If you survey any large group of runners, there’s a good chance that at least one of them has or has had runner’s knee. In fact, studies show that the prevalence of runner’s knee ranges from about 19–30% in female runners, and 13–25% in male runners.
Runner’s knee can crop up suddenly or develop more gradually, but regardless of its time course, the injury can make running extremely uncomfortable if not inadvisable.
Naturally, one of the most common questions is, “Can I run with runner’s knee?”. After all, there’s nothing more frustrating when it comes to training than having a nagging injury that requires you to take time off.
So, if you find yourself battling runner’s knee, keep reading for our guide to running with runner’s knee and how to rehabilitate your knee so you can return to pain-free mileage.
In this guide, we’re going to look at:
- What Is Runner’s Knee?
- What Causes Runner’s Knee?
- How to Treat Runner’s Knee
- Can I Run With Runner’s Knee?
- How to Run With Runner’s Knee
Let’s jump in!
What Is Runner’s Knee?
Runner’s knee, which is also known as patellofemoral pain syndrome (PFPS), is a common running injury characterized by anterior knee pain at, under, or right around the knee cap (patella). The pain is usually exacerbated by activities that load the flexed knee, such as running, hopping, squatting, and ascending stairs.
Pain may also be present after prolonged sitting, kneeling, or when pressing on the knee cap. Some runners also complain of clicking, popping, and grinding.
Runner’s knee is particularly common among runners, hence the coinage of its familiar name rather than PFPS.
What Causes Runner’s Knee?
Runner’s knee is thought to occur because of abnormal tracking of the patella (knee cap) in the trochlear groove of the femur.
Research suggests that the causes of runner’s knee are multifactorial and usually related to training errors, though four main contributing factors have been identified: malalignment of the knee and/or lower extremity, imbalances in the muscles of the leg, overtraining, and trauma.
Let’s dig a bit deeper into these affecting factors:
Lower Limb Alignment Issues
In a normal, healthy lower limb, the patella tracks along a groove in the femur (thigh bone) called the trochlear groove. However, various structural alignment issues of the lower extremity, as well as muscular imbalances, can pull the patella one way or another relative to the groove, causing pain, friction, and debility.
Examples include, but are not limited to, leg length discrepancies, overpronation, a large Q angle, and rotational deformities of the hip or knee such as femoral anteversion, and genu varum.
Muscular imbalances and/or tightness can also pull the knee cap out of its proper alignment and contribute to the development of runner’s knee.
The prevailing theories based on evidence to date are that either weakness in the quads, specifically the vastus medialis obliquus (VMO) or weakness in the hip abductor and external rotators cause malalignment of the patella and abnormal tracking when you run.
When the IT band or lateral quad muscle known as the vastus lateralis overpowers the strength of the VMO, it tilts the patella and pulls it too far to the outside of the groove, causing compression and pain.
Weak hip abductors and external rotators allow your femur to rotate inward relative to the knee cap when you land in your running stride, causing abnormal tracking and pain.
Studies show that decreased flexibility and myofascial tightness can lead to runner’s knee by compressing the patella in the trochlear groove.
Tightness in the hip flexors, quads, and or IT band and tensor fasciae latae, as well as potentially the hamstrings, can place undue compressive forces on the knee cap, leading to pain when running.
Overtraining or Overuse
While structural deformities and muscular imbalances can lead to runner’s knee, it’s more common to result from overloading the knee by increasing your mileage or training volume too aggressively.
For this reason, beginner runners who go from no running or limited activity to running several days per week are especially prone to developing runner’s knee.
Finally, runners with a higher BMI have higher loading forces on their knees, and are at an increased risk of runner’s knee.
How to Treat Runner’s Knee
Treating runner’s knee is a matter of correcting whatever has caused the injury. In cases of training errors, such as ramping up your training too quickly, you should be able to return to running when the pain has subsided, though, of course, taking things on more conservatively when you do return to training.
