Here’s one thing that might surprise you: You don’t have to be a runner to get “runner’s knee.” If you feel a dull, aching pain in the front of your knee or around your kneecap (patella), it could be runner’s knee, even if the last time you ran was in high school gym class. The pain can occur when walking, going up or down stairs, squatting, or even sitting.

Technically known as patellofemoral pain syndrome, this condition is often called runner’s knee because it’s more common in people who do activities involving running. But that doesn’t mean these activities are causing the problem or that you should stop doing them. In fact, movement is an integral part of the treatment plan for runner’s knee.

Read on to learn more about runner’s knee, what causes it, and what you can do to feel better, including exercises from our Hinge Health physical therapists. 

What Is Runner’s Knee?

Runner’s knee is an irritation of the kneecap joint, the area where the femur bone in your thigh connects with the patella bone in your knee. “The joint is like a pulley system responsible for bending and extending your knee,” says Gwen Smith, PT, DPT, a physical therapist at Hinge Health. “And that pulley system can get irritated by many reasons.” 

Symptoms of Runner’s Knee

Runner’s knee usually develops gradually. When it does, you may notice one or more of these symptoms:

• A dull, aching pain in the front of the kneecap or around or behind it.

• Pain during activities in which you bend your knee, like walking, running, climbing stairs, kneeling, squatting, or getting up from a chair.

• Pain after sitting for a long period with your knees bent.

• Pain that may be worse when walking downstairs or downhill.

• Tenderness to the touch.

• Swelling around the knee.

• A popping or rubbing feeling when you bend your knee.

Some of these symptoms may sound scary, but remember, “you can manage it,” says Dr. Smith.

Runner’s Knee: A Hinge Health Perspective

Running gets a bad rep when it comes to your knees, and referring to patellofemoral pain syndrome as “runner’s knee” doesn’t help. Add in myths about running damaging your knees, and it’s easy to see why you may be fearful to continue running. 

But giving up running may be worse for your knees. Inactivity can actually make the pain worse over time as muscles weaken and joints stiffen, which can increase pain and make you more susceptible to other knee injuries. That’s why movement is medicine when it comes to knee pain. By taking an active approach to managing your knee pain, you can improve your overall health, prevent future pain flares, and get back to doing what you love including running. 

“You are not damaging your knees, breaking anything, or causing arthritis by continuing to run,” says Dr. Smith. “You can still run with runner's knee as long as you're managing the load, which includes understanding your pain buffer zone and when to scale back or push forward.” Movement, even if you feel some discomfort, builds strength, flexibility, and resilience to pain. It can also help with other factors like stress and anxiety that can influence pain.

Common Causes of Runner’s Knee

Despite its name, running doesn’t necessarily cause runner’s knee. This type of knee pain can occur for many reasons. No matter what might be contributing to it, there’s a lot you can do to reduce or prevent it. Here are some of the most common reasons you may experience runner’s knee:

Too much, too often, too soon. Your knees are designed to move and withstand lots of activity. But when you don’t prepare them for more miles, more reps, inclines, or higher intensity — whether you’re running, walking, cycling, hiking, stair climbing, or doing squats — it can result in irritation in the knee joint. That doesn’t mean you shouldn’t challenge yourself with more strenuous workouts. You just want to do it gradually to build strength and tolerance. 

Changes in your routine. Most of the time, switching up how you workout is good for you. Trying new strength exercises works muscles differently for better muscle balance. Alternating high-intensity workout days with lower-intensity ones can prevent injuries. But some changes — like new running surfaces or shoes — may cause issues if you don’t ease into them. You may be able to run four or five miles on a gravel path, but on harder concrete, you might need to start with a mile or two before building up. If you’re used to walking or running in a very supportive sneaker, trying to log the same number of miles in a minimalist-style shoe could trigger some knee pain. 

You don’t have to avoid these changes, but if you notice some knee pain after making a change, back off a bit and gradually work up to your usual distance or time.

Terrain (or running surface). There may be certain factors about where you run that can take your body and knees some time to get used to. For example, many roads have a big lateral slope to them. If you increase how much you walk or run on sloped surfaces too quickly, it can place stress on your knees. You may need to find some variety in where you run, or dial back the miles until your body adapts to the terrain.

Muscle weaknesses or imbalances. When muscles aren’t strong, or groups of muscles are out of balance, it can make you less tolerant to changes. Strong, balanced muscles distribute stress more evenly, so your bones, muscles, tendons, and ligaments can tolerate the load and become gradually stronger. “You want to have adequate strength in the quads, hamstrings, glutes, and calves to help with your stride,” says Dr. Smith.

Foot issues. Overpronating (rolling in too much) can increase stress on the knees and may contribute to runner’s knee.

Tight muscles. Limited range of motion from tight muscles can cause changes in walking and running patterns which can result in increased stress on the knees. Tight hip flexors, for example, may impact your stride and place more stress on the knee.

Lifestyle factors. While they may not be the primary cause of runner’s knee, factors like stress, poor sleep, and anxiety can contribute to knee pain. Your body recovers, repairs, and gets stronger when you’re sleeping, but if you’re not getting enough rest, these processes may be affected. Poor sleep quality significantly contributed to injury risk in endurance athletes, according to a study in the Journal of Medicine and Science in Sport. 

