Knee Pain With Running and Three Exercises for Runner’s knee

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Who Gets It?

If you have been running for any length of time there is a very good chance that you’ve faced some knee pain.  This can be frustrating and discouraging for both new runners and experienced, competitive runners alike.   A quick google search for “knee pain with running” can lead you down a path thinking that it’s no big deal or that surgery is imminent.  Fortunately most conditions causing knee pain for runners can be addressed with a conservative approach like physical therapy.  Union Physical Therapy has  skilled therapists who can assess the root cause of your knee pain and develop a plan for getting you back on the road, track, or trail in no time.

Patellofemoral Syndrome; aka: ‘Runner’s Knee’

One of the most common sources of knee pain in runners is patellofemoral syndrome or, very appropriately named, “runner’s knee”. Patellofemoral syndrome is a condition where the underside of the patella (kneecap) becomes irritated as it glides through the channel at the bottom of your femur (trochlear groove).  Patellofemoral syndrome is sometimes known as chondromalacia.  This can cause pain with running, squatting, and stairs. 

Other Causes of Knee Pain with Running

Patellar tendonitis or tendinopathy

Knee pain in the front of the knee below the knee cap can be related to the patellar tendon.  The patellar tendon is the large tendon in the front of the knee that houses the patella, it attaches the quad muscle to the lower leg.  Patellar tendonitis or tendinopathy will present in a similar way to pain on the under surface of the knee cap.  You may be able to feel pain under your fingers when you touch the patellar tendon whereas pain under the patella is harder to “palpate” (or touch with your fingers).  Tendon pain may present as something that is worse when your knee is cold and seems to warm up or feel better the more you move.  You may also notice increased pain after activity.  

IT Band or IT Band Friction Syndrome

The Iliotibial band or ITB can become irritated when running.  This will usually show up as pain on the outside part of the knee.  This is often an overuse injury but is also affected by knee and hip strength deficits and their impact on running mechanics. 

What is the treatment for runner’s knee?

If you are having patellofemoral related knee pain, taking away the offending cause is a great first step.  As we talked about earlier, it results from your kneecap not tracking correctly.  Sometimes tape can help to keep the kneecap in line and reduce pain (this can be a good diagnostic tool – if it helps with relieving symptoms then it is a good indication the knee pain is related to the undersurface of the patella).

Working on the factors that are causing the kneecap track incorrectly is an important step in keeping this from recurring.  One common thing we see is when someone’s foot pronates (flattens out) too much causing the knee to dip towards the inside when walking, squatting or going up and down stairs.  To treat this your therapist might suggest insole use and/or strengthening your arch. 

Weakness at the hip can cause a similar action at the knee.  To combat the knee from falling to the inside, strengthening the muscles that abduct, or bring your leg away from center, can help.

Again, pain sources at the knee often present similarly and having a physical therapist assess and help plan a course of action for getting you back to running is a great place to start.

What else can I do?

Changing your running style may be helpful if you are trying to overcome an injury or pain when running.  There may be other things to consider if you are running with pain, such as load and volume.  Load refers to the part of the body that has the most stress with a movement. When considering load you should also consider running volume.  Volume refers to how much and how often you are running.  If you have increased your running too fast, too far, too often you may be experiencing new aches and pains.  Changing your strike pattern may be helpful, but you may also need to plan for some rest days.  

Which Strike Pattern is Best?  Should you heel strike, forefoot strike or toe strike?

The debate over heel striking vs forefoot striking or toe striking came to the forefront with the barefoot running movement.  Many people who run barefoot or run with minimalist footwear will naturally adopt a strike pattern that is more on the forefoot.  Runners often want to know what pattern is better and typically it depends on their strengths and weaknesses.  Those who forefoot strike put more load through the calf and the Achilles complex, while those who heel strike put more load through the knee and patellar tendon.  Therefore if you are struggling with anterior knee pain you may benefit from trying a forefoot-striking pattern.  If you are having more heel pain when you run, check out our blog on this and consider a heel strike pattern.


Perhaps more important than the strike pattern, you may want to consider cadence.  Cadence refers to the number of footfalls per minute.  Optimal running cadence is thought to be around 180 footfalls per minute, however your optimal cadence may be a little slower than that.  If you are struggling to figure out the right cadence for your body, consider coming into Union PT.  One of our therapists can complete a running assessment to give you advice on what to address. 

Do I Need New Shoes?

Just like there is not a single “correct” running pattern there is not a single correct type of shoe.  Finding the type of shoe that fits your type of running is a good place to start though.  If you are a heel striker, having a shoe with a cushioned heel complex will be far more important than having that in the shoe of someone who is a forefoot runner.  Type of footstrike aside, the speed and duration of your runs should be an important consideration as well.  If you are running a fast 5k or doing interval training you will typically be looking for a much lighter, more responsive shoe than someone who is logging lots of mileage every week.

It’s also important to note that even if you have the ideal pair for your running style, each shoe does have a shelf life. The more miles you log, the sooner you will have to replace your shoes.  One can expect to get 300 to 500 miles out of a pair of shoes.  You can extrapolate this by averaging your typical miles run in a week and setting a reminder in your calendar to replace your shoes _____ weeks from purchase.  Aside from miles alone, look for holes in the mesh upper, deflated looking foam or worn tread. 

Seeking Care

These exercises should not be painful, they should be pain free.  If you are seeking this advice because of knee pain when bending your knee or pain with running, you may want to be assessed by a physical therapist.  The physical therapists at Union Physical Therapy in Seattle have advanced training in orthopedics and assessing and treating runners of all abilities.  Schedule an appointment today to learn more on strengthening exercises and getting back to doing what you love.