Runner's Knee

Patellofemoral pain syndrome — dull ache around or behind the kneecap, worsened by stairs and hills.

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Understanding Runner's Knee

Runner's knee (patellofemoral pain syndrome) is a dull, aching pain around or behind the kneecap that's aggravated by running, squatting, stairs, and prolonged sitting. It's the most common knee complaint among runners and accounts for about 25% of all running injuries.

Despite the name, the problem usually isn't the knee itself — it's the hip and thigh muscles that control kneecap tracking. Weak quadriceps (especially the VMO muscle on the inner thigh), tight IT bands, and weak hip stabilizers allow the kneecap to track improperly in its groove, creating friction and pain.

Treatment focuses on strengthening the muscles that stabilize the kneecap: quad-focused exercises (wall sits, step-ups, terminal knee extensions), hip strengtheners (clamshells, lateral band walks), and reducing training volume until pain subsides. Most cases respond well to 4–8 weeks of targeted strengthening exercises.

Key Facts: Runner's Knee

Key facts and insights about runner's knee that every endurance athlete should know.

Accounts for ~25% of all running injurie

Accounts for ~25% of all running injuries

Pain is under or around the kneecap

Pain is under or around the kneecap — different from ITBS (outer knee)

Aggravated by stairs, squats, prolonged

Aggravated by stairs, squats, prolonged sitting, and downhill running

Root cause is usually weak quads and hip

Root cause is usually weak quads and hip stabilizers, not the knee itself

Pro Tips: Runner's Knee

Strengthen quads with wall sits, step-ups, and single-leg squats (VMO focus)

Shorten your stride length — overstriding increases patellofemoral stress

Avoid deep squats and excessive stair climbing during acute flare-ups

See a physical therapist if pain persists beyond 4 weeks — they can identify specific imbalances

Frequently Asked Questions About Runner's Knee

A patellar tracking strap or knee sleeve can provide short-term relief by improving kneecap alignment. But it's a band-aid, not a solution. Strengthening the quads and hips is the real fix. Use a brace to get through runs while doing your rehab exercises consistently.

If pain is mild (1–3/10) and doesn't worsen during or after running, you can continue at reduced volume and intensity. If pain is above 3/10, gets worse during runs, or causes limping, take time off from running and cross-train while strengthening. Running through significant pain delays healing.