Your Complete Guide to Treating & Preventing Runner’s Knee

6 months after I started running on a regular basis, my right knee began to hurt really badly.

I couldn’t run. In fact, I couldn’t walk straight on my right knee for weeks.

As a result, I did what every sane person would do in a similar position:  I went to see a doctor.

And after a couple of questions and a quick assessment, I learned that I was suffering from what’s known as Runners Knee.

But the doctor wasn’t that helpful. He just told me to rest it, ice it, prescribed some anti-pain meds…you know… the type of advice you can find with a simple Google search (and without the side bill!).

Anyway, I listened to the doctor.

I took a step back from running, iced my right knee, and so on. And it took me at least a month to recover.

Nonetheless, the whole resting and icing thing were nothing but an instant and short fix. It didn’t last.

Fast forward 4 or 5 months into the future, and there I was again, in the same predicament, but this time in more agony. And for more than 4 years, I had chronic knee pain and runners knee.

Research Enters the Picture

However, once I started looking up more things about running, exercise physiology and injury prevention, I learned that I wasn’t a hopeless case, and thus began my journey to getting rid of knee pain, period.

Of course, this didn’t happen overnight.

It took me a long and frustrating research and many months (maybe years) of experimenting with different methods (massage, weight training, Yoga, stretching and so on), to learn the keys and strategies needed to fix my knee problems for good.

And today I’m going to share with you some of the strategies that I believe have helped me the most.

By the end of this post you will know all you need about:

  • The exact definition of runners knee and its symptoms, and causes,
  • The best treatment options for runner’s knee,
  • How to get back safely to running after runners knee, and
  • The right preventative measures you can take so you no longer have to endure another (or your first) runner’s knee nightmare.

So are you excited? Then let’s get the ball rolling

What is Runner’s Knee?

Standing for a number of conditions affecting the knee, such as Patellar Tendinitis, Chondromalacia Patella, and Patellofemoral Pain Syndrome, or PFPS for short, Runner’s knee is a general term that’s been used to describe pain and tenderness around and/or below the kneecap.

PFPS is the most Common

Patellofemoral pain syndrome (what a mouthful!), is the most common form of runner’s knee, accounting for about 20 percent of all running injuries, according to study.

Note: This whole post is mainly focused on patellofemoral pain syndrome. In future posts, I’ll be dealing other conditions affecting the knee. That’s why in this post, I’ll be using the terms PFPS and runner’s knee interchangeably, but please keep in mind that they are not the same thing.

The Injury Process

In hale and hearty knees, the kneecap rests in the femoral groove—a groove in the thighbone (see the picture)— and glides effortlessly up and down when you use your knees—whether while walking, running, taking the stairs, squatting, you name it.

But in the case of runner’s knee, the patella—the kneecap—is “out of place,” tracking incorrectly over the femoral groove, which results in irritation and the wearing away of the cartilage beneath the patella.

And as you keep running, the damage to the articular cartilage builds up as does the pain.

Not Just Runners

As I have already stated, Runners’ Knee is the most common overuse injury among runners, but it can also strike any athlete in a variety of fields—especially sports that require plenty of cutting and sharp lateral movements, such as skiing, basketball, and tennis, or any type of sport that’s arduous activity on the legs.

Symptoms Of Runner’s Knee

Since the knee is a joint—Read: it moves around a lot—pinpointing the exact painful spot can prove difficult.

Nevertheless, by and large, Runner’s Knee is described as an aching pain behind and/or around the kneecap.

More precisely, toward the center of the knee where the kneecap and thighbone meet. (Image Source)

And if you experience any of these symptoms, then chances you have the condition:

  • Pain is worse when you perform knee bending motions, such running, squatting, using stairs, and sitting for prolonged times with the knee
  • Grinding or popping sensations in the knee.
  • The knee might be swollen.
  • Pain worsens when walking downhill or downstairs

To make sure you actually have PFPS, you may need to visit a doctor to give you a thorough physical exam. In some cases, X-rays and MRIs—Magnetic Resonance Imaging)—and other tests are needed for a complete assessment.

But in most cases, if you are a runner, and you started experiencing the above symptoms, rest assured that you have runner’s knee, and it’s time to step back from running and treat the condition before you do more damage to the cartilage.

What Causes Runner’s Knee?

It can happen for a variety of reasons, many of them have to do with muscle imbalances, running mechanics, overuse and so on.

Nonetheless, here are the common causes:

Overuse. This is the most common cause. The repetitive high impact nature of running—and other high impact activities that are strenuous on the knees—can irritate the nerves around kneecap and damage the tendons.

Misalignment. When the patella—kneecap—is slightly out of its correct position—in other words it’s out of alignment—running and other high impact activities that require a lot knee bending and twisting can wear down the cartilage of the kneecap, leading to pain and damage to the joints.

