What is Runner’s Knee

Runner’s knee, also known as patellofemoral pain syndrome (PFPS) is a common overuse injury where there is dull pain arising around the kneecap due to the contact of the patella rubbing against the femur (thigh bone). It occurs when repetitively high levels of stress are placed on the knee joint more than what the soft tissues have adapted to handle. It is very common in runners but can also affect people who are active in sports like cycling, jumping and hiking.


The hallmark of runner’s knee is a dull aching pain in front of the knee that is aggravated by activities that increase the patellofemoral compressive force such as:

  • Climbing stairs
  • Squatting
  • Kneeling
  • Jumping
  • Prolonged sitting with the knee bent
  • Running

Risk factor

Assume the kneecap as a train and the groove of the thigh bone (femur) as a track: anything that causes the train (kneecap) to run off the track (thigh bone) can result in patellofemoral pain.

The most common causes include:

  • Excessive stress to the knee joint (overuse / excessive training)
  • Mal-alignment of the limb (Flat feet / High arch; Knock knee/ Bow Leg)
  • Tight muscles (Hamstring, Quadriceps & Hip flexor)
  • Weak muscles (Quadriceps and Gluteal)

How can it be diagnosed?

Runner’s knee is diagnosed based on:

  • X-ray, CT scan or MRI.
  • History of the patient.
  • Physical examination of the knee and the surrounding structures including alignment of the feet, strength of the hip, thigh and leg muscles, as well as walking and running patterns.
  • Special test such as Q-angle test, patellar apprehension test, Clarke’s sign (patellar grind test) and the patella alto test.

How can it be prevent?

We CANNOT prevent any injuries to happen but we can minimize the risk. Several ways to reduce the risk of getting PFPS or runner’s knee are as below:

  • Strengthening the quadriceps and hamstring muscles can help to support and stabilize the kneecap.
  • Use correct equipment for training and appropriate shoes for the activities.
  • Include stretching and flexibility exercises in the training regime.
  • Control body weight to avoid excessive stress on the knees.
  • Consult a physiotherapist to assess the running pattern and check for any mal-alignment.

How to self-treat?

The American Academy of Orthopaedic Surgeons suggests several strategies for relieving the pain of a runner’s knee:

  • Rest: Take a few days off from any exercises that will cause pain such as squatting or
  • Ice: Reduce pain and inflammation by icing the injured knees for 10-15 minutes several times throughout the day.
  • Compression: Using some type of compression or wrap on your knee can keep swelling down.
  • Elevation: Rest with your knee elevated, preferably above your heart.
  • Medication: Taking an over-the-counter nonsteroidal anti-inflammatory (NSAID) can also help reduce your runner’s knee pain.
  • Exercise: Research indicates that exercise therapy helps reduce pain and improve knee function.

Exercises for Runner’s Knee

If you are experiencing runner’s knee, here are 6 simple yet effective exercises that you should do to relieve the pain and maximize your running performance:

1. Standing quad stretch

  • Stand upright. Bend your left knee back by grasping your ankle with left hand.
  • Bring your left foot toward your glutes until you feel the stretch in your quads.
  • Hold for 15 seconds, then repeat with the right leg.
  • Perform 3 to 5 times for each leg.

2. Iliotibial band stretch (side-leaning)

  • Stand tall with the left side of your body next to a wall. Place your hand on the wall.
  • Cross your right leg in front of your left leg, and place your right hand on your hip.
  • Slowly push your left hip towards the wall and lean away from the left hip until you feel a stretch.
  • Hold up to 15 seconds, perform 3-5 times.
  • Switch sides and repeat.

3. Lying Hamstring Stretch

  • Lie flat on the mat with both legs extended. Bend your left knee towards your chest, while keeping your right leg extended.
  • Slowly straighten your left knee by looping a strap around your left foot to assist, or simply grab the back of your left leg with both hands. Pull it until you feel a stretch at the back of your left thigh (hamstring).
  • Hold for 15 seconds, perform 3-5 times.
  • Repeat on the opposite leg.

4. Clamshell exercise with resistant band

  • Place a resistance band around your knees. Lie on your right side with both knees bent at a 90 degree angle, one leg on top of the other.
  • Keep your feet together, engage your core and lift the left knee up. Maintain for 3 seconds. Keep your upper body and hips stationary.
  • Slowly lower the left knee back to the starting position, perform 20 times.
  • Switch sides and repeat.

5. Wall Squat

  • Stand with your back leaning against the wall. Keep both feet at hip-width apart.
  • Engage your core muscles and slowly slide your back down the wall until both hips are roughly parallel to the floor. Align both knees with your ankle.
  • Hold for 10-20 seconds and slowly return to standing position. Repeat 10 times.
  • Perform this exercise for 2 to 3 sets.

6. Single leg squat

  • Stand on your left leg with your foot pointing forward, and keep the right leg slightly bent and lifted up from the floor. Keep your arms at your hips or extended in front for balance.
  • Slowly lower to a squat position while pushing your hips back. Your knee should not extend beyond your toes. Keep your core engage throughout the movement.
  • Raise your body back up to original position while tightening your glutes.
  • Repeat 10 times and switch to the right leg.
  • Perform 3 sets for each side.

Extra Tips to Prevent Runner’s Knee

  • Gradually increase in training intensity.
  • Do not abruptly increase in the duration, distance and intensity of your workout. Make changes in your training regime incrementally instead.


  • Warm up before and stretching after physical activity.
  • Incorporate dynamic stretches such as lunges and leg swings into your warm-up routine. Always stretch after training to increase your knee flexibility.


  • Wear proper running shoes.
  • Make sure that your shoes fit comfortably with good shock absorption. Foot orthotics can be effective for those who have flat feet.


  • Use proper running form.
  • Avoid leaning your body too far forward or backward by tightening your core muscles. Slow down your pace when going down steep surface.


  • Maintain healthy body weight.
  • Maintain healthy eating habits, get optimal sleep and perform physical activity regularly. Create achievable plan to lose weight if needed.

Prepared by:


Your Physio Ampang & Cheras

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