Exercise can help with many knee pain causes, but some symptoms require immediate attention. If you’re experiencing any of these symptoms, talk to a doctor or physical therapist:

• Loss of function in your legs

• Your knee is giving out 

• Significant swelling 

• Radiating pain 

• Lack of improvement 

• Worsening of symptoms

Treatment Options for Runner’s Knee

Exercise therapy is the treatment of choice for runner’s knee, according to the most recent consensus statement from the International Patellofemoral Research Network, which bases its recommendations on the latest evidence. These treatment strategies prioritize movement while managing pain as you recover.

Follow the PEACE & LOVE method. This new pain relief approach offers a more comprehensive plan than the traditional RICE (rest, ice, compression, and elevation) method. Instead of rest, PEACE & LOVE encourages movement as you heal.

Practice load management. Movement is an essential part of recovery, and being able to continue doing an activity like running, walking, or cycling that you enjoy can have additional physical and mental benefits. To stay active, practice load management. That means identifying potential pain triggers like distance, time, frequency, and running surfaces, and then scaling them back so you can still exercise comfortably until you’re ready for more. 

Pay attention to how you feel. You can effectively manage your activity level when your knee hurts by staying within what Hinge Health physical therapists call the “pain buffer zone.” To find yours, assess your pain on a scale of zero to 10, with zero being no pain at all and 10 being so painful that you’d go to the emergency room. If your pain level starts to get higher than a five, you want to scale back. Keeping pain below five ensures you get the healing benefits of exercise without further irritating your knees. 

Strengthen your running muscles. Your glutes, quads, hamstrings, and calves are key running muscles, and the exercises below will strengthen them without irritating your knees. When these muscles are strong and working effectively, they reduce stress on the knees. 

Land softly. When novice runners learned to land more quietly, the amount of force they experienced decreased, according to a study in the American Journal of Sports Medicine. During the yearlong study, the gait-trained runners were 62% less likely to be injured than those who didn’t change how they landed. While this study used a gait-training program, other research has shown that simply focusing on running softly or making less noise when you land can decrease impact.

Cross train. Even when you’re not recovering from an injury, cross-training is an effective load management strategy. Cross-training involves alternating impact activities like walking and running with non-impact cycling or swimming. This allows you to remain active without increasing irritation in your knees. 

Exercise therapy is one of the best tools to rehabilitate runner’s knee. These exercises recommended by Hinge Health physical therapists strengthen the muscles that support the knee joint. Most of them are done without bending your knees to reduce further irritation. When your knee pain has subsided, you can progress to knee exercises for runners to prevent a recurrence or other knee issues.

The information contained in these videos is intended to be used for educational purposes only and does not constitute medical advice or treatment for any specific condition. Hinge Health is not your healthcare provider and is not responsible for any injury sustained or exacerbated by your use of or participation in these exercises. Please consult with your healthcare provider with any questions you may have about your medical condition or treatment.

PT Tip: Take Shorter Steps

When you take shorter steps as you run, you increase your cadence or step rate, which can reduce knee pain. Cadence is the number of steps you take in a minute while running (or walking). Increasing your cadence doesn’t necessarily mean running faster. You’re just taking more steps in the same amount of time to cover the same distance. The effect is better running form and less impact.

“When you have longer step lengths or strides, it may throw off the mechanics of the hip and the knee,” says Dr. Smith. “Shortening your strides can improve your movement and reduce the force coming up through the joint.” Dr. Smith recommends aiming for 165 to 180 steps per minute. You can use an online metronome to keep the beat.

How Hinge Health Can Help You

If you have joint or muscle pain that makes it hard to move, you can get the relief you’ve been looking for with Hinge Health’s online exercise therapy program.

The best part: You don’t have to leave your home because our program is digital. That means you can easily get the care you need through our app, when and where it works for you. Through our program, you’ll have access to therapeutic exercises and stretches for your condition. Additionally, you’ll have a personal care team to guide, support, and tailor our program to you.

See if you qualify for Hinge Health and confirm free coverage through your employer or benefit plan here.

This article and its contents are provided for educational and informational purposes only and do not constitute medical advice or professional services specific to you or your medical condition.

References

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2. Patellofemoral pain syndrome (runner’s knee): How can you relieve pain at the front of the knee? (2020, August 13). InformedHealth.org. Institute for Quality and Efficiency in Health Care (IQWiG). https://www.ncbi.nlm.nih.gov/books/NBK561504/ 

3. Mulcahey, M.K., Hettrich, C.M., and Liechti, D. (2020, October). Patellofemoral Pain Syndrome. OrthoInfo. American Academy of Orthopaedic Surgeons.  https://orthoinfo.aaos.org/en/diseases--conditions/patellofemoral-pain-syndrome/

4. Johnston, R., Cahalan, R., Bonnett, L., Maguire, M., Glasgow, P., Madigan, S., O'Sullivan, K., and Comyns, T. (2020). General health complaints and sleep associated with new injury within an endurance sporting population: A prospective study. Journal of Science and Medicine in Sport. 23(3):252-257. doi:10.1016/j.jsams.2019.10.013

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7. Creaby, M.W. and Franettovich Smith, M.M. (2016, April). Retraining running gait to reduce tibial loads with clinician or accelerometry guided feedback. Journal of Science and Medicine in Sport. 19(4):288-92. doi:10.1016/j.jsams.2015.05.003