Muscle weakness. Muscle imbalances in the legs can also lead to the condition. Weak glutes, hip abductors, and quadriceps muscles can reduce support and stability around the knees, which forces the kneecap to track out of alignment.

Muscle tightness. Tight hamstrings and calf muscles can put pressure on the knee, resulting in misalignment of the kneecap, thus increasing kneecap friction and pain.

Add to this the repetitive high impact nature of running and you have a recipe for runners knee.

Foot problems. If you have flat feet—also known as fallen arches or overpronation—this anatomical condition can overstretch the muscles and tendons of your legs, resulting in knee pain and irritation.

An unusual foot position forces the foot to roll inwards which significantly changes the way the forces go through the knee

Direct trauma. This is when you receive a direct trauma to the knee, such like a blow or a fall. The shock impact can dislocate the kneecap, or even move it out of place, forcing it to mal-track over the femoral groove.

How to Treat and Prevent Runner’s Knee

To get things going, let’s first talk about the right way to treat Runners Knee:

Treatment Of Runner’s Knee

To rehab a runners knee and speed up your recovery do the following:


This is your first defense against any running injury. At the first sign of trouble, you should always take a step back and rest from running. And avoid any weight-bearing activities, including running, that leads to knee pain and irritation.

In other words, stop putting weight on the injured knee.

You can always switch to low-impact activities like swimming or any other activity that is low impact and doesn’t require any knee bending.

Ice your Knee

Ice therapy can help you assuage pain and reduce the swelling. Do it for 10 to 15 minutes three to four times per day until the pain is gone. Use cold packs or ice wrapped in a towel.

Compress The Knee

Support the injured knee by using sleeves, straps or an elastic bandage to accelerate the healing process and reduce pain.

Elevate your Knee

Another measure you can take is to keep the knee raised up higher then you chest level by elevating it on a pillow when you are sitting or lying down.

Take Drugs

Non-steroidal anti-inflammatory medication, like Aleve, Advil, or most commonly Ibuprofen, will help with the swelling and the pain—especially if you needed more pain relief.

Just be careful. These drugs—like any other drug—have a dark side. They can boost the risk of bleeding and ulcers—only used when your doctor says so or in cases of severe pain.

Severe Runners Knee Cases

In some severe cases of runner’s knee, the above steps may not help as much.

So what to do then?

Well, severe cases of the runner may need immediate surgery to fix the damage. A surgeon could take out the injured cartilage or mend the position of the patella.

Hopefully, you will never have to endure severe cases of runner’s knee.

This condition—and most other running injuries—can be easily treated—when spotted at the right time and before they get any worse—and with the implementation of the right preventative strategies.

How to Get Back Running after Runner’s Knee

Here are the three keys to return safely to running after runner’s knee

Take your Time

Returning back to running, of course, will depend on how severe you damaged your knee.

Thus, it’s hard to guess how much recovery time you will need, especially when you put into consideration the biomechanical causes of the condition. You cannot fix your muscles imbalances or running mechanics overnight.

So this cannot be rushed up. No one can.

For instance, you may only need a few days off if you spot runners’ knee early, but if you have been running through pain for a while, you may need a lot longer.

But as a general guideline, full recovery from runner’s knee can take from four to eight weeks (or even more in severe cases) of no irritating activities—including running and other activities that require a lot of knee bending and twisting.

To stay on the safe side, opt for cross-training activities that don’t aggravate the pain and require minimum knee twisting and effort. Take up aqua jogging, swimming, and the like.

And if a cross-training activity leads to knee pain, you shouldn’t be doing it.

Restart Slowly

Depending on how long you were out of the running field, it will take you to get back to running the way you used to. A loss of cardio base and stamina is expected after a moderate layoff—even for just a couple of weeks.

As a result, restart your running engine carefully and slowly.

Don’t force it. Adopt a beginner’s runner mindset.

Fix the Root-Cause

Whether the root cause of your injury was biomechanical or any other cause, you will need to continue on working on it until it poses no future threats.

So please keep in mind that if you don’t strive to gradually fix the root-cause, it won’t just repair itself. That was my mistake. And please don’t repeat my mistake.

Prevention of Runner’s Knee

Here is my master 3-step plan for preventing runner’s knee (and runner’s pain) for good.

  • Strengthen your lower body muscles
  • Improve flexibility
  • Improve running form and mechanics

Let’s start discussing each measure and learn why they are paramount to warding off runners’ knee in the future.

Strength Training

Strength training can help you build strong and balanced leg muscles, which adds more support and stability to the knees.

Focus on the Glutes & Hamstrings

As I’ve stated earlier, one of the leading causes of runners’ knee is weak glutes—also known as the butt muscles—and quadriceps.

Glutes are the powerhouse of your lower body. When you run, these muscles support your pelvis and keep it steady, and also keep your legs, pelvis and torso aligned.

But when your glutes are too weak for the job, your entire kinetic chain suffers, affecting knee alignment like nothing else.

