Why Runner’s Knee Happens—And How to Avoid It

Runner's knee, or patellofemoral pain syndrome (PFPS), is a frequent cause of knee pain. 

PFPS is the most common running-related injury. It's more common in:

• Athletes

• Women

• Teens

• Adults under 60 

But even though it's more common in these groups, anyone can develop runner's knee.

Fortunately, there are science-backed ways to treat and prevent it. 

What does runner’s knee pain feel like?

Typically, patellofemoral pain syndrome (PFPS) causes pain in or around the front of the knee. More specifically, the soreness occurs between the knee cap (patella) and the lower part of the thigh bone (femur). 

When you have runner's knee, it may feel like a dull ache. The pain may develop gradually and occur or intensify with activity, limiting your range of motion. You might also notice that the soreness is widespread across the front of your knee, making it hard to pinpoint one spot or source of pain.

Symptoms of runner's knee –– which can affect one or both knees at the same time –– include:

• Knee pain during exercise and activities that bend or flex the knee, like running or jumping  

• Knee pain after sitting for prolonged periods 

• Knee pain after new or higher-intensity exercise 

• A popping or cracking sound when you move your knee  

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What causes runner’s knee?

Overuse and knee cap misalignment are common causes of runner's knee. Repetitive strain or overuse can happen with activities –– such as cycling, squatting, and going up or down stairs –– that repeatedly stress your knees. 

Misalignment, on the other hand, is a bit more complex. When you bend and straighten your knee, the patella slides up and down the trochlear groove at the end of the femur. But when your patella is misaligned, it moves abnormally in this groove, rubbing against surrounding bone and soft tissue. As a result, you may feel pain in the front of your knee. 

Some people with runner's knee may also have damaged cartilage under their knee cap. This softening or breakdown of cartilage is called chondromalacia patella. Although runner’s knee and chondromalacia patella can overlap, they are different. This is worth noting because some people use the terms interchangeably. 

Researchers aren't sure why some people develop runner's knee while others do not. But additional factors that may cause or contribute to runner's knee include: 

• Imbalances, weakness, or tightness in lower-extremity muscles around the knee, such as the quadriceps or hamstrings 

• Improper exercise or running form 

• Weight gain, which increases pressure on your knees 

• Unstable or abnormal muscle or joint movement 

• Hip, ankle, or foot misalignment 

• Falls or other acute injuries 

If you have pain consistent with runner's knee, and one or more of the above risk factors, you may want to see your healthcare provider. They can provide a proper diagnosis and rule out other possibilities. 

How do you treat runner’s knee?

While there is no magic cure for runner's knee, there are several treatment options. Both home remedies and medical treatment can help reduce pain and improve strength and mobility. But talk to your healthcare provider before trying any treatments. 

• Rest: This may seem obvious, but it's essential to rest your knee and avoid any activities that make the pain worse. When you rest your knee, try elevating your leg as well. 

• Medications: Over-the-counter NSAIDs like ibuprofen and naproxen may help ease runner's knee symptoms. But talk to your healthcare provider before taking these medications to relieve knee pain.  

• Taping: Studies show that kinesiology taping may shift the knee cap and reduce the pain. And less knee pain can make it easier to participate in rehabilitation exercises. 

• Orthotics: Orthotics or supportive shoe inserts may help stabilize muscles in your lower leg and reduce knee pain. Runners with the condition might benefit from orthotics, especially if they overpronate. Overpronation means that the arches of your feet roll in or down when you walk or run.   

• Strengthening exercises and other physical therapies: Certain exercises can improve your range of motion and strengthen your core and leg muscles that support your knees. This includes stretching and strengthening moves that target your quadriceps and hip adductor muscles. And stronger muscles can help reduce knee pain. A physical therapist can recommend safe exercises for knee pain and other interventions for rehabilitation. 

Can you still run if you have runner’s knee?

It depends on the severity of your symptoms. If you have mild runner's knee pain, you might still be able to keep running. But the key is to stick to shorter distances and run a bit more slowly. Remember to focus on proper running form to reduce strain on your knees. You may want to avoid hill running, take smaller steps, and take frequent walking breaks. 

How do you prevent runner’s knee from coming back?

Simple treatments and physical therapy typically resolve runner's knee. But it's essential to maintain good practices –– like wearing supportive shoes –– even after you feel better. Consider making your rehabilitation exercises part of your fitness routine for long-term knee pain relief. Gait retraining with a physical therapist may also improve the way you walk and run (gait). 

Finally, be sure to increase your training load slowly and give yourself plenty of rest and recovery time between training sessions. These practices can help you prevent runner's knee from happening again. 

The bottom line 

Runner's knee can be a frustrating source of knee pain, especially in active people. Luckily, there are many options to relieve the pain and improve your strength and range of motion. You can make some runner's knee treatments –– like stretching and strengthening exercises –– part of your routine. That way, you can get back to the activities you love and maintain your active lifestyle for the long run. 

Why trust our experts?

Written by:

Jennifer Clements, MD, MSEd, NBHWC

Jennifer Clements, MD, MSEd, NBHWC, is a board-certified physician and health coach who believes in achieving optimal health through healthy lifestyles. She’s a diplomate of the American Board of Obesity Medicine.

Edited by:

Lauren Savage, MA

Lauren Savage, MA, is a health editor at GoodRx, where she focuses on movement, exercise, and healthy aging. She aims to provide readers with the information they need to live healthier, more active lifestyles.

Reviewed by:

Sanjai Sinha, MD

Sanjai Sinha, MD, is a board-certified physician with over 20 years of experience. He specializes in internal medicine.

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