5 Exercises for Runner's Knee

By: Alivia Thorn, PT, DPT

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Runner’s knee, also known as patellofemoral pain syndrome, is a common overuse injury in novice runners. It leads to pain around or behind the kneecap, which becomes exacerbated with movement. Runner’s knee can be felt not only when running, but also when squatting, jumping, or going up or down stairs.

What Causes Runner's Knee?

Some common causes of runner’s knee are:

  • Poor mobility
  • Weakness
  • Overtraining or sudden mileage increases
  • Improper footwear and poor running mechanics

Poor mobility, especially in the hip and ankle, require the body to achieve full range of motion elsewhere in the body. This can lead to unhelpful compensations, further leading to injury.

Weakness, especially in the glutes, can cause biomechanical changes in a running form that can cause injury along the knee or other areas of the body such as in the hips and ankles. Strong hip stabilizers are essential to prevent any hip obliquity and allow proper running form.

Overtraining or sudden mileage increases can cause more strain on the body due to fatigue. When the body is not accustomed to this mileage, it places a higher demand on the joints to complete the task, which can lead to knee pain.

Improper footwear and poor running mechanics can put the body in positions that cause more stress and demand on the body. When a runner lands with their heel outstretched in front of their body, this is considered a poor running form and creates a lot of stress on the knee to absorb that shock.

Luckily with runner’s knee, there are a few things that can help in treating the pain and managing it. First, rest and activity modification. This means that you would reduce your mileage or avoid any aggravating activities like deep squats or jumping. Giving your body time to recover reduces inflammation.

Strengthening is a HUGE help when it comes to runner’s knee. Many runners are weak in their proximal musculature. This includes your quads, glutes, and hip abductors. Strengthening these muscles can help improve a runner’s stability and take the pressure off the knee joint to perform most of the work. See below for 5 exercises that I prescribe my patients to focus on their proximal musculature!

5 Exercises to Address Runner’s Knee

1. Eccentric Step Downs

Use a box, step, or sturdy platform that is about 6-12 inches high depending on your ability. Stand on one leg at the edge of the step with your foot fully on the platform. The non-working leg hovers off the edge.

Engage your core, keep your chest upright, and balance on your standing leg. Slowly bend the knee of the standing leg. Let your hips hinge back slightly as if you’re sitting down. Lower the opposite heel toward the floor in a slow and controlled manner. Lightly tap the heel of the non-working leg on the ground, but do not transfer weight to it. Push back up to the starting position using the working leg only. Reset and repeat for desired reps, then switch legs.

2. Resisted Knee Extension

Sit on a sturdy chair or bench. Anchor a resistance band behind you (e.g. around a table leg or heavy object). Loop the band around your ankle of the working leg. Start with your knee bent at 90 degrees.

Engage your thigh muscle (quad). Slowly extend your knee, pushing your foot forward and straightening the leg. Go until your leg is nearly straight, but not locked. Pause briefly at the top, squeezing the quad. Slowly return to the starting position. Reset and repeat for desired reps, then switch legs.

3. Resisted Side Stepping

Place a mini resistance band just above your knees (easier) or around your ankles (harder). Stand with feet hip-width apart, knees slightly bent. Engage your core and keep your chest up. Maintain a slight squat position throughout the movement.

Step sideways with one foot, pressing against the band’s resistance. Follow with the other foot, keeping tension in the band (don’t let feet come too close). Take 10-15 steps to one side. Step back in the opposite direction the same way, maintaining tension. Keep the movement controlled and deliberate. Reset and repeat for desired reps.

4. Step Ups

Stand facing a sturdy box, bench, or step that is 6-18 inches tall with your feet hip-width apart. Engage your core and keep your chest lifted.

Place your entire foot of the working leg firmly on the step. Press through your heel to lift your body up onto the step. Bring your other leg up to stand tall on the step briefly. Step back down with the leg that just came up. Control your descent and land softly. Reset and repeat for desired reps, then switch legs.

5. Side-Lying Clamshells

Lie on your side with your legs stacked and knees bent at about 90 degrees. Place a mini resistance band just above your knees. Rest your head on your lower arm or a pillow for comfort. Keep your feet together throughout the movement. Place your top hand on your hip or the floor for stability.

Engage your core to keep your pelvis stable. Slowly lift your top knee upward, opening your legs like a clam shell, while keeping your feet touching. Raise the knee only as high as you can without rotating your hips backward or forward. Hold the position for 1-2 seconds at the top. Slowly lower your knee back down to the starting position. Reset and repeat for desired reps, then switch sides so your other leg is on top.

Once the inflammation reduces and the pain of runner’s knee subsides, a runner should slowly start integrating running back into their routine. If you don’t know where to start, it is best to reach out to a physical therapist or health professional to prevent any further injury! To schedule an evaluation with a certified gait analyst, contact us online or call (804) 764-1000.

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