This Is the Best Thing You Can Do to Both Prevent and Treat Runner’s Knee, According to a Sports Medicine Doctor
As one of the most common running-related injuries, runner’s knee is aptly named.
“It's actually rather rare that you’ll meet a runner who has never had this problem,” John Vasudevan, MD, an associate professor of Clinical Physical Medicine and Rehabilitation and co-director of the Penn Medicine Running and Endurance Sports Program, tells Runner’s World. Indeed, research suggests an incidence of up to 30 percent in female runners and up to 25 percent in male runners.
Formally known as patellofemoral pain syndrome, runner’s knee is a catch-all term for pain between the backside of the patella (kneecap) and the frontside of the femur (thigh bone), Vasudevan explains. Most people feel this discomfort on the front of the knee, or just behind the kneecap. But it can be tough to zero in on.
“When I ask people to point [to the pain], they can never quite put their finger on it,” Vasudevan says. “It’s always either pointing around the kneecap, or it seems to be tucked just where the fingers can’t reach.”
Runner’s knee usually comes on at some point during a run, and once it flares up, it’s difficult to turn off again during that workout—even if you slow down or take a walk break, Vasudevan says. The syndrome also typically begins as a dull ache, but over time, it can morph into a sharp, stabbing sensation, which intensifies when going downhill and downstairs, he says.
So why is runner’s knee so prevalent? A big reason is that there is a “hodgepodge” of factors that can cause it, Vasudevan says. These range from anatomical elements that are outside of a runner’s control—like the shape of their kneecap or femur; the width or angle of their hips; and whether they are knock-kneed or bowlegged—alongside factors folks can control, including problems with muscle strength, flexibility, dynamic control, or muscle activation, he says.
As Vasudevan puts it: Runner’s knee is “not so much a simple disorder with a simple solution, but rather the result of a large amount of factors that can get you there.” And that can make the treatment path complicated.
That said, there is one thing in particular that Vasudevan overwhelmingly recommends to both treat and prevent runner’s knee. Read on to learn what it is—and how to incorporate it into your routine.
The Best Way to Prevent and Treat Runner’s Knee
Even though runner’s knee has a bunch of underlying causes, “by far” the number-one culprit, according to Vasudevan, is glute weakness. “Almost everyone comes to me saying my knee hurts, and I tell them: the problem is your hip,” he says.
Here’s why: When you’re running, walking, standing, or going up and down stairs, your glutes—especially the glute medius, a smaller muscle toward the outside of the butt—work to keep your pelvis level and prevent your thigh bone from collapsing and twisting inward.
But when the glutes get fatigued, they biff this job, allowing the thigh bone to rotate inward. This causes the kneecap and the thigh bone to rub against each other, which places pressure on the knee joint and ultimately triggers pain there.
Glute weakness is such a common culprit of runner’s knee that glute medius strength is often the first thing Vasudevan tests on runners who come into his clinic complaining of patellofemoral pain.
His favorite way to assess glute strength: a single-leg squat. “I’m looking for a drop of the hip on the opposite side, as well as any abnormal motion of the knee inward, dynamic instability of the ankle, or too much flattening (pronation) of the foot as they do it,” Vasudevan explains. “This can give me some clues as to where the kinetic chain might be breaking down.”
If the test shows glute weakness—particularly from the hip drop and knee collapse—it’s actually good news, because it’s “usually an easy thing to fix,” Vasudevan says. That’s because it typically just involves doing glute-strengthening exercises a few times a week… which is also what Vasudevan recommends to prevent runner’s knee in the first place.
Vasudevan’s three favorite glute moves, which you can do with just a resistance band and limited space, include side-lying banded leg lifts, monster walks, and squats (starting with basic squats and progressing to single-leg squats, if you need a greater challenge).
Pro tip for the squats: As you lower down, make sure your knees don’t drift in front of your toes or collapse inward, Vasudevan says. Instead, focus on pushing your hips back (rather than lunging your knee forward) and make sure your knees stay in line with your toes. (The cue “spread the floor with your feet” can help some people with glute activation.)
However you choose to work your glutes, make sure you perform enough reps of them to fully fatigue your muscles, meaning you can’t eke out any more reps with good form; this level of challenge is needed to improve strength.
For people currently dealing with runner’s knee, Vasudevan suggests doing glute strength work three times a week; for those who are pain-free, he recommends two weekly sessions. Make sure to pencil in at least one rest day in between sessions so your glutes have the downtime they need to build back stronger.
Lastly, because your core is another big source of stability as you run, Vasudevan also recommends incorporating core-strengthening moves alongside your glute exercises, for both the prevention and treatment of runner’s knee.
What If I Already Have Strong Glutes?
For some runners wrestling with runner’s knee, glute strength isn’t the issue. Instead, it’s that the glutes aren’t properly activating on the run, in which case working with a coach or physical therapist to improve neuromuscular control can be a game changer.
In other scenarios, the glutes may be strong and activated, but maybe you’re not getting the oxygen, hydration, and/or nutrition you need as you tackle longer distances, which causes the glutes to power down, Vasudevan says. In those scenarios, he recommends making sure hydration and fueling are on point, and/or fine-tuning your training to incorporate more workouts that improve the efficiency of your cardiovascular system (like tempo runs or speed intervals, for example).
When to See a Doctor
In many cases, runner’s knee should start to improve (though it may not be totally resolved) with about six weeks of consistent glute and core strength work, Vasudevan says. So if you’ve reached that point with zero progress, he recommends getting checked out by a doctor or physical therapist.
Vasudevan also suggests visiting a healthcare pro, at any point, if your pain is unpredictable (meaning, it seems to flare up randomly, rather than following certain patterns), or if it’s progressive (for example, it starts coming on earlier and earlier in your runs).
You should also get evaluated if your pain is accompanied by numbness, tingling, or weakness of any kind; same goes if it’s causing your performance to drop or plateau, he adds.
Jenny is a Boulder, Colorado-based health and fitness journalist. She’s been freelancing for Runner’s World since 2015 and especially loves to write human interest profiles, in-depth service pieces and stories that explore the intersection of exercise and mental health. Her work has also been published by SELF, Men’s Journal, and Condé Nast Traveler, among other outlets. When she’s not running or writing, Jenny enjoys coaching youth swimming, rereading Harry Potter, and buying too many houseplants.