutral’ running style. This can contribute to patellofemoral pain syndrome. Stability running shoes are designed to ‘correct’ the movement of your feet by using solid foam and plastics in the midfoot, so less pressure is placed on your knees. 

Learn more: What is pronation?

4. Perform strengthening exercises

One of the most effective ways of preventing runner’s knee is to strengthen the muscles in your legs and core. Stronger muscles help stabilise your legs, meaning you avoid unnatural movements when running (such as your knees bending inwards or out to the side). 

Exercises to strengthen your legs and core include:

• Reverse lunges

• Glute bridges

• Step ups

• Lateral step downs

• Squats

Read our strength training guides for runners for step-by-step instructions for many more leg strengthening exercises you can start using. 

5. Avoid overuse by doing cross-training

As mentioned above, a key cause of runner’s knee is overuse. This is especially common when runners suddenly increase the distance, intensity or frequency of their sessions. The simplest way to avoid overuse injuries is with cross-training. In cross-training, you build other kinds of exercise into your running routine. Crucially, you want to choose alternative exercises that don’t place as much stress on the knee. 

There are many different kinds of running cross-training you can try, including:

• Strength training

• Circuit classes

• HIIT classes

• Cycling (be aware that pedalling can also strain your knees, so begin slow and low)

• Swimming (as with cycling, some kinds of swimming - particularly breast stroke - can strain your knees, so start slow and low)

• Yoga and Pilates

• Aqua jogging

• Elliptical machines

6. Increase running mileage gradually

If you are training for a 10k, a marathon, or any other distance event, then you will need to increase your mileage over time in order to get race fit. So, how do you do this without risking runner’s knee? Here are some pointers:

• Follow a suitable training plan: A proper training plan should give you enough time to build up your running legs, without risking injury. You’ll start with shorter runs, and only gradually increase distance and intensity from one week to the next. 

• Rest: Giving yourself enough time to rest between runs is vital. On an average week, you should have at least three days of full rest dotted between training days. This gives your joints and muscles time to repair any damage and recover. 

• Cross-training: Aim for at least one cross-training session per week during your event preparation. Cycling, swimming, elliptical machine workouts or yoga are all great options. 

• Look out for early warning signs: If you are increasing the amount of running you do, be conscious of the risk of injuries and listen to your body. Pay attention to early warning signs of things like runner’s knee pain. If you experience discomfort, rest for at least one week. Avoid the urge to ‘run through it’, as this only increases your chances of injury. 

Reduce your risk of runner’s knee

The knee is well known for being one of the most common areas for runners to get injuries. The good news is that while runner’s knee is painful and frustrating, it can be treated. With the correct care and adequate rest, most people who get runner’s knee can return to running within a few weeks or months. 

But of course, prevention is better than cure. By following some of the methods and exercises we’ve described above, you can avoid getting runner’s knee altogether, and keep training without breaking your stride.