“Runner’s Knee”: How To Combat Patellofemoral Pain Syndrome

Picture this….you wake up in the morning and are super excited to get to work on your fitness goals and sculpt your body to show off your strength and overall weight loss.  You lace up your sneakers and hit the concrete for a run.  Or maybe, you grab those weights and start your leg workout of squats and lunges and plyometric exercise.  Instead of feelings of  rejuvenation and strength, you notice stabbing and aching pains in your knees.  They feel “puffy” and just plain hurt.  You have to stop because your knees just ache with every hop, skip, and squat.  Getting fit and in shape can be seemingly risky business and if you ever experienced “runner’s knee,” you might be likely to question how healthy it really is to run and lift weights and live an active life style.  It can be confusing to understand the cause of “runner’s knee” and how to combat it.  How do you know when enough is enough and when you need to push yourself?  Let’s take a look into what “runner’s knee” really is and how to keep yourself safe and/or how to treat symptoms if you currently experience them.

What is “Runner’s Knee?”

“Runner’s Knee” is actually a fancy term for Patellofemoral Pain Syndrome (PFPS).  It is a common ailment amongst runner’s, therefore, the term “runner’s knee” was coined.  Initially, PFPS is caused by an abnormality in how the patella (kneecap) slides over the femur (lower part of leg). Typically the patella “tracks” in a straight line, but when the “tracking” of the patella moves more towards the outer portion of the femur, it can through the alignment off and the grating of the patella along the femur can lead to inflammation and pain. There are various ways that PFPS can begin:

  • If there is overuse or a quick onstart into a more aggressive activity.
  • It is very common in females, due to their lower body alignment and larger Q-angle, and it can strike any athlete that  performs repetitive knee bending exercises, such as, biking, squatting, lunging, jumping, walking, etc.  People who are knock-kneed,  flat-footed runners, or have an unusually shaped patella are predisposed to PFPS.
  • Misalignment of bones and joints can put much added stress onto the knees, causing patellar tracking issues.
  • Weakened leg muscles, especially the thighs and quadriceps.

How does it feel?

PFPS typically presents with pain behind or around the patella and tenderness along the inside border of the patella.  The knee may be mildly swollen. Popping and grinding sensations can occur in the knee when bending. This pain and swelling is usually aggravated by activities like running, jumping, descending stairs (which is when the pain is usually the worse) or by sitting for long periods in a bend position. If symptoms are not addressed, strength can be loss in the quadriceps  and the leg can give out during activities.

How do I treat the symptoms?

Don’t worry, my fellow fitness fanatics with painful knees!  These symptoms can be addressed and knee health can be improved to allow us to participate in activities or sports that bring us pleasure.  Check this out…

  • Try icing, elevation of leg, compression, and anti-inflammatories to decrease the swelling and the pain. Ice the knee for 15-20 minutes every 3-4 hours until the pain is gone.
  • Initially, avoid motions which irritate the kneecap. Rest the knee and allow the irritation to calm down.
  • Focus on proper strengthening and stretching exercises to build up the legs and hips so that the muscles are balanced and strong.  This is a super important part of long-term recovery from PFPS!
  • Reconsider your shoes and consider orthotics. Changes in training that may have led to the PFPS pain and running shoes examined for proper biomechanical fit to avoid repeating the painful PFS cycle should be discussed and assessed. Orthotics that are custom-made or bought from store personnel that can properly fit your foot, may help with flat feet and arch problems.

How can I prevent “Runner’s Knee?”

Want to know how to prevent PFPS?  Get your butt moving the right way!  If you currently have pain, some of these exercises should be performed with caution.  Remember, if it hurts, either don’t do the exercise or decrease the range of motion of how far you allow the knee to bend. For example, if it hurts to squat, don’t squat so low.  Try out the following exercises to make those legs strong:

  • Strengthening (Perform 10-15 repetitions and 2-3 sets for each exercise)
  1. “Test the water” steps: Stand on a one foot-high step or bench with your feet together (decrease step height if this height causes pain.) Lift your right foot off the bench and squat down trying to perform a heel tap on the floor. Press back up through the left heel until your left leg is straight.
  2. VMO squats: Place a Swiss Ball against a wall and lean into it with your lower back supported. Gradually lower yourself into a seated position, pushing your hips backwards towards the wall.  Lean forward slightly and lift your toes up off the floor. Lower yourself until your thighs are roughly parallel with the floor, but if you get pain, decrease that range of motion.
  3. Standing cable hamstring curls: Attach the foot harness to the low pulley. With foot harness on one ankle, grasp support bar with both hands and step back with other foot. Elbows remain straight to support body. Attached foot is slightly off floor. Pull cable attachment back by flexing knee until knee is fully flexed. Return by straightening knee to original position and repeat. Continue with opposite leg. If your perform this at home, you can use exercise bands or ankle weights to substitute.  If you perform this at the gym, you can also substitute the seated or lying hamstring curl.
  4. Banded sidestepping: Place an exercise band around your ankles and spread your feet wide enough until the band is taut.  Perform a mini squat. Side step to the right for approximately 20 ft while squeezing your buttocks.  Maintain tension on the band for the entire 20 feet.  Then side step to the left.
  5. Calf raises: Begin by standing in front of a step or riser with feet shoulder width apart, facing forward. Step up onto the step with both feet, holding on a rail or chair, and letting heels hang off the edge. Rise up onto your toes as high as possible in one smooth motion. Hold for a couple of seconds. Slowly lower heels as far as possible, below the level of the step to complete one rep. To increase the challenge, you can perform single leg calf raises.
  6. Split squats: Start with your feet hip width apart and take a slightly longer than normal step out with one leg. Keep most of your body-weight through the front leg, but particularly through the heel of the front leg. Slowly start to lower your self down, pushing back through the hips and maintaining a fairly upright position. Make sure that your knee is also being pushed forwards, but the heel remains in contact with the floor. Once you are in the bottom position, push through the heel of the front foot to return to the starting position. Hold onto a railing, wall, or broom handle for support if balance is an issue. Gradually add more weight through the use of dumbbells, a barbell or even a knapsack on your back
  7. RDL’s: Grabbing appropriately weighted dumbbells or a barbell, stand with straight legs slightly wider than shoulder width and straight arms hanging in front of your body. Take a deep breath and lower the weight by leaning the torso forward at the waist and pushing with the hips way back. Continue to lowering the weight until you feel a good stretch in your hamstrings. Then carefully change the direction of the movement and bring the weight up by driving the hips forward and straightening your torso to the upright position as you breathe out. Remember to: Keep the bar as close to your body as possible during the movement, maintain a straight back and keep your chest up during the movement, keep your head in one line with your spine as you perform the exercise, keep your knees slightly bent during the movement, and keep your arms straight with unflexed elbows.
  8. Lunges (if tolerated): Stand with your torso upright holding two dumbbells in your hands by your sides. Step forward with your right leg around 2 feet or so from the foot being left stationary behind. Lower your body straight down towards the floor by bending your right knee and keeping the heel on the floor and bending the left knee and allowing the heel to rise as needed. Inhale as you go down. Using mainly the heel of your foot, push up and go back to the starting position as you exhale. Remember, do not allow your right knee to go forward beyond your toes as you come down, as this will put undue stress on the knee-joint. Make sure that you keep your front shin perpendicular to the ground.
  • Stretching (Hold each stretch for 15-30 seconds and perform 1-2 repetitions of each)
  1. Supine hamstrings: Lie on back with knees bent or with opposite leg straight. Bring left knee to your chest and place both hands behind the left thigh. Slowly straighten your leg. Hold the stretch and then slowly lower leg down. Repeat on the opposite side.  Use a strap for a deeper stretch.
  2. Illiotibial band (ITB): Either sitting or lying on your back, cross one leg over the opposite side and pull the leg as close to your chest and towards your opposite shoulder as possible. Allow bottom leg to stay straight.  Hold stretch. Repeat on the opposite side.
  3. Calves off step: Position toes and balls of feet on stair step or calf block with arches and heels extending off. Use railing or wall for balance. With knees straight, shift body weight to one foot. Hold stretch. Repeat with opposite leg.
  4. Quadriceps: Stand and touch wall or stationary object for balance. Grasp top ankle or forefoot behind. Pull ankle or forefoot to rear end. Straighten hip by moving knee backward. Hold stretch. Repeat with opposite side.
  5. Pigeon (if tolerated): From an inverted “V” position (yoga move of “downward dog”), raise your right leg to the sky, then sway it forward as the rest of your body moves forward as well. Think of it as a one-legged plank. Cross your leg underneath your body so that your lower leg is parallel to your hips. Your right heel should underneath your left wrist and your right knee should be under your right wrist. Let your back left knee drop down gracefully.  Keep torso tall and hold position.  Repeat on the opposite side.



Take action now! Plan your lower body workout around these exercises and concepts that will keep potential pain at bay and improve the strength and mobility of your lower body.  Make a concrete plan and put it on your workout calendar. Perform these exercises 1-2 times per week.

Comment below and tell me if you have ever experienced PFPS, how it affected you, and what you did about it. Never experienced PFPS?  Tell me what you will do to make your legs stronger so you can prevent potential pain.

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