Plus, strengthening your quadriceps might improve patellar tracking, adding more support to your knees.

Consequently, your off-road strength routine should include plenty of exercises to strengthen these muscle groups.

Try to incorporate these 5 quadriceps and butt exercises to bulletproof your knees against PSFS.

Glute Bridge

Squat with kick back

Single leg deadlift

Prisoner Squat


Also, stretch regularly your hips, hamstrings and calf muscles.

Stated earlier, stiff calf muscles and hamstrings put excessive pressure on the kneecap, forcing it to track out of alignment.

Nonetheless, a regular stretch routine can reduce the muscle tightness and also improve how the patella slides up and down in the patellar groove, diminishing the friction on the kneecap.

So make stretching a part of your running program—especially post run.

Try to incorporate these three stretches into your training program.

Strap Calf Stretch

Hip Flexor Stretch

Hamstring Stretch

Running Mechanics

Following sound running form and other mechanics is also another powerful key that can help you ward off runners pain for good.

Try incorporating these four bullets into your daily running routine.

Proper Running surfaces

Improper running surfaces, like concrete and asphalt, can put excessive stress on the knees, increasing the risks of the condition.

As a result, do your knees a solid and do the bulk of your running on grass, woodland trails or a synthetic track with a merciful surface.

Plus, make sure also to change u your running routes because doing so helps you vary your foot strike and stride, thus keeping your muscles balanced and reducing repetitive stress impact—keys for warding off injury.

For instance, if you are a professed trail runner, try an indoor track, and vice versa.


If you are more prone to runner’s knee—whether you are biomechanically challenged or have a bad history of runner’s knee—you can use special insoles that can be worn on your shoes to support your foot position, thus reducing the amount of stress going through the kneecap.

Plus, orthotics can also help you recover faster from the condition and assist in runner’s knee rehab.

Watch your Body Weight

Knee pain is most common among overweight beginner runners for an obvious reason: The heavier you weigh, the more load you put on your knees.

And by losing weight and getting in shape, you avoid overstressing your knees, decreasing the risks of pain and injury.

Therefore, if you are overweight and looking to shed the extra pounds with running, you should go after your weight loss goal without hurting yourself.

In other words, you should aim to get fit without getting hurt.

Check my articles on how to start running the safe way.

The 8-Week Beginner Running Program

The 30-Day Beginner Runner Challenge

Listen to your Body

In the end, how you treat your body and interpret its signals of pain and discomfort is going to have the most impact on your runners’ knee (and running injury) prevention strategy.

It’s the difference that makes the difference.

If your knee hurts, then know for sure that your body is trying to tell you to stop doing whatever you are doing.

Thus,  in case of pain—whether it’s pain around the knee, behind the knee, knee pain when running or after finishing the run—be sure to reconsider your running routine,  cut back on your mileage, cross-train or take complete rest and let your knee heal.


See, most running injuries can be prevented and treated with ease. So you better start incorporating the above strategies and training tips if you are serious about warding off runner’s knee and staying injury free for the long haul.

In the meantime, thank you for reading my post.

Feel free to leave your comments below.


David D

Image Credit – Doug Sparks Through Flickr.


  1. I run track and Cross Country both on Varsity and for a freshman i am really good runner. But during cross country this year I fell hard and fished my race almost last and was booted down to Junior varsity. When I fell I hurt my knee my coach said that it was runners knee. Now I cant join track and I cant do much running activity’s until my coach and doctor give the all-clear. All I’m saying be aware of your body and any pain should be checked immediately or it could ruin your season. If you do get runners knee follow this websites information they really know what they are talking about. Thank you to the author of the article.

  2. Awesome article David! You answered just about every question about runners knee that could have been asked. I’am an avid runner and a couple years back I suffered quite a set back from runners knee. Back then I didn’t listen to my body and thought the pain would go away boy was I wrong. Now I listen to my body and when I feel some pain in my knee I give it a rest, ice it, and make sure to wear my knee brace which helps alot.

    • Of course my friend, the key is listenining to your body and acting accordingly. There is no way around.
      And thank you for taking the time to read my long post


  3. Thanks for your tips on recovering from runners knee. I think it is going to be hard for me to start slow, but I will definitely try to fix the root cause of the injury. In my case, muscle tightness. Stretching here I come!

  4. WHAT… WHATT… WHATTT… WHATTTT an amazing article…! thanks David for explaining this in detail in simple words…
    i have a question… i am a regular runner and never had this issue before. However, i was not able to run for the last 6 months and gained some weight. Somehow, i developed this condition a month ago, with no apparent reason. It took me awhile to diagnose myself and started treatment. There is no pain anymore but i can feel that i have fully recovered yet. I am not sure when to start my running routine again. I really wanted to start running asap as i have been out of this for more than 6 months and have been gaining weight. Any advise? thanks

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