In cases of muscular imbalances and tightness, you should begin a runner’s knee strengthening and flexibility program.
Focus on strengthening the quads, particularly the VMO, along with the hip abductors and external rotators. Examples of runner’s knee exercises include:
- Side-lying leg lifts: Keep your knee straight. Progress to using an ankle weight.
- Quad sets: Lie on your back with a towel under one knee and an ankle weight on. Bend the other leg with your foot flat on the floor. Engage your quad to lift your heel off the ground. Hold for 5 seconds.
- Resisted glute bridges: Place a resistance loop band around your thighs just above the knees and keep tension on it over the duration of the exercise by pushing outward with your legs. Squeeze your glutes.
- Single-leg glute bridges: Engage your glutes.
- Donkey kicks: Keep your core tight and engage your glutes.
- Straight leg raises
- Clamshells with a resistance band
- Single-leg squats
- Resisted band walks: forward, lateral, and backward
Do 2-3 sets of 15-30 reps of each exercise twice a day. If you have pain with any of the moves, do not do them.
Stretch your quads, hip flexors, IT bands, calves, and hamstrings upon completing each workout.
Can I Run With Runner’s Knee?
Running with runner’s knee is potentially possible, though it should be approached with caution. Assuming running is what caused your case of runner’s knee, it can be difficult to heal the issue while still running, particularly if your injury is stemming from muscle imbalances, (which can take a while to correct), or an alignment issue.
That being said, many runners continue to run through runner’s knee by reducing their mileage and cutting back on speed work. If the pain is more of a dull ache than a sharp, shooting pain, running with runner’s knee should be possible.
However, it’s important to bear in mind that running can increase inflammation in the knee, and if you aren’t addressing the root cause of the injury when you’re not running, running is only going to make it worse.
If your level of pain exceeds a 3 out of 10, it’s wise to stop running and try low-impact cross-training or rest until the pain has decreased.
How to Run With Runner’s Knee
If you want to keep running with runner’s knee and your pain is manageable, there are a few tips and tricks to make running through the injury more comfortable:
- Warm up thoroughly: Gentle running and dynamic stretching can loosen your quads and IT band before you take on faster speeds. Warm up for at least 10 minutes prior to settling into your run.
- Reduce your volume and intensity: Even if you are able to run with runner’s knee, it’s critical that you reduce your mileage and intensity. Cut the duration of your runs and put all speed workouts and long runs on hold until your injury has resolved. Supplement with low-impact cross training as needed.
- Run on softer surfaces: Grass, trails, cushioned tracks, and cinder are more forgiving and can reduce the intensity of pain with runner’s knee over hard surfaces like asphalt and concrete.
- Massage your quads, hip flexors, hamstrings, calves, and glutes: Use a massage gun, foam roller, or lacrosse ball to search for trigger points and release tight tissue. Myofascial release prior to running can help loosen any excessive tightness affecting the knee.
- Stretch your quads and hip flexors: If muscle tightness is contributing to your case of runner’s knee, stretch your quads, calves, hamstrings, and IT bands after warming up and again after your workout.
- Start physical therapy: Work with a physical therapist on a supportive rehabilitation program that promotes healing, range of motion, correction of muscle imbalances, and restores function to your knee, hip, and ankle.
- Support optimal patella tracking: Some runners find relief with a patella strap knee brace or kinesiotaping. While not ideal for long-term solutions, these aids can support the patella in the trochlear groove while you run.
- Try orthotics: If you overpronate, consider getting custom orthotics for running to correct alignment issues.
- Do your strengthening exercises consistently: Twice a day, do the strengthening exercises for your quads and hips.
As with any injury, if you have runner’s knee, the best plan is to listen to your body and shift your mindset to focusing on doing whatever you can to support healing rather than training.
Perhaps instead of asking yourself, “can I run with runner’s knee”, take a break with some low or no impact cardio and heal up. You can take a look at our list of low-impact cardio workouts to use during your recovery period.