Patellofemoral pain syndrome, commonly known as Runner’s Knee, is a frequent overuse injury causing discomfort around or beneath the kneecap (patella). This condition arises when repetitive stress from activities like running or jumping causes irritation where the patella meets the thigh bone (femur). Addressing this issue involves immediate symptom relief, long-term strengthening, and adjustments to training habits.
Recognizing the Symptoms and Underlying Causes
The most common symptom of Runner’s Knee is a dull, aching sensation felt in the front of the knee. This pain worsens during activities that increase joint load, such as walking up or down stairs, squatting, or sitting for long periods with bent knees. Patients might also notice a grinding, popping, or clicking sensation when bending and straightening the knee.
The underlying issue is often patellar maltracking, where the kneecap does not glide smoothly in its groove on the femur. This abnormal movement stems from muscle imbalances in the hip and upper leg, not the knee itself. Weakness in the hip abductor and external rotator muscles, particularly the gluteus medius, causes the thigh bone to rotate inward excessively while running.
This inward rotation pulls the kneecap out of alignment, leading to increased pressure and irritation of the underlying cartilage. Tightness in surrounding muscles, such as the quadriceps, hamstrings, and the iliotibial (IT) band, also contributes to misalignment.
Immediate Steps for Pain Reduction
When a pain flare-up occurs, the first action is to reduce acute inflammation and stress on the joint through activity modification. This means taking time away from running and any activities that reproduce the knee pain. Temporarily switching to low-impact exercises, like swimming or cycling, maintains fitness while the knee rests.
Applying ice to the painful area helps manage discomfort and swelling. Use an ice pack for 15 to 20 minutes several times a day, or perform an ice massage until the area feels numb. Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, can also lessen pain and reduce inflammation, provided they are taken as directed.
Targeted Strengthening and Flexibility Protocols
The long-term solution involves strengthening and stretching to correct the muscle imbalances that caused the maltracking. Focus on strengthening the hip and gluteal muscles to improve stability and control the thigh bone’s rotation. The clamshell exercise targets the gluteus medius, requiring you to lie on your side with bent knees and lift the top knee while keeping the feet together.
The single-leg deadlift is another effective exercise, strengthening the hamstrings and glutes while improving balance and hip stability. These movements train muscles to stabilize the pelvis and prevent the knee from collapsing inward during activity. For the quadriceps, straight-leg raises and wall squats performed at a shallow angle (around 45 degrees) maintain strength without excessive kneecap load.
Flexibility is addressed by stretching tight muscles that pull on the joint. Stretching the quadriceps, hamstrings, and the IT band restores normal muscle length. A standing quad stretch, pulling the heel toward the glute, should be held for at least 30 seconds.
Adjusting Training Load and Running Form
Preventing the return of Runner’s Knee requires careful attention to training load and movement. A common trigger is increasing mileage or intensity too quickly, making the “10% rule” advisable. This guideline suggests not increasing weekly running volume by more than 10% to allow the body adequate time to adapt.
Modifying running form can significantly reduce impact forces on the knee. Increasing your running cadence, or step rate, to 170–180 steps per minute shortens your stride length and reduces lower body impact. This faster turnover encourages a softer landing with the foot closer to the body, minimizing stress on the patellofemoral joint.
Ensure you are wearing appropriate, supportive footwear that is not excessively worn out. During recovery, limit downhill running, as this significantly increases compressive forces on the kneecap.