Taking the pain out of runner’s knee

Kay Cahill Allison

Former Editor, Harvard Health

My left knee hurts. When I put weight on it with my leg bent, like when I get out of the car, I feel a dull pain in my knee. My doctor and physical therapist have given me a diagnosis of patellofemoral pain syndrome, also known as “runner’s knee” or patellar knee-tracking syndrome. Simply put, my kneecap doesn’t run smoothly up and down its track—a groove called the trochlea.

Anyone can get patellofemoral pain syndrome, but for some reason it is more common in women than men—especially in mid-life women who’ve been running for many years. The problem, say researchers who just published a study in the journal Gait and Posture, is that lots of “mature” women develop alignment problems with their knees. The researchers compared younger female runners to older female runners and found misalignment of the knee to be much more common in the older women. Some knees sagged inward, others bowed outward or were rotated.

When the alignment is off, the kneecap can’t smoothly follow its vertical track as the knee bends and extends. This causes wear and tear on the joint. That leads to overuse injuries like runner’s knee and, down the line, osteoarthritis, which can really put a cramp in a runner’s career.

My physical therapist recommended that I support my kneecap by strengthening my quadriceps (thigh) muscles and that I stretch the iliotibial band, a long band of connective tissue that runs from the knee to the hip. When that tendon is too tight, it pulls the kneecap off to one side. I also decided to vary my exercise routine. I haven’t stopped running, but I did cut back to three days a week. On the other days, I do yoga, weight training, or bicycle—anything to cut down on the repetitive force that running places on my knees.

You can look up this condition and other common knee-pain problems in Harvard’s Special Health Report, Knees and Hips: A troubleshooting guide to knee and hip pain. It describes the causes of different kinds of knee and hip pain and the array of treatments available. It also helps evaluate when the problem has become severe enough to warrant a knee or hip replacement. That’s something I hope to put off as long as possible.


  1. Athena Jo Johnson

    You’re describing ways in which one can strengthen their muscles so that the skeleton, joins, and important organs in the body can be supported. I found an interesting, and tempting, blog post, proclaiming belly dancing to be a highly recommended physical fitness exercise. This is something that surprised me but after looking into it, we see more and more people of all ages taking up this activity…maybe because it’s more like fun than a hard workout.

  2. Anonymous

    For people that have never run barefoot and want to, I recommend you start of slowly. Start of with Nike Free’s and work your way into Vibrams. If you go directly into Vibrams or Inov-8 shoes and do not have correct form, you run the risk of injury.

  3. DA

    I’m intrigued to hear more about the quadriceps concept, too…in part because it’s widely held, and in part because my knees bother me *less* in my 40s than they did when I was younger. I’m more choosy about running shoes, but for the past several years, I belly dance at least 3 or 4 days a week, for at least an hour (or more). Belly dance requires a *lot* of quad strength! — but maybe it’s just coincidental, or perhaps because belly dance also requires flexibility, so I stretch more than I used to. So…hopefully we’ll hear more!

  4. Julie-Ann

    This is an interesting post although Kay does not actually mention if she is a runner herself or just woke up one day with this injury. That said running does put an enormous strain on knees and therefore if the knees or legs are slightly out of alignment (age or just poor posture) it will probably speed up this process, resulting in “runners knee”

    I teach baby swimming (Aquababies-UK) and after 25 years firmly believe that when children are taught swimming at an early age it teaches them and helps to improve their mobility and the correct movement of their limbs. Additionally as water reduces the effect of gravity it is a safe form of exercise (for both mothers and babies).

    I would postulate here that such training might also help reduce “runners knee” in later years (to some extent anyway) as a persons’ movements would have been ingrained at such an early stage of their development and so be intuitive.

    Having been one of the first “aquababies” to be taught baby swimming I am happily pretty fit and suffer from no such pain. However if I did I would immediately look at swimming as the best form of exercise to start the healing process.

  5. john sanders

    Good article, i will use this information.

  6. Sean Gunner

    Excellent article! A superb way of dealing with a running injury without losing your running fitness is to do interval training on a home exercise bike. Whether you use an upright stationary exercise bike or a recumbent exercise bike, the advantages are the same – low-to-no impact on the joints whilst boosting your heart rate and working on your muscles.

    [URL removed by moderator]

  7. Lisa

    Hi, great post! Mother’s and their babies can benefit from doing prenatal yoga. [URL deleted by moderator]

  8. Paul

    Nice article.I agree with Bootique, make sure you have the right shoe.

  9. Bootique

    Very informative article, the right shoe for the right occasion is certainly a must!

    Hope you have recovered!

  10. Anonymous

    Thanks for posting this blog. I found it very interesting. I have reviewed many running shoes and found that the right shoe makes a huge impact on how a person runs thus minimizing injury.

  11. Massagekurse

    Youre so cool! I dont suppose Ive read anything like this before. So good to search out somebody with some original thoughts on this subject. realy thanks for starting this up. this website is one thing that’s wanted on the internet, somebody with a little originality. useful job for bringing one thing new to the internet! King Regard Stefan

  12. Daniel

    Kay, it’s been about 7 weeks since you’ve posted this article. I’m curious how your recovery is going, since I’ve been having the same knee problem lately.

  13. Venita

    If it is a tight ITB as Nathan mentioned then I’d be inclined to look at Callan Pinckney’s Callanetics exercises, and chose only those that have zero knee involvement.

    I would try everything before considering surgery, you may even find your solution with Theta Healing.

    Best of luck

  14. Justin

    I found daily stretching if the iliotibial band to be extrememly helpful in lessening my pain throughout training leading up to my first half marathon.

    For anyone who is interested try vibram five fingers or ino-v8 running shoes to promote correct running technique.

    It should also be noted the huge benefits of core strengthening exercises and the affect they can have on running. Turkish get-ups are perfect.

  15. James S.

    Isn’t it necessary to strengthen the quadriceps to help relieve the amount of stress the knee takes?

    I’ve done some of the quad strengthening exercises [URL removed by moderator] and it has helped to say the least.

    Even though jumper’s knee and runner’s knee are different I would say that the exercises would still be beneficial for the health of your knees.

  16. Eric P

    Patellofemoral pain is a common knee problem.The pain can get worse when you’re active or when you sit for a long time. Usually, putting ice on your knee, changing your activities, and following a physical therapy program works best.

  17. Nathan

    There are a couple things to quibble with in this article.

    Firstly, the advice to strengthen the quadriceps is based off of a conclusion drawn from a faulty study.

    Varying the activity can be good to provide some recovery time, however this injury is not caused by the impact of running. It’s caused by the tightness in in the ITB. Cutting back on impact won’t resolve it.

    Additionally, this pain can be caused or worsened by cycling as the same muscle groups are also utilized.

    • Kay Cahill Allison
      Kay Cahill Allison

      I’d be interested to know the details about the suggestion (in the above comment) that strengthening the quadricepts to help support the knee isn’t valid. It’s a very widely held concept.

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